Introduction: Intracranial neoplasms will always be a challenge for neurosurgeons. They present a frequently unpredictable evolution, considerable morbidity and mortality during neurosurgical treatment and high costs for the healthcare provider. This study was performed in the main neurosurgical center of Ceará state, in Brazil, and focused in epidemiology and perioperative factors with influence in treatment results.
Methods: Retrospective study with 627 cases of intracranial tumors, either primary or metastatic. All cases were operated at the Hospital Geral de Fortaleza, via craniotomy (487 cases), neuroendoscopy (126 cases) or stereotactic biopsy (14 cases) between 2014 and 2016.
Results: Average age of patients was 48.9 years. 52.8% were male. 59.3% from the city where hospital is located. 82.9% were admitted at the Emergency Service. Previous neuroimaging with evidence of intracranial neoplasms were present for 58.6% of the patients, and 14.8% of all had a previous neurosurgical procedure. The most common symptom was headache (57.1%). In prevalence order, the most frequent hystologic types were: gliomas (28.3%), meningiomas (23,1%), pituitary adenomas (19.6%) and brain metastasis (12,3%). Frontal lobes were the most affected anatomic location. Preoperative embolization was performed in 5,6% of the cases. The average stay in ICU was 4.5 days after surgical procedure. Emergency neurosurgery was necessary for 13.2% of patients, with ventriculoperitoneal shunt as the most common procedure. The intra-hospitalar death rate was 9.8%. Each variable was discussed and compared with up-to-date literature. Hydrocephalus has the strongest association with adverse outcomes. Younger patients had proportionally more emergency surgeries indicated. Most of our patients were admitted at the emergency medicine service, unlike other series, specially in developed countries.
Conclusions: Some epidemiologic findings presented here, like the female predominance in low grade gliomas or the earlier age of glioblastoma patients, should provoke new studies. The management of some perioperative factors, when possible, can lead to a better neurosurgical care.
Patient Care: Understanding the relationship of perioperative factors like early extubation, preoperative embolization of selected tumors and duration of the surgery with the patients' outcomes can lead to a better neurosurgical care.
Learning Objectives: Better understand the epidemiology of intracranial tumors among brazilian population and the influence of perioperative factors in patients' outcome.