Introduction

Encephalic neoplasms (EN) are neurological disorders considered within the group of diseases of the central and peripheral nervous system ¹. Hundreds of millions of people worldwide suffer from neurological disorders. Among them, ENs are one of the main causes of death, both primary lesions originating in the cells of the central nervous system (CNS) and secondary lesions originating in other tissues and subsequently reaching the brain (secondary tumors) ^2-3.

The World Health Organization (WHO) classifies ENs into four groups, which allows establishing a prognosis in terms of mortality according to the grade. Grade I tumors have low proliferative potential, and have the possibility of cure when surgically resected. Grade II tumors are infiltrative tumors with low proliferative activity. Grade III tumors are lesions with histological evidence of malignancy, predisposition to necrosis, with rapid and fatal evolution. Therefore, grade III and IV tumors are taken as high grade or malignant. In some cases gliomas tend to develop to grade III and IV ^3-4. The WHO classifies tumors according to their origin as astrocytic, oligodendroglial, ependymal, neuronal, pineal, embryonal, cranial nerve and meningeal³. ENs are usually differentiated and relatively benign lesions, e.g., hemangiomas. However, they can also present as invasive and differentiated lesions, e.g., glioblastoma multiforme. Overall, ENs account for 2% of neoplasms ^4-5.

Although the data are heterogeneous, in general an overall incidence rate of primary CNS tumors of 23.0 cases per 100,000 population is reported ⁵, and other authors report 10.8 per 100,000 persons per year ⁶. As for malignant brain tumors, an age-adjusted incidence of 4.3 cases per 100,000 persons was reported; although it varies by region, from 6.8 in Europe, 5.3 in Latin America and up to 2.8 in Africa ⁷. Survival of patients with CNS tumors is more than 10 years, in 14% of the cases of people with CNS tumors in developed countries, 1% being preventable ⁸. More recent studies indicate that neoplasms occupy the 20th place in incidence and mortality globally, with a total of 308,102 new cases and 251,329 deaths in 2020 ⁹. In the United States, secondary neoplasms have an incidence of 10 per 10,000 inhabitants ¹⁰.

Additionally, 79,718 deaths attributable to primary brain and CNS neoplasms have been registered from 2012 to 2016, which represents an average annual mortality rate of 4.4%. The incidence of both benign and malignant EN and CNS is 23.4 per 100,000 population, being higher in women, white race, and non-Hispanics ¹¹. Another study reports that adjusting for age, this incidence is 22.6 between 2010 and 2014 and prevalence of 47.6 per 100,000 population ¹². Meningiomas are the most common primary brain tumors (36.4%) followed by gliomas (27%) ¹¹. Among malignant tumors, glioblastoma is the tumor with the highest incidence (14.6%) and among benign tumors, meningioma (37.6%). Glioblastoma is more common in men and meningioma is more common in women. The relative survival rate 5 years after diagnosis of a malignant brain and CNS tumor is 35.8% and 91.5% for benign brain and CNS tumors ¹².

In Mexico, a study was published in which the records of CNS neoplasms treated at the National Institute of Neurology and Neurosurgery from 1965 to 2014 were analyzed. Neuroepithelial neoplasms had the highest frequency (33%) and of these, the main ones were astrocytic (67%), meningeal (26%), and pituitary (20%), presenting between the third and fourth decade of age. Meningeal neoplasms had a frequency of 26% and pituitary neoplasms 20% in ages around the second decade. In terms of sex, meningeal neoplasms predominated in women and neuroepithelial neoplasms in men ¹³. In another study, it was reported that from 1993 to 2013 at the Manuel Velasco Suarez National Hospital of Neurology and Neurosurgery, the prevalence of CNS tumors and histopathology was 511 patients with EN, with the highest prevalence being meningeal (n=171) and neuroepithelial (n=121) ¹⁴. Likewise, according to the National Institute of Statistics and Geography (INEGI), of the total of the main tumors in the population aged 18 to 29 years in 2011 to 2017, morbidity due to malignant brain and CNS tumors represented 0.5 per 100,000 inhabitants ¹⁵.

For nursing professionals involved in the care of people with EN who undergo surgery in a high-specialty hospital, it is important to know the epidemiological panorama, which lays the foundation for the development of comprehensive in-hospital and out-of-hospital post-surgical care programs and plans. Therefore, our objective is to describe the epidemiological picture of patients with EN who underwent surgery from January 2017 to July 2018 in a tertiary care hospital.

Methodology

Descriptive observational, cross-sectional and retrolective study. The clinical records of the files of people over 18 years of age with a diagnosis of EN who received neurosurgical treatment in a high specialty hospital during the period from January 2017 to July 2018 were included. A total of 152 cases were registered, eliminating 64 corresponding to spinal surgeries and duplicate records, leaving a sample of 88, sociodemographic variables such as age, sex, marital status, schooling, occupational status, place of residence were collected. The clinical variables were tumor origin, tumor type (primary/secondary), tumor location, type of surgical procedure, complications of surgical treatment, other treatments, chronic diseases and follow-up. Descriptive statistical treatment was carried out for quantitative variables such as mean and standard deviation, and for qualitative variables, frequencies and percentages. The statistical software IBM Statistical Package for Social Sciences (SPSS) version 21 was used, creating a database for the statistical tabulation, presentation and data analysis.

Regarding the protection of humans and animals, this study adheres to the World Medical Association Code of Ethics for the Protection of Human Subjects and the Declaration of Helsinki ²⁷. The protocol was approved by the research ethics committee and the research committee by the institution (IRB/30/18 and CI/HRAEB/047/2018). Regarding confidentiality, it is stated that the protocols for data protection were followed. Likewise, the authors declare that no personal data of patients appear in this article. According to the Regulations of the General Health Law on Health Research of the United Mexican States ¹⁶ article 17, it is considered a category 1 research, with no risk or probability that the subject will suffer any harm as an immediate or delayed consequence of the study, since it is a documentary research.

Results

The sociodemographic data presented an age range between 18 and 82 years (49,315), with a predominance of female sex (52.3%), marital status married (65.9%), level of basic education (63.6%), residents mostly in the State of Guanajuato in Mexico (70.5%), (Table 1).

The prevalence of chronic diseases were arterial hypertension with 18.2%, type II diabetes 7.9%, and presence of both with 7.9%. The clinical variables related to the type of EN showed that most were malignant (70.5%). EN of primary origin had a higher incidence (89.8%) and occurred in younger age (48.7(15.9) as opposed to EN of secondary origin (54.9(9.3). Primary tumors, gliomas occurred most frequently (42%), followed by meningiomas (29.5%). Most of them were located in the brain (39%), (Table 2).

Of the two most frequent types of ENs, gliomas occurred at a younger age than meningiomas, with an average of 44.7 vs. 57.3 years, respectively. On the other hand, of the 42% of glioma cases, ependymomas and glioblastomas were more frequent in males (66.7% and 59.1%) and astrocytomas in females (66.7%). Meningeal ENs predominated in females (53.8%). Medulloblastoma was the EN that occurred at the youngest age (31(7 years). Supratentorial craniotomy was the most commonly used surgical procedure (48.9%) and the complications reported were: fistula (11.4%), infection (9.1%) and bleeding (4.5%). The 35.2% of the patients required between 8 to 15 days and 16 to 30 days of hospitalization (17.0%), (Table 3). The EN with the highest percentage of cases requiring more than 30 days of hospitalization was meningioma (50%).

After neurological surgery, the treatment indicated was rehabilitation, radiotherapy, and radiotherapy with chemotherapy. The reason for discharge in most cases was improvement (89.7%), with follow-up in the outpatient clinic (48.9%) (Table 4).

A total of 2.3% were discharged due to maximum benefit and 8% due to death. NE of secondary origin had a proportionally higher number of deaths (22%).

Discussion

The results of the epidemiological overview of EN in 2017-2018 agree with most references from studies reported in other countries in that the highest incidence of tumors are those of the glioma and meningioma type ^3,6,10,11,14. Likewise, the higher frequency in general in women than in men ^13-14. Other studies report results that differ in the characteristics of the population and the treatment offered to the patients. In the case of Carter et al ¹⁷, glioblastoma survivors had an average age of 64 years and were mostly men; in our study with a younger average age but also present in men. One difference is that in the American study they reported that patients were treated with radiotherapy and in this one they received radio and chemotherapy . Regarding age, the results of this study coincide with Anaya ¹⁴ with an average of 49.3 years, and a predominance of women. However, their results revealed a higher prevalence in meningiomas and in our study it was gliomas.

Moreover, in our results the majority of ENs glioma-type neoplasms were glioblastomas, while in another study in Mexico ¹⁴ they found that astrocytoma was the most frequent. Regarding sex, the results coincide in those meningeal neoplasms predominated in women and neuroepithelial neoplasms in men. The high incidence of gliomas was also reported by Drewes and collaborators who studied 136 patients operated on for low glioma and high glioma, without obtaining significant differences when comparing the quality of life in the first six months (p=.518) ¹⁸. In addition, in Croatia, a study conducted from 2001 to 2014 describes a higher incidence of malignant EN in the male sex as well as mortality, contrary to this study; the highest incidence was in the female sex ¹⁹. Regarding complications, it has been reported in a study in India ²⁰ that 12.1% of patients undergoing neurological surgeries present chronic obstructive pulmonary disease. This situation was not present in the institution since the hospital stay is not prolonged, 75% is less than or equal to 30 days. Regarding surgeries for meningioma, in this study supratentorial craniotomy is the most used surgical procedure, while in a French study it was reported that the most common procedures were through the cranial convexity and the middle base of the skull ²¹. It should be considered that, although it has been possible to compare the results, there are considerable methodological differences in the studies, which were carried out in different periods of time and with diverse populations in number and characteristics, making it difficult to draw conclusions. On the other hand, the records consulted in the hospital files are not uniform and do not use the classification of brain tumors recommended by the WHO in 2007 ⁴, which uses molecular biology markers, and they do not mention the grade, which has limited the possibility of contrasting the results with other publications. There are really few epidemiological studies that have been published on this subject so, in agreement with other authors, it is recommended to encourage and promote the reports of registries that provide more information on the behavior of ENs in the CNS that give rise to better treatment and care strategies, and have an impact on survival and potential sequelae ¹⁴. Post-surgical follow-up is important to address the disorders that may occur such as changes in memory, changes in concentration and ability to multitask, etc. As well as changes in sleep, balance, sensations and senses ²². Other studies mention categories found as a terminal prognosis of negative experiences, positive experiences, coping with the tumor, surgery, the role of the family ²³. It is important to address in all aspects in the brain tumor patient, after surgery are: interrupted life, navigating the new reality of life, and social survival versus separation ²⁴, other patients found depression, cognitive deficits, decreased role function, neurological deficit, neurological disability, and wheelchair use, post-surgery ^25,26.

Conclusions

For the nursing professional, it is important to take a holistic and individualized approach to the care of patients with EN, taking into account the spiritual, psychological, social, physiological and emotional needs of the patient in order to plan actions with better health outcomes. The epidemiological overview of ENs is the first necessary step to promote the integration of proposals for nursing clinical practice guidelines and care plans during hospitalization and at discharge. It is recommended that studies be carried out to learn about the experiences of the people who undergo surgery, as well as phenomenological approaches that contribute to the establishment of new nursing care models to improve the quality of life in the reincorporation of the person to his or her daily life.

Conflicts of interests

The authors declare that there is no conflict of interest.

Financing

The authors declare that there was no funding of any kind.