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

Abstract

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.

ICAR: endoscopic skull‐base surgery

“…There are only 2 Level 1 studies on sinonasal‐related QOL outcomes following ESBS, both by Little et al., both studies focused on pituitary lesions. One study found that there was no difference in nasal morbidity and QOL outcomes between microscopic and endoscopic approaches .…”

Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas

“…12,14,47) Sinonasal QOL following endoscopic pituitary surgery reaches a nadir at 2 to 3 weeks and recovers by 6 weeks to 3 months postoperatively. 49–51) Sinonasal QOL and overall health status are well correlated in the postoperative period, suggesting the importance of sinonasal QOL on the patient experience. 49) Many authors noted better sinonasal QOL after endoscopic approach than microscopic approach at least in short-term period after surgery.…”

“…49–51) Sinonasal QOL and overall health status are well correlated in the postoperative period, suggesting the importance of sinonasal QOL on the patient experience. 49) Many authors noted better sinonasal QOL after endoscopic approach than microscopic approach at least in short-term period after surgery. 49–54) However, Pledger et al 51) reported that although patients who underwent endoscopic surgery experienced significantly fewer nasal symptoms during the first 8 weeks, by 1 year after surgery, there were no significant differences between the endoscopic and microscopic groups.…”

Robotic surgery of the anterior skull base

“…The endonasal approach may result in temporary side effects such as sinusitis and nasal crusting. The longer‐term side effects/complications of EESBS include anosmia/hyposmia, synechiae, chronic sinusitis, and cosmetic changes from excessive septal resection or removal of the piriform aperture . Finally, the field of vision in EESBS is limited to an anterior aspect only.…”