Clinical And Pathology Patterns, Management Strategies, And Outcomes Of Low-Grade Gliomas At Kenyatta National Hospital

Abstract

Background: Low-Grade Gliomas (LGGs) are a subset of primary brain tumors characterized by their indolent growth but potential for recurrence and malignant transformation. LGGs account for a significant proportion of central nervous system tumours, with a high prevalence in paediatric populations. Comprehensive data on the clinical and pathology patterns, management, and outcomes of LGGs in low-resource settings like Kenya are limited, necessitating this study. Methods: We conducted a single-centre ambispective cohort study of 48 histologically confirmed LGG patients managed at KNH. Demographics, presentation, imaging, histology/grade, surgery, adjuvant therapy, and outcomes (extent of resection [EOR], functional status, Karnofsky Performance Scale [KPS], mortality, recurrence) were abstracted. Data collection utilised structured forms. Associations were tested primarily with χ² or Fisher’s exact tests. Results: Median age skewed young (mean 21.9 years; range 1.3–61.0) with 52.1% female. Headache (68.8%) and seizures (52.1%) predominated, and frontal and cerebellar tumours were most frequent. Gross total resection (GTR) was achieved in 68.8%; complications were uncommon (4.2%). At last review, 66.7% were functionally independent and 70.8% had KPS ≥80; 22.9% were deceased. Pilocytic astrocytoma (37.5%) and diffuse astrocytoma (25.0%) were the most common, with WHO grade I/II nearly evenly split. Patients presenting with motor deficits trended toward greater independence post-treatment (LR p=0.041), and laterality correlated with current functional status (Pearson p<0.001). On KPS, motor-deficit presentation was associated with higher scores (χ² p=0.034; LR p=0.010), and tumour location correlated with KPS distribution (Pearson p<0.001). For survival, the only factor associated with mortality was absence/presence of motor (Fisher p=0.029).  Conclusions: The study provides critical insights into the clinical and pathological patterns, management strategies, and outcomes of LGGs in a resource-limited setting. In this KNH cohort, GTR was common with low complication rates. Motor-deficit presentation paradoxically associated with better functional/overall status and lower mortality, and anatomical factors related to KPS.