To the Editor: Tumors of the central nervous system comprise 9.2% of all primary tumors in the West and are found in 1.2% of all postmortems. No such data are available for Saudi Arabia, though recently there have been a few reports published on intracranial neoplasms and other intracranial lesions in Saudi Arabia. This is the first report of the pattern of intracranial neoplasms in the Southwestern region of Saudi Arabia. 

In reports published from Riyadh, Saudi Arabia, crude relative frequency of central nervous system neoplasms was 3.5% and was 13th in rank order. In a recent report from Asir Central Hospital, central nervous system neoplasms ranked 12th. Between March 1988G and April 1992G, 72 cases of intracranial neoplasms were operated on in the Neurosurgery Department of Asir Central Hospital, Abha. All cases were histologically confirmed. All were investigated by computed tomography (CT) scan, some by magnetic resonance imaging (MRI) and a select few by cerebral angiography. All neoplasms were classified according to the World Health Organization (WHO) classification.

Out of the total of 72 cases of intracranial neoplasms, 41 (56.9%) were males and 31 (43.1%) were females with a malerfemale ratio of 1.3:1. The supratentorial:infratentorial ratio in adults was 4:1 while in children it was 1:1. The youngest patient was one month of age and the oldest was 90 years of age. Highest incidence (19.5%) was seen during the first decade. The next peak was in the fifth decade (16.7%). Forty-five (62.5%) of the cases were neuroepithelial tumors; meningiomas with 15 cases (20.8%) ranked second. Twenty-two (48.9%) of the neuroepithelial tumors were glioblastoma multiforme, while well differentiated astrocytoma comprised 35.6% (16 cases), medulloblastoma 11.1% (5 cases) and ependymoma 4.4% (2 cases). Twenty (27.8%) of our cases were in the pediatric age group (below 16 years).

The percentage of intracranial neoplasms in our study is high in children compared to Germany,¹ the United States,² India,³ and China,⁴ and is comparable to the figures in Thailand.⁵ This is probably due to the fact that postmortems are rarely performed in Saudi Arabia and therefore a large part of the geriatric population is overlooked. This also probably accounts for the low incidence of metastatic intracranial tumors in our study (2.8%) in comparison to the United States,² where it is found to be as frequent as all primary intracranial tumors combined.

The highest incidence of intracranial neoplasms in our study was seen in the first decade (19.5%). Western studies showed the highest incidence during the fifth and sixth decades while studies from Asia³ showed the highest incidence during the fourth decade.

Neuroepithelial tumors constituted 62.5% of all cases seen in our study. Glioblastoma multiforme comprised 48.9% of all cases of neuroepithelial tumors in the present study, while well differentiated astrocytomas were seen in 35.6% cases. Meningioma formed the second most common tumor in our study. We had an interesting case of meningiosarcoma in a 10-day-old male. Vascular tumors formed 5.5% of all cases and the two metastatic tumors seen were from malignant melanomas found elsewhere in the body.

The crude relative incidence (2.8%) of pituitary adenomas seen in the present study is low in comparison to studies from the Central Province of the Kingdom. The exact cause of this remains unexplained.

Our results show that the pattern of intracranial neoplasms in the Asir region of Saudi Arabia is similar to published reports from other provinces of the Kingdom except for the higher incidence of intracranial tumors in the pediatric age group. Patients generally presented with advanced stage of the disease.

Increased awareness of the intracranial neoplasms by medical personnel as well as health education of the community and the availability of facilities such as CT scan will enhance early diagnosis and better treatment for these patients.