Quality of Life Following Endonasal Skull Base Surgery

Abstract

The importance of quality of life (QOL) outcomes following treatments for head and neck tumors are now increasingly appreciated and measured to improve medical and surgical care for these patients. An understanding of the definitions in the setting of health care and the use of appropriate QOL instruments and measures are critical to obtain meaningful information that guides decision making in various aspects of patient health care. QOL outcomes following cranial base surgery is only recently being defined. In this article, we describe the current published data on QOL outcomes following cranial base surgery and provide preliminary prospective data on QOL outcomes and sinonasal morbidity in patients who underwent endonasal cranial base surgery for management of various skull base tumors at our institution. We used a disease-specific multidimensional instrument to measure QOL outcomes in these patients. Our results show that although sinonasal morbidity is increased, this is temporary, and the vast majority of patients have a very good QOL by 4 to 6 months after endonasal approach to the cranial base.

Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base

“…In the present study, eight cases of postoperative synechiae (19.5%) were identified, a percentage similar to previous reports in the literature, which ranged from 9% to 20%. 21,24 In the present authors' experience, the main causes of synechiae are the lack of proper nasal lavage with saline in the postoperative period and failure to place the nasal splint, exposing areas of bloody septal mucosa.…”

“…In the first month, the presence of crusts in the nasal cavity resulting from surgical procedures play an important role and can persist for 30---100 days. 20,24,25 However, these crusts occur transiently; with the correct cleaning of the nasal cavity, there can be a significant improvement in the sense of smell. In addition, other factors that can minimize olfactory complaints are the preservation of 2 cm from the upper region of the nasal septum mucosa during the making of the flap, as this region is rich in olfactory neuroepithelium, and the preservation of the middle and upper turbinates, structures with the presence of olfactory fimbriae.…”

Endoscopic Resection of Sinonasal Malignancies

“…Although these studies mostly included patients with benign lesions and tumors originating from sites other than the sinonasal tract, the results can be to some extent extrapolated to patients treated for sinonasal malignancies. In one study [42] the evaluation was performed through a sinonasal outcome test (SNOT-22 questionnaire), which provides a symptom score for parameters relating to sinonasal function, and a multidimensional disease-specific questionnaire for anterior skull base neoplasms developed by Gil et al [44]. The results appear to indicate that there may be a greater disruption of normal sinonasal anatomy and function related to the extensive mucosal denuding which may be higher compared to standard external approaches.…”

“…Quality of life has been extensively evaluated in patients treated for head and neck cancer, while only a few reports have addressed this issue in patients undergoing endonasal skull base surgery [42,43]. Although these studies mostly included patients with benign lesions and tumors originating from sites other than the sinonasal tract, the results can be to some extent extrapolated to patients treated for sinonasal malignancies.…”

Moderne Schädelbasischirurgie aus Sicht des Neurochirurgen

“…verbliebene Reste von Tumoren, die durch den orthogonalen Strahlengang des Mikroskops mög-licherweise verborgen bleiben, darzustellen und zu entfernen. Nach unserer Erfahrung bietet sich hier eine Kombination aus navigationsgeführter, mikrochirurgischer Resektion und navigierter Endoskopie an, um möglichst große Sicherheit zu erzielen.Eine andere Strategie ist die rein endoskopische Entfernung von Hypophysentumoren, wobei der endonasale, transsphenoidale Zugang ähnlich dem in der Mikrochirurgie durchgeführt wird[8,18]. Auch im Bereich der frontalen Schädelba-sis gewinnt die endoskopische Chirurgie zunehmend an Bedeutung sowie im Bereich der hinteren Schädelgrube[26].…”