Andrews N B, Ramesh R, Odjidja T
Tema International Neuro Center, Nath-Bita Hospital, Tema, Ghana.
West Afr J Med. 2003 Jun;22(2):167-72. doi: 10.4314/wajm.v22i2.27942.
In January 2000, the first ever neurosurgical program in Tema was established. This preliminary survey was conducted for the following purposes. 1) to determine the relative frequencies of the various histopathological types of CNS tumors. 2) To relate the occurrence of the various types of CNS tumors to age, sex, symptoms, neurologic findings and location. 3) to review the current use of neurodiagnostic modalities.
A retrospective analysis of the records of 30 consecutive patients seen at T. I. N. with histologically proven CNS tumors was carried out. The following parameters were analysed; sex, age, symptoms, neurologic status, surgical procedure, histopathological diagnosis, pre and post operative Karnofsky rating.
30 patients (14M, 16F) constituted the series. Their mean age was 39.8 (R 2-72, SD, 18.7) years. The difference between the mean ages of patients with intracranial or spinal tumors was not significant (P>0.05). For intracranial tumors, there was a significant difference between the mean ages of those with infratentorial and supratentorial tumors. Spinal tumors constituted 13% of the series and they all presented with paraplegia. Eighty seven percent had intracranial tumors; of these 27% presented with headaches and 31% with seizures. Only 62% of patients with intracranial tumors presented with neurologic deficits. CT scanning was the diagnostic modality utilized in the diagnosis of all the intracranial tumors. Cerebral angiography was not obtained in any case. Myelography and post myelography CT scanning diagnosed all spinal tumors. Surgical procedures for CNS tumors constituted 23% of all neurosurgical surgical procedures performed during the study period. All patients with spinal tumors underwent laminectomy only. Sixty five percent of those with intracranial tumors underwent craniotomy; 34% underwent stereotactic biopsy. The most common intracranial tumor was high-grade astrocytoma (HGA), 23%. The left frontal lobe was the most common location of the intracranial tumors (54%), followed by the left temporal lobe (36%). No significant relationship was demonstrated in the brain tumor sites (P>0.05). At presentation, 46% of those with intracranial tumors had a karnofsky rating >70. One week after surgical intervention, this had increased to 62%. There was no significant relationship between tumor histopathology and preoperative or postoperative Karnofsky rating. The mortality rate in the first 10 days following intracranial tumor surgery was 8%; there were no deaths in the spine surgery group. The post operative complication rate for CNS tumor surgery was 11.5%.
Intracranial tumors are the most common type of CNS tumors in Tema. More than one third of patients with intracranial tumors presented without neurologic deficits. HGA is the most frequently seen intracranial tumor. All patients with spinal tumors presented with neurologic deficits, specifically paraplegia.
2000年1月，特马首个神经外科项目成立。进行这项初步调查有以下目的：1）确定中枢神经系统肿瘤各种组织病理学类型的相对频率。2）将各种类型中枢神经系统肿瘤的发生情况与年龄、性别、症状、神经学检查结果及部位相关联。3）回顾神经诊断方法的当前应用情况。
对在特马综合医院连续就诊的30例经组织学证实患有中枢神经系统肿瘤患者的记录进行回顾性分析。分析了以下参数：性别、年龄、症状、神经学状态、手术方式、组织病理学诊断、术前及术后卡氏评分。
该系列包括30例患者（14例男性，16例女性）。他们的平均年龄为39.8岁（范围2 - 72岁，标准差18.7）。颅内或脊髓肿瘤患者的平均年龄差异无统计学意义（P>0.05）。对于颅内肿瘤，幕下和幕上肿瘤患者的平均年龄存在显著差异。脊髓肿瘤占该系列的13%，所有患者均表现为截瘫。87%为颅内肿瘤；其中27%表现为头痛，31%表现为癫痫发作。仅有62%的颅内肿瘤患者有神经功能缺损。CT扫描是所有颅内肿瘤诊断中使用的诊断方法。所有病例均未进行脑血管造影。脊髓造影及脊髓造影后CT扫描诊断了所有脊髓肿瘤。中枢神经系统肿瘤的手术占研究期间所有神经外科手术的23%。所有脊髓肿瘤患者仅接受了椎板切除术。65%的颅内肿瘤患者接受了开颅手术；34%接受了立体定向活检。最常见的颅内肿瘤是高级别星形细胞瘤（HGA），占23%。左额叶是颅内肿瘤最常见的部位（54%），其次是左颞叶（36%）。脑肿瘤部位之间未显示出显著相关性（P>0.05）。就诊时，46%的颅内肿瘤患者卡氏评分>70。手术干预1周后，这一比例增至62%。肿瘤组织病理学与术前或术后卡氏评分之间无显著相关性。颅内肿瘤手术后前10天的死亡率为8%；脊柱手术组无死亡病例。中枢神经系统肿瘤手术的术后并发症发生率为11.5%。
颅内肿瘤是特马最常见的中枢神经系统肿瘤类型。超过三分之一的颅内肿瘤患者就诊时无神经功能缺损。高级别星形细胞瘤是最常见的颅内肿瘤。所有脊髓肿瘤患者均有神经功能缺损，特别是截瘫。
