Quality of Life Following Endonasal Skull Base Surgery

Pant, Harshita; Bhatki, Amol M.; Snyderman, Carl H.; Vescan, Allan; Carrau, Ricardo L.; Gardner, Paul A.; Prevedello, Daniel M.; Kassam, Amin

doi:10.1055/s-0029-1242983

Cited by 166 publications

(67 citation statements)

References 32 publications

(40 reference statements)

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“…The same instrument had been evaluated and validated for application to patients who had undergone endonasal surgery. 14 The overall results showed that endoscopic resection of tumors of the anterior and middle skull base preserves health-related QOL measures in most patients. Most of our patients reported that the surgical procedure either improved or did not interfere with their overall QOL.…”

Section: Discussionmentioning

confidence: 92%

Quality of Life Following Endoscopic Resection of Skull Base Tumors

et al. 2012

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There has been an increasing acknowledgment of the importance of topics addressing the quality of life (QOL) of patients with cancer. QOL is assessed in an effort to improve treatment modalities, to promote restoration of the patient's daily function, and to accelerate his return to normal life. Estimation of the influence of specific surgical procedures on QOL can serve as a means by which the most appropriate surgical approach can be selected for a given patient, especially when no single modality has a clear survival advantage over the others. Detailed understanding of the different aspects of QOL may help surgeons improve assessment and management of patients, identify possible obstacle as early as possible during follow-up, and guide the choices of medical interventions. 1 Furthermore, early access of patients to detailed information about their disease can yield better adjustment to an imminent medical condition. A multidimensional evaluation of QOL involves retrieving information on the physical, emotional, social, and economical aspects of the patient's lifestyle, as well as on specific symptoms associated with their disease. Valid interpretation of the data requires disease-specific instruments, which cover the morbidity associated with the site of cancer and its treatment. 2 The technical development of endonasal surgery has had a major positive impact on the management of patients with Keywords ► quality of life ► endoscopy ► morbidity ► skull base ► sinuses ► craniofacial AbstractThe objective of the study is to evaluate patients' quality of life (QOL) after endoscopic resection of skull base tumors. We estimated the QOL of 41 patients who underwent surgery for removal of skull base tumors via the expanded endonasal approach (EEA). The Anterior Skull Base Surgery Questionnaire (ASBS-Q), a multidimensional, diseasespecific instrument containing 36 items was used. The rate of meningitis and cerebrospinal fluid leak was 1.4 and 0%, respectively. There was one case of uniocular visual impairment. The internal consistency of the instrument had a correlation coefficient (α-Cronbach score) of 0.8 to 0.92. Of 41 patients, 30 (75%) reported improvement or no change in overall QOL. Improved scores were reported in the physical function domain and worse scores in the specific symptoms domain. The most significant predictor of poor QOL was female gender, which led to a significant decrease in scores of all domains. Site of surgery, histology, age and comorbidity were not significant predictors of outcome. This paper further validates the use of the ASBS-Q for patients undergoing endoscopic skull base resection. The overall QOL of patients following endoscopic extirpation of skull base tumors is good. Female patients experience a significant decline in QOL compared with males.

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Section: Discussionmentioning

confidence: 92%

Quality of Life Following Endoscopic Resection of Skull Base Tumors

et al. 2012

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“…Pant et al reported on a series of 51 patients undergoing endoscopic surgery who completed the SNOT-22 and ASBQ at 4 postoperative time points. 34 The investigators found that SNOT-22 scores were significantly better at 6 months and 12 months postoperatively as compared with 1-3 months postoperatively. Conclusions from this study are limited by the absence of preoperative data, unspecified distribution of tumor pathology, and a lack of information about the response rate at each time point.…”

Section: Discussionmentioning

confidence: 94%

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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“…This trend is now well documented with validated outcomes measures and demonstrates the time course of nasal cavity healing. 2,15,19 Symptoms such as nasal congestion and nasal discharge, while troubling to patients, were temporary. Second, we learned that certain intraoperative maneuvers that impact the nasal airway, such as use of absorbable nasal packing and nasal splints used in a minority of patients, were negatively correlated with sinonasal QOL early in the postoperative period (2 weeks to 3 months).…”

Section: Discussionmentioning

confidence: 99%

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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Quality of Life Following Endonasal Skull Base Surgery

Cited by 166 publications

References 32 publications

Quality of Life Following Endoscopic Resection of Skull Base Tumors

Quality of Life Following Endoscopic Resection of Skull Base Tumors

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

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