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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 24  |  Issue : 1  |  Page : 44-47

Some characteristics of gliomas managed at a Neurosurgery centre in Nigeria


Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria

Date of Web Publication9-May-2017

Correspondence Address:
Chika A Ndubuisi
Memfys Hospital for Neurosurgery, P.O. Box 2292, Enugu
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/npmj.npmj_2_17

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  Abstract 

Background: Gliomas are important primary brain tumours with varying prognosis. Aim: To study the histology characteristics of brain gliomas managed in a Neurosurgical centre in Nigeria. Materials and Methods: A retrospective analysis of prospectively recorded data of patients managed for intracranial gliomas at our Hospital for Neurosurgery, between year 2006 and 2015. Only the patients with conclusive histology diagnosis following surgery were analysed. Results: Glioma was 23.8% of the 252 histology-confirmed brain tumours. Male-to-female ratio was 1.4:1.0. Peak age at diagnosis was in the fifth decade of life. There was an increase in the frequency of diagnosis from seven (2006–2009) to 15 (2011 and 2012) and 39 patients managed (2013 and 2015). In sub-group analysis, grade IV tumour was the most common (34.6%) followed by grade II (30.7%), grade I (18.3%) and grade III (16.7%). Seven patients of grade II oligodendroglioma and one patient each of anaplastic oligodendroglioma, subependymal giant cell astrocytoma and astroblastoma were seen. The anatomical location of the tumour was the frontal lobe in 23.3% of patients followed by the parietal lobe in 16.7% of patients. The pre-operative Karnofsky score was ≥70% in 36.7% of the patients. Conclusion: Gliomas are more common brain tumours than were imagined. Most patients present relatively late and with advanced disease. High-grade gliomas seem to mostly affect the middle age population in the study environment with higher proportion of grade IV lesions.

Keywords: Epidemiology, glioma, Nigeria


How to cite this article:
Ndubuisi CA, Ohaegbulam SC, Chikani MO, Mezue WC, Mbadugha T, Okhueleigbe M. Some characteristics of gliomas managed at a Neurosurgery centre in Nigeria. Niger Postgrad Med J 2017;24:44-7

How to cite this URL:
Ndubuisi CA, Ohaegbulam SC, Chikani MO, Mezue WC, Mbadugha T, Okhueleigbe M. Some characteristics of gliomas managed at a Neurosurgery centre in Nigeria. Niger Postgrad Med J [serial online] 2017 [cited 2022 May 28];24:44-7. Available from: https://www.npmj.org/text.asp?2017/24/1/44/205975


  Introduction Top


Gliomas are important primary brain tumours with varying prognosis. As with other tumours, the epidemiology of gliomas has been shown to have geographical variations.[1],[2],[3],[4] It is probably the most common brain tumours based on published reports from many parts of the world with variations in the reported regional incidences.[5],[6] Reports from sub-Saharan Africa have shown that the incidence of gliomas is not as high as the Caucasian series suggesting racial influence both in the case frequency and distribution of sub-types of gliomas.[2],[7],[8] Earlier studies from Nigeria reported a very low proportion of glioblastoma (GBM) in Ibadan relative to the low-grade gliomas.[5],[9] Recently, there has been a significant improvement both in and availability of neurodiagnostic and neurosurgery services, and one expects these to provide a basis for an updated epidemiology and management outcomes for Gliomas in Nigeria. Unfortunately, very few recent studies have looked at the incidence, distribution and pathology of gliomas in Nigeria, especially in the eastern part of country.

This study was conducted to analyse the demographic, clinical and histology characteristics of brain gliomas managed in Enugu. The findings from this study will be compared with other studies conducted in the other parts of the world.


  Materials and Methods Top


This study was a retrospective analysis of prospectively recorded data of patients managed for intracranial gliomas at Memfys Hospital for Neurosurgery (MHN). MHN is the major neurodiagnostic centre that provides tertiary neurosurgical services to over 16 million patients[10] with links to neuropathology and radiotherapy services. The study period was from years 2005 to 2015. The diagnosis and anatomical location of the lesion were confirmed in all the patients with both non-contrast and post-contrast enhanced brain Magnetic Resonance Imaging (MRI) scan by both the neurosurgeon and the radiologist. Brain Computed Tomography (CT) scan was accepted for diagnosis if the patients could not afford MRI scan and earlier in the study period (2005–2009), when the hospital did not have an MRI machine. All the patients analysed in this study had neurosurgical intervention, and following surgery, the tumour specimen was sent for histopathology review. Age, pre-operative Karnofsky score, anatomical location, and histology grade of tumour were analysed. However, we excluded the patients operated upon without a conclusive histology report from this study. The patients were followed up clinically and radiologically for an average of six months. The World Health Organisation classification was used for the tumour grading, ranging from grade I (benign without malignant potential) to grade IV (GBM).[11] Data were analysed using descriptive statistics. Ethical committee approval was obtained for the study.


  Results Top


Glioma was 23.8% of the 252 histology-confirmed brain tumours. Male-to-female ratio was 1.4:1.0. The mean age was 42 years, and the peak age range at diagnosis was in the fifth decade of life [Table 1]. There was an increase in the frequency of diagnosis from seven (2006–2009) to 15 (2011 and 2012) and 39 patients managed (2013 and 2015) − [Figure 1]. In the earlier part of the study, significantly more meningiomas were diagnosed compared to gliomas but in the past 4 years, the ratio of glioma to meningioma managed seemed to have evened out [Figure 2]. In sub-group analysis, grade IV tumour was the most common (36.7%) followed by grade II (28.2%), 16.7% for grade III and 18.3% for grade I gliomas [Table 2]. Among the grade IV lesions managed, 77.3% presented between the fifth and seventh decades of life. Seven patients of grade II oligodendroglioma and one patient each of anaplastic oligodendroglioma, subependymal giant cell astrocytoma and astroblastoma were seen. Most of the grade II gliomas (88.3%) occurred before the patients were aged more than 50 years [Table 2]. The most common anatomical location of the tumour was the frontal lobe in 23.3% of the patients followed by the parietal lobe in 16.7% of the patients. Cerebellar lesions were seen in 11.7% of the cases, whereas temporal lobe was the anatomical location in 8.3% [Table 3]. Fifty-nine percent of the high-grade gliomas (HGG) involved the frontal and parietal lobes. Analysing the pre-operative Karnofsky score, 36.7% presented with a score of ≥70%, 31.6% presented with score of 60%, whereas 25% presented with a score of 50 and 6.7% presented with a score of 30–40% [Table 4].
Table 1: Age and sex table

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Figure 1: Graph shows the pattern of glioma diagnosis over the years. This shows a rising trend, especially, in the last 5 years

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Figure 2: Comparing the frequency of glioma and meningioma diagnosed, it is suspected that the gap seems to have reduced in the last 3 years

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Table 2: Age group analysis compared with tumour grade

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Table 3: Anatomical location of tumours compared with grade of tumour

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Table 4: The preoperative Karnofsky score of patients

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  Discussion Top


The findings from this study revealed that patients with gliomas have apparently increased over the years at a progressive rate across the decades. This may be explained by increasing awareness in the population and availability of improved neurodiagnostic services in the study environment. This implies that the real problem may have been the patient under-diagnosis, under-reporting and poor referral system emanating from the limitations of clinical-based diagnosis of neurology-related complaints. The consistent rise in the annual diagnostic rate of gliomas shown over the recent years [Figure 1] suggests that indeed the epidemiological pattern of the condition is still evolving. Compared to previous studies, however, it is now clear that gliomas are not as rare as had been believed in the study environment.[12] Interestingly, although meningioma is still the most common brain tumour managed in the institution, the meningioma to glioma ratio seems to have narrowed over the past 3 years, further strengthening the increasing frequency of diagnosis of glioma in the study environment.

GBM is the most common glioma managed in this series. This is also the pattern in many other countries worldwide. However, previous studies from Nigeria[5] identified a lower proportion of the HGG among the gliomas analysed at different periods. This apparent shift may be argued to negate a geographical difference in gliomas, suggesting that any differences may be due to hitherto poor facilities. The current trend in this study may be a reflection of an improving health seeking behaviour among the populace as a result of increasing literacy level and belief in orthodox medical practice.

It is also interesting that most patients with GBM presented at a relatively younger age when compared to the presentation among the Caucasians.[13] In settings where there is poor health insurance coverage, the treatment decisions will more likely favour the productive age group. Secondary GBM is known to be more common among the younger age group and runs a relatively benign course compared to that of primary GBM.[14] However, given that secondary GBMs are less frequent than the primary GBM,[15] a possible genetic or racial predisposition should be explored and consideration given to the possibility that many patients managed in the study environment may have de-novo GBM despite the relatively young age at diagnosis. Unfortunately this possibility was not explored in the current study’s histological analysis due to the limitation of resources.

Most of the patients managed in this series presented for management at an advanced stage of the disease. Delay in presentation is a trend that has been highlighted by other studies in the study environment.[8] For an intracranial tumour such as glioma, late presentation may make surgery more challenging and indirectly increase the risk of poor outcome. Majority of the patients presented with a poor pre-operative Karnofsky score, which may also be related in a direct causative manner with late presentation. Delay and clinical state of patient on presentation have been recognised to affect the fitness of patient for anaesthesia, extent of tumour resection, recurrence rate and post-operative quality of life.[16],[17],[18] This is particularly important in HGG with its poor natural history and rapid rate of disease progression. Serious case has been made[19],[20] but needs to be reinforced that clinicians especially general practitioners should optimise the use of early neuroimaging investigations in the assessment and management of patients with neurology-related complaints such as headaches, seizures and focal neurological deficit.


  Conclusion Top


Gliomas are more common than were imagined in the study environment. HGG mostly affect the middle age population, and GBM is the most common glioma managed in the study. Unfortunately, most of the patients still present for management in a relatively advanced stage of disease.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Central Brain Tumour Registry of the United States (CBTRUS). CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumours Diagnosed in the United States in 2004–2007. Hinsdale, IL; 2011. p. 48. Available from: www.cbtrus.org/2011-NPCR-SEER/WEB-0407-Report-3-3-2011.pdf. [Last accessed on 2017 Mar 6].  Back to cited text no. 13
    
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Wai-man L, Kan-suen JP. Astrocytomas. In: Greenberg MS, editor. Handbook of Neurosurgery. 8th ed. New York: Thieme Medical Publishers; 2016. p. 612-28.  Back to cited text no. 15
    
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Ndubuisi CA, Mezue WC, Ohaegbulam SC, Chikani MC, Ekuma M, Onyia E. Neuroimaging findings in pediatric patients with seizure from an institution in Enugu. Niger J Clin Pract 2016;19:121-7.  Back to cited text no. 19
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Mezue WC, Ndubuisi CA, Chikani MC, Onyia E, Iroegbu L, Ohaegbulam SC. Epilepsy in primary intracranial tumors in a neurosurgical hospital in Enugu, South-East Nigeria. Niger J Clin Pract 2015;18:681-6.  Back to cited text no. 20
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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