Endoscopic skull base surgery and its impact on sinonasal‐related quality of life

McCoul, Edward D.; Anand, Vijay K.; Bedrosian, Jeffrey C.; Schwartz, Theodore H.

doi:10.1002/alr.21008

Cited by 94 publications

(119 citation statements)

References 21 publications

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“…Finally, McCoul and colleagues compared preoperative with postoperative SNOT-22 scores in a series of 66 patients and found a transient worsening at 3 weeks that returned to baseline values afterward. 28,29 Our data are consistent with these previous reports; no significant change in SNOT-22 scores was found > 9 months after surgery. These data indicate that long-term nasal function is as unchanged for extended craniopharyngioma surgery as it is for pituitary macroadenoma surgery.…”

Section: Discussionsupporting

confidence: 93%

Long-term quality of life after endonasal endoscopic resection of adult craniopharyngiomas

Patel

Raza

McCoul³

et al. 2015

JNS

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T he management of craniopharyngiomas is fraught with challenges that not only hinder achievement of optimal oncological outcomes but potentially have adverse effects on the quality of life (QOL). At time of presentation, and certainly after treatment, craniopharyngiomas can be associated with visual field defects, endocrinopathies, hypothalamic syndromes, increased cardiovascular risk, and neurocognitive sequelae. 7,9,33,37,46 Although considered benign tumors, their location can impact critical structures such as the optic nerves and chiasm, hypoabbreviatioNs ASBQ = Anterior Skull Base Quality of Life; BMI = body mass index; GTR = gross-total resection; QOL = quality of life; obJect Craniopharyngiomas are benign parasellar tumors for which surgical removal, although potentially curative, often leads to morbidity with resulting decreases in quality of life (QOL). The endonasal endoscopic approach is a minimal-access technique for removing these tumors and may reduce postoperative morbidity. The QOL following this method for resection of craniopharyngiomas has not been documented. methods The authors reviewed a database of consecutive endonasal endoscopic surgeries done at Weill Cornell Medical College. Adult patients with histologically proven craniopharyngiomas were included who had completed either only postoperative (> 9 months) or both pre- and postoperative QOL forms, the Anterior Skull Base Quality of Life (ASBQ) questionnaire, and the 22-Item Sinonasal Outcome Test (SNOT-22). Rates of gross-total resection (GTR), complications, and visual and endocrine function were collected. Retrospective independence (Wen score) was also assigned. A contemporaneous group of patients undergoing endonasal endoscopic pituitary macroadenoma resection was used as a control. results This study included 33 procedures performed in 31 patients. The average postoperative ASBQ score was 3.35 and the SNOT-22 score was 19.6. Better QOL was associated with GTR and postoperative radiation. Worse QOL was associated with persistent visual defects, hypopituitarism, tumor recurrence, increase in body mass index, and worsening Wen score. In a subset of 10 patients, both pre- and postoperative (> 9 months) QOL scores were obtained. Both ASBQ and SNOT-22 scores showed stability and a trend toward improvement, from 2.93 ± 0.51 to 2.96 ± 0.47 (ASBQ) and . Compared with 62 patients undergoing endoscopic pituitary macroadenoma resection, patients with craniopharyngiomas had worse postoperative QOL on the ASBQ (3.35 vs 3.80; p = 0.023) and p = 0.12). coNclusioNs This report of validated site-specific QOL following endoscopic surgery for craniopharyngiomas shows an overall maintenance of postoperative compared with preoperative QOL. Better QOL could be seen in patients with GTR and radiation therapy, and worse QOL was found in patients with visual or endocrine deficits. Nevertheless, patients with craniopharyngiomas still had worse QOL than those undergoing similar surgery for pituitary macroadenomas, confirming the worse prognosis of craniop...

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Section: Discussionsupporting

confidence: 93%

Long-term quality of life after endonasal endoscopic resection of adult craniopharyngiomas

Patel

Raza

McCoul³

et al. 2015

JNS

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“…13 As in our study, the authors did not detect a relationship between functioning pituitary tumors and sinonasal QOL. A multivariate analysis would have strengthened their analysis to identify the truly independent covariates.…”

Section: Discussioncontrasting

confidence: 48%

“…2,3,6,13,16,19 These results are providing practitioners with valuable information for managing patient expectations and modifying surgical technique to optimize QOL. A summary of recent findings is reported in Table 4.…”

Section: Discussionmentioning

confidence: 99%

“…Our study did not examine the impact of extent of tumor resection on sinonasal QOL, although McCoul et al reported subtotal resection as a negative prognostic factor. 13 Pant et al 15 studied 51 patients and de Almeida et al 6 studied 63 patients from the same institution and noted that the use of an extended approach was a negative prognostic factor. 15 These studies have methodological limitations that impact the authors' conclusions.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery

Little

Kelly

Milligan

et al. 2015

JNS

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OBJECT Despite the increasing application of endoscopic transsphenoidal surgery for pituitary lesions, the prognostic factors that are associated with sinonasal quality of life (QOL) and nasal morbidity are not well understood. The authors examine the predictors of sinonasal QOL and nasal morbidity in patients undergoing fully endoscopic transsphenoidal surgery. METHODS An exploratory post hoc analysis was conducted of patients who underwent endoscopic pituitary surgery and were enrolled in a prospective multicenter QOL study. End points of the study included patient-reported sinonasal QOL and objective nasal endoscopy findings. Multivariate models were developed to determine the patient and surgical factors that correlated with QOL at 2 weeks through 6 months after surgery. RESULTS This study is a retrospective review of a subgroup of patients studied in the clinical trial “Rhinological Outcomes in Endonasal Pituitary Surgery” (clinical trial no. NCT01504399, clinicaltrials.gov). Data from 100 patients who underwent fully endoscopic transsphenoidal surgery were included. Predictors of a lower postoperative sinonasal QOL at 2 weeks were use of nasal splints (p = 0.039) and female sex at the trend level (p = 0.061); at 3 months, predictors of lower QOL were the presence of sinusitis (p = 0.025), advancing age (p = 0.044), and use of absorbable nasal packing (p = 0.014). Health status (multidimensional QOL) was also predictive at 2 weeks (p = 0.001) and 3 months (p < 0.001) and was the only significant predictor of sinonasal QOL at 6 months (p < 0.001). A Kaplan-Meier analysis was performed to study time to resolution of nasal crusting, mucopurulence, and synechia as observed during nasal endoscopy after surgery. The mean time (± SEM) to absence of nasal crusting was 16.3 ± 2.1 weeks, mucopurulence was 6.2 ± 1.1 weeks, and synechia was 4.4 ± 0.5 weeks. Use of absorbable nasal packing was associated with more severe mucopurulence. CONCLUSIONS Sinonasal QOL following endoscopic pituitary surgery reaches a nadir at 2 weeks and recovers by 3 months postoperatively. Use of absorbable packing and nasal splints, while used in a minority of patients, negatively correlates with early sinonasal QOL. Sinonasal QOL and overall health status are well correlated in the postoperative period, suggesting the important influence of sinonasal QOL on the patient experience.

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“…Multiple studies evaluating sinonasal morbidity after endoscopic endonasal skull base surgery have found that there is a 3-to 4-month period of increased sinonasal morbidity associated with these procedures. 11,13,14,17,18 After this early period of increased sinonasal morbidity, improvements in sinonasal symptoms compared with preoperative levels following endoscopic endonasal skull base surgery have been shown. 14,18,19 The most common sinonasal complaints after endoscopic endonasal skull base surgery included nasal crusting, nasal discharge, nasal airflow blockage, and disturbances in olfaction.…”

Section: Discussionmentioning

confidence: 99%

Free Mucosal Graft Reconstruction of the Septum after Nasoseptal Flap Harvest: A Novel Technique using a Posterior Septal Free Mucosal Graft

Yoo¹,

Kuan²,

Bergsneider

et al. 2016

J Neurol Surg B

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Endoscopic skull base surgery and its impact on sinonasal‐related quality of life

Cited by 94 publications

References 21 publications

Long-term quality of life after endonasal endoscopic resection of adult craniopharyngiomas

Long-term quality of life after endonasal endoscopic resection of adult craniopharyngiomas

Predictors of sinonasal quality of life and nasal morbidity after fully endoscopic transsphenoidal surgery

Free Mucosal Graft Reconstruction of the Septum after Nasoseptal Flap Harvest: A Novel Technique using a Posterior Septal Free Mucosal Graft

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