Multimodal management of meningioma: Experience from a low-middle-income country.

Objective: To evaluate the effects of multimodal management for intracranial supratentorial meningioma in terms of their surgical outcome and the functional status of patients in a low-middle-income country. Methodology: This retrospective, observational study analyzed consecutive cases of surgically excised supratentorial meningiomas at the Department of Neurosurgery, Unit-I, Punjab Institute of Neurosciences, from January 2022 to August 2024. Patients aged 18 or older with at least three months of follow-up were included, excluding those with incomplete records. Patient data, including clinical, radiological, surgical, and postoperative details, were collected via Google Forms and analyzed using SPSS for descriptive statistics. Results: This study included 60 patients with a mean age of 45.90±13.05 years, with the majority being males (65%,39). Gross total resection was achieved in 48.3%(29) of cases. Post-operative GCS scores were 13-15 in 95%(57) of patients, and 60%(36) experienced no complications. Histopathology showed 85%(51) of meningiomas were WHO grade I, with 70%(42) meningothelial and 10% (6) fibrous. Most (90%,54) of them did not require adjuvant therapy, with average pre-treatment and post-treatment KPS of 77.17±21.64 and 83.00±28.95, respectively. WHO grade II tumors (10%,6), including atypical and clear-cell types, were treated with adjuvant therapy in 5%(3) of all cases, with KPS scores of 76.32±19.54 and 82.13±26.35. WHO grade III tumors were found in 5% (3) of cases and were all treated with adjuvant therapy, with KPS scores of 75.13±19.34 and 80.21±26.72. Conclusion: Multimodal management of intracranial meningiomas based on comprehensive clinical assessment, timely neuroimaging workup, surgery, and appropriate referrals for adjuvant therapy based on WHO tumor grades reduces the risk of postoperative complications and improves the functional status of patients overall.