Fellowship Thesis
Volume 3, No.1
April 1999
  Ibrahim A. Al Luwimi
 Dept. of Neurosurgery
 King Fahd University Hosp.
 Al Khobar
 Saudi Arabia
 Correspondence:
 Dr. Ibrahim M. AI Luwimi,
 MD, KFUF (NS)
 Department of Neurosurgery
 King Fahd University Hospital
 P O Box 40106
 Al Khobar 31952
 Saudi Arabia
 Fax No: (966 3) 865 0596  
 
Clinical and Epidemiological Study of CNS Tumours in the Eastern Province of Saudi Arabia

   ABSTRACT


The principle investigator conducted a retrospective clinical and epidemiological study of the CNS tumours in the Eastern Province of the Kingdom of Saudi Arabia. There were 370 patients collected in the study from January 1982 to January 1991. Primary brain tumours constitute 294 patients (79.4%), secondary brain tumours were 23 patients (6.2%) and primary spinal tumours were 26 patients (7.03%). Secondary spinal tumours were (5.0%) and others (vertebral column and skull bony tumours) were 10 patients (2.7%). Age and sex distribution shows that there were 66.2% adult, 25.4% paediatric and 8.4% elderly. There were 214 males (57.8%) and 156 females (42.2%). Male:Female (1.4:1). Their nationality showed that 72.7% were Saudi and 27.3% were Non?Saudi. There were 317 patients with brain tumours which constitute 241 supratentorial tumours (76.0%) and 76 (24.0%), infratentorial tumours.

Significant CT scan variables, with regards to the outcome, statistically analysed were of midline shift (P=0.0001) and presence of hydrocephalus (P=0.012). Gross total resection for all types of brain tumours was found to be significant (P=0.0000002). The primary brain tumours consist of: neuroepithelial tumours 45.1%, (astrocytic tumours 40.6%, glioblastoma multiformis 20.6%, PNET 20.0%, oligodendroglial tumours 6.3%, ependymal tumours 4.9%, choroid plexus tumours 2.8% and mixed glioma 2.1%). Meningioma 19.2%, pituitary adenoma 9.8%, malformative tumours 6.3%, neural sheath tumours 1.3%, tumours of blood vessel origin 1.0% and clivus chordoma 0.3%. Non operated patients (9.5%) which include 30 patients; 10 patients had radiological and hormonal diagnosis of pituitary adenoma, making total incidence of pituitary adenoma 14.0%, 7 patients had radiological diagnosis of meningioma making total incidence 23.13% of the primary brain tumours.

The diagnosis of the remaining non operated 13 patients could not be verified. The 5 years survival rate for the brain tumours were as follows: Low grade astrocytoma 51.5%, anaplastic astrocytoma (10.5%), glioblastoma multiformis 10.3%, medulloblastoma 54.8%, meningioma (86.1% ), malformative tumours 84.0%, pituitary adenoma 95.1%. The histological diagnosis of secondary brain tumours were carcinoma metastasis 69.57%, malignant melanoma 8.7%, unknown 8.7%, and neuroblastoma 4.35% of all secondary tumours. The site of origin was unknown 56.5%, lung 17.39%, breast 13.04%, kidney 4.35%, scalp 4.35% and abdomen 4.35%.

The histological diagnosis of the primary spinal tumours were neural sheath tumours 23.26%, teratoma 11.63%, meningioma 9.3%, ependymal tumors 4.65% and unknown 4.65% of all spinal tumours. The histological diagnosis of secondary spinal tumours were lymphoproliferative disorder 10 patients 23.26%. (They consist of lymphoma in 6 patients, multiple myeloma in 2 patients and plasmacytoma in 2 patients) and carcinomatous metastasis was seen in 7 patients 16.28%. The overall mortality was 2.3% for primary spinal tumours and 16.3% for the secondary spinal tumours.

The skull and vertebral column tumors were seen in 10 patients, skull osteoma in 2 patients, osteoblastoma in 2 patients, eosinophilic granuloma in 2 patients and fibrous dysplasia in 1 patient. Vertebral column tumours were chordoma in 2 patients and eosinopbilic granuloma in one patient.

CONCLUSION

This study has shown the incidence of brain and spinal cord tumours both in primary and secondary. It is low in comparison to their incidence in other parts of the world from literature review. Gliomas are the most common, as reported in both Western and Eastern literature. There is predominance of meningioma in the Eastern Province of Saudi Arabia as in other parts of the Kingdom, but with equal female and male ratio. There is also predominance of the CNS tumours in the paediatric age group. The infantile age group showed a predominance of infratentorial tumours as compared to the predominance of supratentorial tumours in world literature review. This is the first study in Saudi Arabia to research epidemiology of different patterns of spinal and brain tumours.
 


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