Early Experience of Endoscopic Endonasal Transphenoidal Surgery in the Democratic Republic of Congo: Expanding Access to Skull Base Oncology.

introductionEndoscopic endonasal transsphenoidal surgery (EETS) has transformed care for sellar and parasellar tumors by providing direct midline access with reduced morbidity. However, adoption across Africa remains uneven due to equipment constraints and training gaps. We report an early Central African experience to describe feasibility, safety, and outcomes, and to contextualize results against regional benchmarks to inform service expansion and workforce development. MATERIALS AND

methodsForty-six consecutive patients with sellar or parasellar tumors underwent EETS at Clinique Ngaliema, Kinshasa, Democratic Republic of the Congo (DRC), between January 2017 and January 2025. Inclusion required complete clinical, radiological, surgical, and follow-up data; combined cranial-endonasal procedures were excluded. Preoperative assessment included visual field testing, pituitary hormone profiling, and magnetic resonance imaging (MRI). A standardized anatomy-based approach was used; neuronavigation was applied when available. Primary outcomes included the extent of resection and complications (cerebrospinal fluid (CSF) leak, infection, vascular injury, mortality). Secondary outcomes included visual and endocrine status at discharge when documented.

resultsForty-six patients underwent EETS (54.3% male; mean age 53.1 years). Pathology comprised pituitary adenoma (89.1%), craniopharyngioma (6.5%), and carcinoma (4.4%). Gross-total resection (GTR) was achieved in 56.5% (26/46). Radiological residual tumor was present in 43.5% (20/46). Among patients with documented CSF-leak status (n=41), transient leaks occurred in 41.5% (17/41) and persistent leaks in 9.8% (4/41); 48.8% (20/41) had no leak. Postoperative infection occurred in 10.9% (5/46). Internal carotid artery (ICA) injury occurred in 4.8% (2/42 with documentation). Mortality was 4.8% (2/42 with documentation). Visual impairment was the most frequent presentation, with improvement frequently documented postoperatively.

conclusionEETS appears feasible and safe in a Central African referral center, with resection rates and morbidity comparable to reports from resource-limited settings. CSF leakage remains the principal technical challenge. Programmatic priorities include standardized multilayer reconstruction (including vascularized options when available), perioperative endocrine and ophthalmic pathways, and prospective registries to refine indications, monitor outcomes, and guide capacity-building efforts.