Clinical profile, indication and outcome of patients who underwent transsphenoidal pituitary surgery at Muhimbili National hospital and Muhimbili orthopaedic institute

Abstract

ABSTRACT Background: Transsphenoidal pituitary surgery is an endoscopic approach to the pituitary gland through the sphenoid sinus for removal of pituitary tumors. The aim of this surgery is to correct any pituitary hormone over secretion, eliminate the mass effect of the tumor, decompress the visual pathway, reduce the risk of tumor recurrence and get histological diagnosis of pituitary tumors. Like any other surgery, there are complications associated with it. Objectives: To assess the clinical profile, indication and outcome of patients who underwent transsphenoidal pituitary surgery at Muhimbili national hospital and Muhimbili orthopaedic institute. Methodology: A retrospective cross sectional study was conducted which included all the patients who underwent transsphenoidal pituitary surgery since the initiation of the approach in 2018. By using a structured checklist & accessing the patient database, demographic information, signs & symptoms at presentation, indication and outcome of the transsphenoidal pituitary surgery was acquired. All of the findings were recorded in a data collection sheet, data was analyzed using Statistical Package for Social Science software version 23, and the Chi-Square and Fisher’s exact test were used to assess the association of variable. A confidence interval of 95% was used, and a P-value of <0.05 was considered significant. Results: A total of 40 patients were enrolled in the study whereby majority were 41-50 years (30%) and females accounted for 57.5% of the patients with a female to male ratio of 1.3:1. Vision loss was the common complaint seen in 87.5% of the patients followed by headache which accounted for 85%. Some patients presented with secretory adenomas which accounted for 17.5%. The most common indication for surgery was progressive mass effect seen at 78.4% of patients followed by hormonal control seen in 13.7% of patients. Symptom relief post-surgery was seen in 85% of patients and hormonal control was seen in 71.4% of patients. Patients who developed diabetes insipidus and hypopituitarism were observed to be vi 12.5%, whereby, cerebrospinal fluid leak as an intra-op or early complication was seen in 7.5% of individuals and 2.5% had it as a late complication. Conclusion: Transsphenoidal pituitary surgery is a novel/modern approach to pituitary tumors in Muhimbili National Hospital and Muhimbili Orthopedic Institute. Most patients were seen in the middle age and females accounted more than males. Patients presented with various clinical complaints whereby vision loss and headache accounted for majority of the complaints. The most common indication was due to mass effect. Majority of patients reported symptom relief and hormonal control post-surgery whereby the most common complication was diabetes insipidus and hypopituitarism. Therefore, this study helps on shedding light as well as contribute to the existing knowledge of surgeons as well as the medical community to improve outcomes of these patients.