Visual outcome of surgically managed pituitary adenomas followed-up at the Yaoundé Central Hospital.

INTRODUCTION: Pituitary adenomas are benign brain tumours arising from the adenohypophysis; representing 10-15% of all intra-cranial tumours. Despite improved management, they are still related to high morbidity. Visual impairment is a common presentation and visual field defects representing 37-96%. We aimed at describing the clinical presentation of operated patients and their visual outcome. METHODS: We conducted a cross-sectional study for 6 months at the Yaoundé Central Hospital's Neurosurgery, Endocrinology and Ophthalmology departments. We included all patients with histopathological confirmation, having pre-operative visual assessment and operated from January 2010 to June 2016. RESULTS: Twenty-five participants (50 eyes) were enrolled. Three subtypes of pituitary adenomas were identified: Non-functional pituitary adenomas (64%) > Somatotropinomas (20%) > Prolactinomas (16%). All cases were macroadenomas. The median duration of symptoms was 14 months. All participants presented with vision impairment and 80% with headaches. Craniotomy was used in 88% of cases. The temporal hemifield was the most quantitatively affected; 76% of eyes presented with visual acuity (VA) < 6/12 and 24% of eyes a visual acuity ≥6/12. Thirty percent of eyes presented with optic atrophy; cranial nerve III palsy was the most observed. The Mean deviation (MD), an automated visual field index, improved though non-significant and 16% of eyes had a normal visual field printout after surgery. Left eye mean deviation improved significantly (p = 0.04). After surgery, there was a mild improvement of VA with 62% of eyes having a VA< 6/12 and 38% a VA ≥6/12. There was no ophthalmoplaegia after surgery. Long delay before diagnosis significantly jeopardizes pre-operative and post-operative visual acuity (r = 0.5; p = 0.01). CONCLUSION: Quantitative vision parameters comparison are suggestive of a potential improvement of vision. This conclusion will be better ascertained on a large-scale sample size. Long delay before diagnosis is associated to poor visual outcome.

Mortality of head injuries in Sub-Saharan African countries: The case of the university teaching hospitals of Cameroon.

BACKGROUND: Reliable data on severe head injury mortality is rarely reported in Sub-Saharan African countries and in Cameroon in particular. It was for this reason that for the first time ever a prospective study was carried out during a one year period in the university hospitals and some selected regional and district hospitals in Cameroon. MATERIALS AND METHODS: All the patients admitted for head injury in the emergency units of the selected hospitals were enrolled and followed up over a period of one month. RESULTS: A total of 2835 consecutive patients were included with a sex ratio M/F=3.7/1. One hundred and seventy nine (179) patients lost to follow up were not included. The mortality rate was 77% in the severe head injury group, 16% in the moderate head injury group and 1% in the mild head injury group. In the group of severely injured patients, the mortality rates were very high in the academic hospitals (Laquintinie Hospital of Douala, General Hospital of Douala, Yaounde Central Hospital, and Yaounde University Hospital; 83%, 83%, 81%, and 73% respectively) and in the Regional Hospital of Garoua (84%). CONCLUSION: Mortality rates associated with head injury remain very high in Cameroon, and this is likely true in many countries across Sub-Saharan Africa. The figures approach the mortality expected in the natural history of the disease. Strategic plans should be taken at the local and national levels as in the case of maternal mortality and HIV infections.