PITUITARY TUMORS-02 EVOLUTION OF PITUITARY SURGERIES TO THE TRANS-SPHENOIDAL APPROACH IN A NIGERIAN TEACHING HOSPITAL: LEANING ON LOCAL TRANSFER OF SKILLS

Abstract

Abstract BACKGROUND Globally pituitary surgeries have evolved from transcranial surgeries (TCS) to transsphenoidal (TSS) as the standard of care. This is due to the many benefits of TSS over TCS. However, this evolution has been comparably slow in some parts of Africa. Before 2019, all sellar surgeries in our hospital, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife were done via TCS. To improve the quality of care to our patients, we started the TSS. The evolution into TSS involved local skill transfer. METHOD We collaborated with a neurosurgeon from another teaching hospital in Nigeria with expertise in TSS who visited three times. All patients had microscopic TSS. The equipment was sourced for by local neurosurgeons with backup brought by the visiting neurosurgeon. The brain scans were sent ahead, and the visiting surgeon arrived the day before surgery. We compared our experience of TCS over the last 10yrs with our recent TSS experience. RESULTS Sixty-nine sellar tumours were surgically operated over 10yrs. 7 of the recent cases had TSS, one was which was done entirely by the local team. There were 2 cases of mortality from the TCS while no mortality from the TSS. The complication rates for the TCS were diabetes insipidus (DI) (22%), Tumour bed hematoma requiring evacuation (10%), SSI (7%) and post-operative seizures (6%). Of the 7 TSS, one had DI, and another had CSF leak and tension pneumocephalus requiring evacuation. 78% of the TCS had intraoperative blood transfusion. None of the TSS had blood. Average post-operative hospital stay was 3 for the TCS and was 9 for the TCS. CONCLUSION Our experience with the TCS approach and evolution to the TSS showed the TSS to be better. While overseas training for skill enhancement is desirable, the transfer of local skills can enhance neurosurgery practice in developing countries.