Background: The transphneoidal approach to the pituitary gland using the microscope has undergone continuous modification since its introduction by Hardy over 50 years ago. It is one of the most effective and safest of major neurosurgical procedures with excellent outcomes and low complication rates.
Objective: To describe the experience of Endonasal microscopic transsphenoidal surgery at Myungsung Christian Medical Center during three-years period.
Patients and methods: This is a hospital based retrospective review of patients with pituitary tumor for whom microscopic transsphenoidal surgery was done in Myungsung Christian Medical Center, Addis Ababa, Ethiopia in the period between September 2010 and August 2014. Patients' demographic data, type of symptoms, hormonal profile, imaging modality, complications and outcomes were recorded in apre-formed questionnaire. Frequencies and means were computed for description of the various variables and presented in prose form and graphs. The association between categorical variables was calculated using Chi-square test.
Results: sixteen (53.3%) patients were males, 14 (46.7%) females. The mean age was 33.77, ± 10.85 years (rang 14 - 53). The most common presentation were headache in 28 (93.3%) patients and visual disturbances in 26 (86.7%), while 18 (60%) had bitemporal hemianopia. prolactin levels were elevated in 4 (13.3%) of them having hyperprolactinemia, cortisol levels revealed hypercortisolemia with clinical evidence Cushing disease in 5 (16.7%). Three ((10%) had elevated growth hormone levels with acromegalic features. All patients included in the study had a MRI; tumors were with suprasellar extension in all (100%) patients, involvement of floor ofsella in 18 (60%), extension to sphenoid sinus in 8 (26.7%) and with parasellar extension in 5 (16.7%). Twenty-seven (90%) were done through direct transnasal, 2 (6.7%) transseptal transphneoidal approach; in one patient the approach was translabial. Early complication and mortality rate was 18 (60%) and 2 (6.7%) respectively. At one-year follow-up period, 22 (73.3%) patients had good functional outcome, while 6 (20% 0 were in the same status as in the preoperative period, 2(6.7%) had residual/recurrent tumor.
Conclusion: Our patients were relatively advanced cases with suprasellar and parasellar extensions. Direct transnasal approach, is straightforward, quick and does not require dissection of nasal mucosa or removal of septal cartilage and that the procedure can be done by neurosurgeon with some experience in the procedure without an increased risk of complications. High early complication rate was tolerable and manageable. Acceptable mortality and good functional outcome during follow up period is encouraging and compares favorably with African and other similar studies.