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Background: Meningiomas are the most common intracranial tumours; they accountfor 13%–26% of all the primary intracranial tumours. Skull base meningiomas make up 25% of allmeningiomas and are one of the most difficult intracranial tumours to be managed surgically. Thisis due to the fact that it is difficult to approach the lesions which are also close to vital structuressuch as cranial nerves and major blood vessels. Despite the abundance of these cases in Malaysia,local data on meningiomas is scarce.Methods: This is a retrospective study consisting of 199 patients with meningiomaswho have been operated at the Kuala Lumpur General Hospital from January 2010–December2014. They were categorised into skull base and non-skull base groups. Demography, tumourcharacteristics, and patient outcomes were analysed. Kaplan-Meier survival curves as well asCox hazard univariable and multivariable regressions for the possible predictors of survival wereanalysed.Results: 97.5% of the patients (n = 194) had WHO grade I meningioma and only fivepatients had WHO grade II meningioma. There was a female predominance (n = 134; 67.3%), witha male-to-female ratio of 1:2. Some 27.1 % patients had skull base meningiomas. Patients with skullbase meningiomas had poorer outcomes and discharge conditions (n = 23; 42.6% P < 0.01), inaddition to higher risk of incomplete resections (n = 34; 63% P < 0.01). Multivariate cox hazardregressions showed that the skull base meningioma group had four times the risk of death of thenon-skull base group.Conclusions: Symptomatic meningiomas can be curative if the tumour is completelyremoved. Our study has revealed that skull base meningiomas which were operated locallyhad higher rates of incomplete resection and poorer surgical outcomes as compared to the nonskullbase group. Patients with skull base meningiomas had four times the risk of death vis-à-visnon-skull base ones. More local studies are needed to look into skull base meningiomas for theimprovement of its surgical outcomes.
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Background: To investigate factors influencing disconnection hyperprolactinemia, including tumour volume, degree of pituitary stalk displacement and extent of tumour growth based on a modified Wilson-Hardy classification in a non-functioning pituitary macroadenoma and to confirm reductions in serum prolactin levels after endoscopic transphenoidal surgery. Methods: This prospective, descriptive study was conducted in the Department of Neurosurgery, General Hospital Kuala Lumpur from Jan 1, 2011 to Jan 1, 2013. Forty patients fulfilling the inclusion criteria were enrolled. All patients underwent endoscopic transphenoidal resection of non-functioning pituitary macroadenoma. Pituitary stalk angle, tumour volume and extent of tumour growth were measured from Magnetic Resonance Imaging (MRI) pre- and post-operatively. These variables were compared to serum prolactin levels measured pre and post operatively. SPSS 21 was used to perform statistical analyses. Results: In 40 patients, the mean tumour volumes were 10.58 cm3 (SD 7.81) pre-operatively and 3.1 cm3 (SD 3.45) post-operatively. There was a 70% reduction in tumour volume post-operatively (P < 0.01). The mean serum prolactin was 457 mIU/L (SD 66.93) pre-operatively and 297 mIU/L (SD 6.73) post-operatively. There was a 65% reduction in prolactin serum levels after surgery (P < 0.01). The mean pituitary stalk angles were 93.45 ± 3.89 degrees pre-operatively and 51.45 ± 1.46 degrees post-operatively (P = 0.01). The mean pituitary stalk angle in the control group was 50.4 ± 8.80 degrees. Hence, there was a 98% reduction in pituitary stalk angle after surgery (P < 0.01). This study showed a linear correlation between the pre-operative and post-operative tumour volumes and serum prolactin levels (P = 0.01 pre-and post-operative) and between serum prolactin levels and pituitary stalk angle (P = 0.20 pre-operative; P = 0.01 post-operative). Conclusion: Tumour volume and pituitary stalk angle displacement have positive predictive values for disconnection hyperprolactinemia in non-functioning pituitary macroadenoma. However, a larger sample size and further objective studies are needed to confirm these findings.
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HiperprolactinemiaRESUMEN
The development of neurosurgical services and training in Malaysia began in 1963, with the first centre established in its capital city at Hospital Kuala Lumpur, aimed to provide much needed neurosurgical services and training in the field of neurology and neurosurgery. This center subsequently expanded in 1975 with the establishment of the Tunku Abdul Rahman Neuroscience Institute (IKTAR); which integrated the three allied interdependent disciplines of neurosurgery, neurology and psychiatry. The establishment of this institute catalysed the rapid expansion of neurosurgical services in Malaysia and paved the way for development of comprehensive training for doctors, nurses, and paramedics. This culminated in the establishments of a local comprehensive neurosurgery training program for doctors in 2001; followed by a training program for nurses and paramedics in 2006. To date, there are more than 60 neurosurgeons providing expert care in 11 centers across Malaysia, along with trained personnel in the field of neurosciences.