NEURLOGICAL OUTCOME OF GLIOMAS

BY MEASURING KARNOFSKY SCORE BEFORE AND AFTER SURGERY

Abstract

Background: Mostly Primary brain tumors are derived from neuroglial cells,
neuronal or primitive bipotential precursors or neuroepithelial cells and they are called
gliomas. These comprise of 45-65% of intracranial tumors. We aimed to conduct a study
to determine the neurological outcome of patients with gliomas on the basis of karnofsky
score who are managed with craniotomy and excision of tumor. Study Design: Descriptive
case series. Setting: Neurosurgery Department, PIMS, Islamabad. Patients reporting to OPD
accident and emergency department and those admitted to neurosurgery unit or referred from
other units were enrolled. Period: July 2014 to April 2015 in duration of ten months. Methods:
140 gliomas patients which were diagnosed on CT/MRI with contrast. Patients with low grade
glioma, those with post radiation necrosis diagnosed on MRI and MR spectroscopy brain,
children having glioma and those gliomas patients having co-morbidities were excluded from
this study. The outcome of this study was determined as neurological outcome of patients
with glioma according to karnofsky score after craniotomy plus excision of tumor. Results:
The patients’ average ages were 37.4 + 11.2 years. Male gender was in dominance with
83 (59.2%) cases compared to 57 (40.7%) females. Of the total 140 patients of gliomas, 24
(17.1%) had neurological deficit. The mean Karnofsky score was 70.0 + 10.0 before surgery
and after surgery it improved to 90.0 + 10.0 and this difference in mean karnofsky score
between before and after surgery was found statistically significant (p-value = 0.001). The
mean Glasgow coma scale was 12.0 + 2.0 before surgery and 14.0 + 1.0 post operatively.
Post operatively it was observed that, of the 24 patients with neurological deficit, 18 (75.0%)
improved completely whereas 6 (25.0%) patients could not improve. Conclusion. There is
a significant improvement in nuerological outcome which is measure through the karnofsky
score of gliomas patients whose undergoing craniotomy and excision of tumor.