Clinicoradiological Pattern and Early Surgical Outcome of Parasagittal Meningiomas at the Kenyatta National Hospital

Abstract

BACKGROUND: Meningiomas account for 34.4% of all central nervous system (CNS) neoplasms in Kenya. According to the literature, parasagittal meningiomas occur between 16.8% and 25.6% of all meningiomas. Surgery of parasagittal meningiomas has always been challenging for the neurosurgeon because of the involvement of the Superior Sagittal Sinus and important bridging veins which may render curative surgical excision impossible. In addition, surgical morbidity may occur from injury to the bridging veins in areas of eloquent brain cortex and this provides a management challenge in comparison with other supratentorial meningiomas. The surgical intervention of these tumors is still debatable; there is disagreement about whether to entirely remove the tumor, which carries the danger of cerebral infarction and severe brain edema or to partially remove it, which carries the risk of tumor recurrence.Parasagittal meningioma patients' quality of life has improved thanks to the use of microsurgical techniques, which have raised the rate of total resections, decreased complications, and protected the Sinus and crucial cortical veins. This study sought to determine the clinicoradiological patterns and the relationship with early surgical outcomes of patients presenting with parasagittal meningiomas at Kenyatta National Hospital. OBJECTIVE: To determine the clinicoradiological pattern and early surgical outcome of patients presenting with parasagittal meningiomas at Kenyatta National Hospital. METHODOLOGY: This was a retrospective cohort study of 28 adult patients who were diagnosed with parasagittal meningioma and underwent surgical treatment for the same at the KNH from January 2013 to December 2022. Patients were recruited through consecutive sampling approach. Exposure data was collected on age, sex, presenting complaint, duration of symptoms, operative procedure performed, and extent of resection – whether complete or incomplete. Outcome data was collected on occurrence of a complication such as mortality, reduced consciousness level, suboptimal motor function, brain edema, venous infarcts and hemorrhage. DATA ANALYSIS: Data collected was recorded in an excel sheet and then transferred for analysis in SPSS 26.0. Categorical data which included the patient's demographic and clinical data were examined and presented as frequencies and percentages for categorical data; for continuous data, it was examined and shown as means with standard deviation or as a median with an interquartile range. The relationship between clinical presentation, radiologic pattern, surgical management and their association with occurrence of surgical complication was analyzed with the use of Chi Square test of Independence. Student T test was used where the exposure data is continuous. For multivariate analysis, to assess the independent risk factors for occurrence of complications, logistic regression was used. Results of the regression model were reported in Odds ratios and their 95% confidence intervals. A statistical test was deemed significant if the p-value was less than 0.05. RESULTS: There were more females at 57.1% than males at 42.9%. The mean age at presentation was 47.9 years with the youngest patient at 28 years and oldest at 66 years. Overall, most patients presented with headaches (80.8%) followed by seizures (60.7%) and weakness of limbs (55.6%).23.1% presented with visual symptoms and only 8.3% experienced personality changes. Anterior third tumours mostly presented with headaches and personality changes. Middle third tumours presented with seizures (58.3%) and weakness of limbs (53.9%). Posterior third tumours majority presented with headaches and visual symptoms and seizures. Majority of the tumours were located in the middle third (50%) followed by anterior third (32.1%) and posterior third accounted for 17.8%. Most tumours were large in size with 64.29% between 4cm-6cm and a further 25% being more than 6 cm. Simpson grade II resection was achieved in majority of the cases (82.14%). Mortality rate in this study was 3.70% with an overall morbidity of 17.3%. There was a positive correlation between the grade of sinus occlusion and the outcome (p value <0.001) with higher grades having suboptimal outcome interms of motor function CONCLUSION: Majority of the patients presenting with parasagittal meningiomas were females as compared to males. Mean age at presentation was 47.9 years. Overall, majority of patients presented with headaches followed with seizures and weakness of limbs. Middle third tumours were the most common followed by anterior third and posterior third tumours. Morbidity rate was higher in patients with preoperative motor deficits, middle third tumours and total sinus occlusion.