BPKMCH, a dedicated national center for comprehensive cancer care, started a subspecialty of Neurooncology(NO) way back in 2002 AD. This center provides comprehensive service including Surgery, Radiotherapy, Chemotherapy and Palliative care. NO is rather a new and less known branch of Neurosurgery in Nepal. It is difficult to set up NO at the periphery of Nepal. Still more difficult is to develop sub specialty like NO.
Aim: to advocate the need and possibility of low tech low cost neurosurgery for neurological tumors in resource poor countries like Nepal
This is a retrospective analysis of thousand cases from Aug 2002 to Feb 2012. 2008 data base, records from the OPD, Indoor, OT, Medical records, and Annual reports of BPKMCH were collected and the database is prepared on MS excel and analyzed .
Of 1000 surgically managed neurological tumor cases, 984 qualified for detail analysis . 74% (n=718) Brain Tumors. Overall hospital mortality, was less than 4% and operative mortality, was 2.3% . Major infection rate was less than 2 %. Of the brain tumors 36% were located in frontal lobe, 18% posterior fossa, 14% parietal, 13% temporal, 6% in parasellar region and 5% occipital lobes. Glial cell lines predominated list (52%) followed by(14%) meningeal tumors. 11% brain met and 6% medulloblatomas, 3% adenoma and Schwannoma . 2% each craniopharyngioma + germinoma and skull base tumor unspecified.1% were Neuroblastomas.
Conclusions: It is very hard to set up neurosurgery more so for subspecialty like Neurooncology at the periphery. Enormous effort, continued patience, honesty in expression, hardness on work are all essential to march towards the success. The results are encouraging and promising but 1000 cases may not be enough to wait for complications to occur. Neurosurgery is a great need of the periphery but unaffordability and inaccessibility are limiting factors.