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Surgical treatment of pediatric low-grade glioma in developing countries
James A Balogun1,2, Suhas Udayakumaran3, Nelci Z Collange4
1Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria. jamesabalogun@gmail.com.
Insights
Pediatric low-grade gliomas are common brain tumors, often diagnosed late in developing countries due to resource limitations. This leads to larger tumors, increased surgical risks, and highlights the need for specialized pediatric neurosurgical training and infrastructure.
Area of Science:
- Pediatric neurosurgery
- Oncology
- Global health
Background:
- Pediatric low-grade gliomas are the most frequent brain tumors in children globally.
- Presentation and surgical management vary significantly in low- and middle-income countries (LMICs).
- Delayed diagnosis in LMICs is linked to cultural factors, limited resources, and infrastructure deficits.
Purpose of the Study:
- To highlight the unique challenges in diagnosing and surgically managing pediatric low-grade gliomas in developing countries.
- To emphasize the impact of limited resources on surgical outcomes and patient morbidity/mortality.
- To advocate for improved training and infrastructure for pediatric neurosurgery in LMICs.
Main Methods:
- The study is a review of clinical presentation and surgical care challenges for pediatric low-grade gliomas in developing nations.
- It discusses limitations in diagnostic imaging (MRI, CT) and the absence of advanced neurophysiological evaluations.
- It examines surgical access, intra-operative mapping constraints, and management of complications like hydrocephalus.
Main Results:
- Children in developing countries often present with advanced-stage, large tumors.
- Surgery is frequently performed by general neurosurgeons due to a lack of pediatric specialists.
- Limited resources lead to increased surgical risks, higher morbidity, and mortality rates.
Conclusions:
- Despite challenges, neurosurgeons in developing countries demonstrate resilience.
- Strengthening pediatric neurosurgical training programs is crucial.
- Advocacy for enhanced infrastructure is essential for improving surgical outcomes in LMICs.
Abstract:
Pediatric low-grade gliomas constitute the most common brain tumors worldwide, though with some peculiarities in the presentation and surgical care in different parts of the world. The symptomatology in developing countries is likely to be over longer periods with a tendency to delayed diagnosis due to cultural, religious beliefs, manpower, and infrastructural deficits. Thus, the children present with large tumors with attendant morbidities and an increased risk of mortalities from surgery. Surgery is mainly by "general" neurosurgeons due to the paucity of trained pediatric neurosurgeons. The pre-operative imaging may be limited to anatomic MR imaging, and in some cases, CT scans, without expansive neuropsychological evaluation. The armamentarium available to the neurosurgeon may warrant large openings to access the tumor, and there may be limited possibility for intra-operative mapping of "eloquent" brain functions when this is deemed necessary. Complicating pre-operative acute hydrocephalus can result in two operations that further worsen the catastrophic spending associated with brain tumor surgeries in these climes. While these challenges appear daunting but certainly have not been enough to deter the "can do" spirit of neurosurgeons in developing countries, it is essential to strengthen the training of pediatric neurosurgeons in LMICs and provide a platform for the advocacy of better infrastructure for the surgical management of these tumors.
