Functional Outcome After Surgery for Intracranial Meningioma at the Kenyatta National Hospital

Abstract

Intracranial meningiomas represent 34.4% to 41.4% of all brain tumors at the Kenyatta National Hospital. Meningiomas and their attendant treatment can cause various functional and neuropsychological impairments that affect the patient life. Traditionally surgical outcomes have been gauged on the Simpson grade achieved at surgery, the recurrence rates, rates of complication, overall and progression free survival amongst other surgical outcomes. The functional outcome that assess the performance of these patients in activities of daily life is a less studied outcome. Functional outcome is significant because it provides insight into the patient's quality of life following intracranial meningioma excision. The Functional Independence Measure is an outcome measure for activities of daily living that can objectively determine impairments in various domains. Study Design The was a retrospective observational cross-sectional study. Broad objective To determine the functional outcome after surgery for intracranial meningioma at the Kenyatta National Hospital Study population Adult patients with intracranial meningioma operated at the Kenyatta National Hospital Materials and Method Consecutive convenient sampling technique was used to recruit participants into the study. A structured data collection tool was be used to collect data relevant for this study. Exposure data was collected on age, sex, extent of resection (Simpson grade) of intracranial Meningioma, and WHO grade of meningioma. Outcome data was the Functional Independent Measure. Exposure and outcome data were measured at the same time though some exposure data was retrieved from patient records. Results In this study, 42 participants were enrolled, with an average age of 46.8 years and a male-to-female ratio of 1:4.25. Majority of the patients presented within 13.6 months with headaches 97.7% and seizures 41.9%. Neuroimaging revealed that the average size of meningioma was 138.4 cm3, and perilesional edema was observed in 90.6% of cases. Surgical resection achieved a Simpson grade II in 52.4% of cases and Simpson grade I in 38.1% of cases. Most meningiomas were classified as WHO grade 1 (95.2%), specifically the Meningothelial variant (61.9%). Following surgery, there was a noticeable improvement in functional status, as indicated by a mean total gain of 161.9% in the Functional Independent Measure (FIM), a motor sub score gains of 174%, and a cognitive sub score gain of 149.6%. However, there was no statistically relevant association between the functional outcome and extent of surgical resection. Conclusion There was statistically significant improvement in the functional outcome after surgery for intracranial meningioma at the Kenyatta National Hospital measured using the Functional Independence Measure. The Simpson grade achieved at surgery did not influence the functional outcome.