Staged brain tumour resection for better outcomes: Management challenges and lessons learned from a series of 12 patients at a tertiary referral hospital in Kigali, Rwanda

Abstract

Background: Twelve patients presented in this study had brain tumors with substantial challenges and operative risks managed in settings where most of the state-of-the-art technologies available today for dealing with such tumors are essentially non-existing.

The purpose of this study is to report the option of staged tumor resection to achieve maximal safe resection in selected patients with difficult brain tumors.  The clinical presentations, operative details, and patients’ outcome are outlined for all 12 patients with 5 selected cases for detailed presentation.

To the best of our knowledge, the present study represents one of the few reports highlighting the advantages of staging tumor resection in dealing with large, difficult brain tumors in settings where resources are scarce.

Methods: This case series reports 12 consecutive patients with brain tumors treated by staged tumor resection performed by a single surgeon at King Faisal Hospital, Kigali, over 5 years from January 2014 to January 2019. We included all braintumor patients where tumor resection was done in more than one stage. Excluded were one-stage resection cases and all cases with multiple brain tumor operations due to recurrent disease.

We prospectively collected data from 12 patients of intracranial tumors treated with staged tumor resection. Patients’ demographic data, clinical presentations, and operative details including reasons for staging, as well as their outcome, were recorded.

Results: Nine of the 12 patients had good outcomes despite post-operative complications; two died and one had permanent complications.

Conclusions: Staged tumor resection is a reasonable approach that can be used selectively for patients with difficult brain lesions to improve patient outcomes, especially in a resource-restricted setting.