Incidence, risk factors, and outcomes of endoscopic sinus surgery after endoscopic skull‐base surgery

Abstract

Background Patients undergoing endoscopic resection of neoplasms with both sinonasal and skull base involvement can develop chronic rhinosinusitis (CRS) after treatment and may occasionally benefit from additional endoscopic sinus surgery (ESS). We investigate risk factors and outcomes associated with revision ESS (rESS) after endoscopic skull‐base surgery (SBS) for neoplasms with combined sinonasal and skull base involvement. Methods A retrospective review of patients with neoplasms with both sinonasal and skull base involvement who underwent endoscopic resection at a single tertiary care academic institution from 2004 through 2017 was performed. Eighty‐three patients were included. Main outcome measures included incidence and timing of revision surgery, Lund‐Mackay (LM) scores, and 22‐item Sino‐Nasal Outcome Test (SNOT‐22) scores. Results rESS was performed in 21 (25%) cases, 15 (18%) of which were due to CRS. Time between initial resection and rESS was an average of 42 months (range, 6 to 142 months). Pre‐SBS and post‐SBS LM scores were not significantly different (5.0 vs 4.7, p = 0.640), although pre‐SBS and post‐SBS SNOT‐22 scores showed significant improvement (32.6 vs 24.5, p = 0.030). Malignant pathology correlated with need for rESS (odds ratio [OR] 5.07, p = 0.04), as well as treatment including chemotherapy (OR 5.10, p = 0.003) and radiation (OR 4.15, p = 0.013). Conclusion A significant proportion of patients develop clinically significant sinusitis after endoscopic SBS for neoplasms with combined sinonasal and skull base involvement and may benefit from rESS. Intervention occurred, on average, 3.5 years after initial tumor resection. Malignant pathology, radiation therapy, and chemotherapy correlate with need for rESS.

Quality of life in sinonasal tumors: an up-to-date review

“…In addition to that, SNOT-22 is commonly used in assessing QOL after endoscopic surgery for benign disease such as chronic rhinosinusitis [8 ▪ ,20,21] (Table 3). Although it lacks questions related to skull base, it has been previously used to assess postoperative QOL in patients undergoing endonasal surgery for sinonasal and skull base tumors, showing significant improvement in sinonasal morbidity [22 ▪ ,23–25].…”

Incidence of Sinus Inflammation After Endoscopic Skull Base Surgery in the Pediatric Population

“…From a radiographic standpoint, Shah et al performed a retrospective review of the adult population undergoing endoscopic skull base surgery and found that up to 18% of patients developed CRS requiring intervention. 15 Langdon et al demonstrated statistically significant increases in pre-and six month post-operative Lund-MacKay scores. 13 McCoul et al found that SNOT-22 scores were significantly higher in patients who underwent endoscopic skull base surgery at three weeks compared to baseline (17.5 vs. 27.8, p = 0.001), and gradually return to pre-operative scores at six weeks, 12 weeks, and six months (23.6, 22.2, and 16.2, respectively).…”

“…Although there is a lack of data in the pediatric population, there have been reports in the adult population which may provide insights in this domain. From a radiographic standpoint, Shah et al performed a retrospective review of the adult population undergoing endoscopic skull base surgery and found that up to 18% of patients developed CRS requiring intervention 15 . Langdon et al demonstrated statistically significant increases in pre‐ and six month post‐operative Lund‐MacKay scores 13 .…”

“…In adults, transnasal endoscopic approaches to the skull base have the potential for negative consequences such as persistently elevated postnasal discharge and sinonasal dysfunction leading to sinusitis. [11][12][13][14][15] Due to the lack of similar outcomes studies in the pediatric population, we sought to examine the incidence of chronic rhinosinusitis (CRS) following skull base surgery. One challenging aspect of studying the pediatric population is the inability to use surveys as is commonly performed for adults (e.g., 22-item sinonasal outcome test ).…”

“…Although early reports focused on technical challenges in anatomy and the limited reconstructive options, little is known about the frequency of long‐term sinonasal complications of extended endonasal approaches (EEA). In adults, transnasal endoscopic approaches to the skull base have the potential for negative consequences such as persistently elevated postnasal discharge and sinonasal dysfunction leading to sinusitis 11–15 . Due to the lack of similar outcomes studies in the pediatric population, we sought to examine the incidence of chronic rhinosinusitis (CRS) following skull base surgery.…”