title: Management of intracranial meningiomas in Enugu, Nigeria.
abstract: BACKGROUND
  Meningiomas may range on presentation from incidentally identified small lesions to large symptomatic tumors in eloquent areas of the brain. Management options correspondingly vary and include careful observation, surgical excision, and palliative application of very limited therapeutic maneuvers in select cases. This paper discusses the options and difficulties in the management of meningiomas in a developing country.
  
  
  METHODS
  This study is a retrospective analysis of prospectively recorded data of patients managed for intracranial meningioma between January 2006 and September 2011 at Memfys Hospital for Neurosurgery, Enugu. Radiographic diagnosis of meningioma was based on computed tomography (CT) and or magnetic resonance imaging (MRI) criteria in all cases, but only patients who had surgery and a histological diagnosis were analyzed.
  
  
  RESULTS
  Seventy-four patients were radiographically diagnosed with intracranial meningioma over the period under review. Fifty-five patients were operated upon and 52 (70.3%) with histological diagnosis of meningioma were further analyzed. Histological diagnosis was complete in 42 (56.8%) patients and in 10 (13.5%) patients the subtype of meningioma was not determined. The male to female ratio was 1:1.08. The peak age range for females was in the 6th decade and for males in the 5th decade. The locations were olfactory groove (26.9%), convexity (21.2%), parasagittal/falx (19.2%), sphenoid ridge (15.4%), tuberculum sellae (7.7%), tentorial (3.8%), and posterior fossa (5.8%). The most common clinical presentation was headaches in 67.3% followed by seizures (40.4%) and visual impairment (38.5%). Histology was benign (World Health Organization [WHO] grade 1) in 39 patients. One patient harbored an atypical and two had anaplastic tumors. Gross total resection of the tumor was achieved in 41 patients. Surgical mortality was 3.9%.
  
  
  CONCLUSIONS
  Effective management of meningioma depends largely on adequate and complete surgical resection and results in good outcomes. Adequate preoperative assessment, including visual assessment, and hormonal assessment in olfactory groove and sphenoid region meningiomas, is necessary.
authors.affiliation: Department of Neurosurgery, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors.forename: Wilfred C
authors.initials: WC
authors.lastname: Mezue
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Ohaegbulam
authors.forename: Chikandu A
authors.initials: CA
authors.lastname: Ndubuisi
authors.forename: Mark C
authors.initials: MC
authors.lastname: Chikani
authors.forename: David S
authors.initials: DS
authors.lastname: Achebe
keywords: Intracranial meningioma; management; outcome; tumors