Clinical experience and outcome of pituitary surgery in Kenyan patients at The Kenyatta National Hospital

Abstract

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.