Patterns And Surgical Outcomes Of Primary Brain Tumors Managed At A Tertiary Hospital In Arusha, Tanzania: A Cross-Sectional Analysis.

Abstract

Background: The epidemiology of brain tumors varies globally between different countries with observed poor outcomes in lower- and middle-income countries. We aimed to analyze the clinicopathological pattern of intracranial tumors in our setting and their post-surgical outcomes. Methods: This is a retrospective study. Data were obtained from clinical records of patients with intracranial tumors treated at our neurosurgery unit between 2019 and 2020. Only patients with primary brain tumors who underwent surgical intervention were included. Analysis was done to identify factors associated with patient outcomes (mortality/survival and Karnofsky performance status). Results: 39 patients with primary brain tumors underwent surgery (adults 72.8%, males 53.8%, mean age 35.8years). Gliomas (46.2%) comprised the most common tumor diagnosis overall and craniopharyngiomas were the most common tumors in pediatric patients (27.3%). The majority (59%) presented more than 3 months after symptom onset, and most (83.3%) had a poor Karnofsky performance status before surgery. Gross tumor resection (25.6%) was low and few patients (39.3%) underwent adjuvant therapy. 30-day mortality rate (10.3%) and one-year mortality rate (46.2%) were high. Pediatric patients had a much worse outcome (46.2% mortality, and 80% with poor Karnofsky performance status). Males had higher postoperative mortality (38.1% vs 27.8% in females), though females were more likely to have poor postoperative Karfnofsky performance status compared to males (70.6% vs 52.4%). Patients with gliomas who did not undergo adjuvant therapy accounted for the majority (69.2%) of the deaths. Conclusion: Delayed presentation and poor access to adjuvant therapies are common in our setting. Inadequate long-term follow-up is also a hindrance to optimal neuro oncological care in our setting.