CLINICAL EXPERIENCE AND OUTCOME OF PITUITARY SURGERY IN KENYAN PATIENTS AT THE KENYATTA NATIONAL HOSPITAL

Résumé

Introduction: Surgical extirpation of pituitary lesions and can be perfomed by craniotomy or trans-sphenoidal hypophysectomy. This could be for pituitary ablation, excision of pituitary adenomas, craniopharyngiomas, suprasellar meningiomas and other types of tumors of the sellar region. Despite this being a common neurosurgical procedure there is a paucity of data on the local Kenyan experience and outcomes following pituitary surgery. Study Design and Site: A retrospective study at the Kenyatta National Teaching and Referral Hospital. Objectives: To evaluate the clinical presentation, management and outcome of patients undergoing surgery for pituitary lesions at the Kenyatta National Hospital. Patients and Methods: Following ethical approval, patients’ records were retrieved and assessed for clinical and radiologic features of pituitary lesions, surgical treatment and post- operative outcome. All the data was coded and analysed using Statistical Package for Social Sciences (SPSS) version 16.0. Results: Sixty five patients, 39 (60%) female and 26 (40%) male patients were included. The mean age was 36.88 years (+14.689). The most common presentation were visual disturbances reported by 57 (87.7%) of the patients having reduction in visual acuity, while 37 (56.9%) had bitemporal hemianopia. Sixty two (95.4%) patients were operated during the study period and of these 28 (45.2%) by the transphenoidal approach as opposed to 34 (54.85%) by craniotomy. The pterional trans-sylvian approach was the most prevalent of transcranial hypohysectomies accounting for 17 (50%) patients, while 15 patients (44.1%) were operated by the subfrontal approach and two patients were operated via midline trans-callosal approach. Majority (96.4%) of trans-sphenoidal hypophysectomies were by sub-labial incision. Fifty (76.9%) of the patients had good functional outcome while 11 (16.9%) and 4 (6.2%) suffered moderate and severe disability respectively. Patients’ age (p=0.0029), duration of symptoms prior to surgery (p=0.0018) and surgical management versus conservative (p=0.001) significantly affected patient outcome. There was no statistically significant difference in outcome between patients of different sex (p=0.058) or the type of operation performed (p=0.191). Conclusion: Transsphenoidal and trans-cranial approaches are effective and safe treatment strategies for pituitary lesions with low morbidity, mortality and recurrence rates.