Constraints in the neurosurgical management of pituitary tumours in an African developing country: a 5-year observational study from Benin Republic.

Introduction: Benin Republic, a very low-income-sub- Saharan African developing country, has a severely resource-constrained health system. There is hardly any data available on the pattern of pituitary tumour in this country METHODS: A single surgeon, hospital-based retrospective analysis of the pattern, presentation and clinical / surgical course of7a prospective cohort of pituitary tumours seen over a 5-year period is presented RESULTS: There were 38 cases, 20 (52.6%) female; 27% of all brain tumours seen. They were macroadenomas in 97. 4%, and greater than 4cm in 63.2%. They occurred mainly (86.8%) in people aged 15 to 59 years. Delayed neurosurgical presentation, mean 5.16years (range 1-23years) was the rule in 94.7%%; and, visual and endocrinological dysfunction the two most prominent symptomatology. Due to severe logistic constraints, neuroimaging evaluation was possible with cranial CT only in about 90% of the cases. Also only 9 cases (23.7%) did eventually receive the planned neurosurgical operative treatment, in 5 cases of which even this surgical treatment Was only facilitated by some foreign neurosurgical missions.

Conclusions: Pituitary adenomas represent a sizeable proportion of brain tumours in Benin Republic. National health care resources in this low income African country for their optimal clinical / radiological evaluation, and surgical treatment, are grossly inadequate; indeed, almost non-existent.