MENG-02 INCIDENCE AND CHALLENGES IN THE MANAGEMENT OF SKULL BASE MENINGIOMA IN SUB-SAHARAN AFRICA; A 16-YEAR SINGLE CENTRE EXPERIENCE

Abstract

Abstract Background SBM presents management challenges related to its complex bony anatomic relationship and invasion of adjoining neurovascular structures. A multimodal approach is essential; however, limited access to surgical care and prohibitive costs are challenges in sub-Saharan Africa. The study aims to identify challenges in the management and outcome of SBM in resource-limited settings. Methodology This was a retrospective analysis of SBM managed between January 2008 to January 2024 in Memfys Hospital, Enugu, Nigeria. Relevant information, including clinical data, surgical outcomes and complications, and follow-up data, were extracted. Paediatrics meningioma and other skull base lesions were excluded. Data obtained were statistically analysed. Results There were 84 SBM accounting for 23% of all meningiomas seen. Mean age was 49.8. ±12.1 with female preponderance (1.3:1). The sphenoid wing (45.3%) and olfactory groove meningioma (23.8%) were the most common. WHO CNS grade 1 meningioma accounted for 96.4%, and 67.8% of the tumours were giant with a mean diameter of 5.6±1.8cm. The mean preoperative Karnofsky Performance score (KPS) was 62.5% and was related to late presentation with the mean symptom-onset-to-presentation interval of 24 months. Simpson grade 1&2 resection was possible in 57.1%, and follow-up KPS improved to 75.7%(P = 0.003). The recurrence rate was 16.7% over a median follow-up period of 16.5 months (range 6-96 months) and was managed by repeat surgery alone (9.5%) or surgery with adjuvant radiotherapy (7.1%). Commonest complications were cranial neuropathy (14.7%) and hemiparesis (11.7%). The overall mortality rate was 10.2%. Only five patients had complete insurance coverage and access to post-surgical radiotherapy was delayed or unavailable for one-third of patients with recurrence. Conclusion Sphenoid wing meningioma was the most common SBM in our series, and surgical intervention was associated with improved clinical outcomes. Challenges were related to late presentation, poor insurance coverage and limited access to radiotherapy services.