Endoscopic Pituitary Surgery in High-Resource Settings Versus a Public Hospital in Ghana

The evidence supporting endoscopic transsphenoidal pituitary adenoma resection (TSPR) is predominantly from skull base centers in high-resource settings (HRSs). This study is the first comparative analysis of TSPR performed at a low-resource setting (LRS), Korle Bu Teaching Hospital (KBTH), a public hospital in Accra, Ghana, versus HRS.

Cohort study.

Tertiary skull base surgery centers in Ghana, the United States, Canada, and Australia.

Patients who underwent TSPR at KBTH from 2021 to 2023 were compared to a multi-institutional cohort of TSPR patients from skull base centers in the United States, Canada, and Australia. Univariate and multivariate analyses were performed controlling for available demographic characteristics and medical history.

The KBTH cohort included 93 patients, and the HRS cohort included 1112 patients of similar age. The HRS cohort had higher incidences of diabetes (P = .013) and cancer history (P = .012). There were two deaths in the KBTH cohort (one intracranial bleed, one meningitis) versus five in the HRS cohort (odds ratio [OR] = 8.07, 95% CI 1.28, 50.98). There were no differences in rates of other postoperative complications.

These findings demonstrate the capacity of LRSs to perform endoscopic pituitary surgery and highlight the need for building rhinologic and skull base surgery capacity around the world. This study was unable to control for important factors including tumor size, postoperative access to health care resources, availability of adjuvant treatments such as neuro-interventional radiology and stereotactic radiation therapy, and others.