Quality of Life Following Endoscopic Resection of Skull Base Tumors

Cavel, Oren; Abergel, Avraham; Margalit, Nevo; Fliss, Dan M.; Gil, Ziv

doi:10.1055/s-0032-1301392

Cited by 37 publications

(43 citation statements)

References 18 publications

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“…Recent case studies on endoscopic skull base surgery evaluating QOL (using the ASBS-Q) have described the female sex as a significant predictor of a poor outcome. 3 Our data do not confirm this difference. Similarly, Palme et al did not find sex to be a prognostic factor, although they used tools different from ours.…”

Section: Discussioncontrasting

confidence: 80%

Quality of life following endoscopic endonasal resection of anterior skull base cancers

Castelnuovo

Lepera

Turri‐Zanoni

et al. 2013

JNS

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Object For several decades, the exclusive purpose in the management of anterior skull base malignancies has been to increase survival rates. Recently, given the improved prognosis achieved, more attention has been focused on quality of life (QOL) as well. Producing data on QOL in anterior skull base cancers is hampered by the rarity of the neoplasm and the lack of specific questionnaires. The purpose of this study was to assess health-related QOL in a large and homogeneous cohort of patients affected by anterior skull base cancers who had undergone endoscopic endonasal resection. Methods The authors conducted a retrospective review of patients treated for sinonasal and skull base cancers via an endoscopic endonasal approach at two Italian tertiary care referral centers. All patients were asked to complete the Anterior Skull Base Surgery Questionnaire to evaluate their QOL before and 1 month and 1 year after surgical treatment. To assess which parameters affect QOL, the study population was divided into subgroups according to age, sex, stage of disease, surgical approach, and adjuvant therapy. Results One hundred fifty-three patients were enrolled in this study according to the adopted inclusion criteria. Overall QOL started at a score of 4.68 for the preoperative period, sharply decreased as far as a score of 4.03 during the 1st postoperative month, and rose again to a score of 4.59 over the course of 1 year after treatment, with a significant difference among the 3 values (p < 0.05). The specific symptoms and physical status domains registered poorer results at the 1-year assessment (4.00 and 4.71, respectively) than at the preoperative assessment (both domains 4.86), with a statistically significant reduction in scores (p < 0.05). Worse outcomes were associated with several variables: age > 60 years (difference of 0.21 points between the preoperative and 1-year period, p < 0.05), expanded surgical approaches with transnasal craniectomy (decrease of 0.20 points between the preoperative and 1-year period, p < 0.05), and postoperative radiotherapy (score of 4.53 at the 1-year period vs 4.70 in patients without any adjuvant treatment, p < 0.05). No statistically significant differences were found when analyzing the study population according to sex (p > 0.1) and T classification of disease at presentation (p > 0.05). Conclusions Radical endoscopic endonasal resection led to either complete or at least partial recovery of patient QOL within the 1st postoperative year.

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Section: Discussioncontrasting

confidence: 80%

Quality of life following endoscopic endonasal resection of anterior skull base cancers

Castelnuovo

Lepera

Turri‐Zanoni

et al. 2013

JNS

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“…The ASBQ was subsequently demonstrated to have psychometric validity for site-specific QOL assessment following anterior skull base surgery for both transcranial and endoscopic approaches. 4,17 A prospective study of QOL in patients undergoing open anterior skull base surgery has only recently been described. Abergel et al assessed a series of 39 patients with the ASBQ prior to surgery and again at 2 postoperative points.…”

Section: Discussionmentioning

confidence: 99%

“…44 Although the ASBQ was originally intended to assess QOL after craniotomy for anterior skull base lesions, it was recently validated for endonasal endoscopic surgery. 4 In addition, by using this measure, our results can be compared with ASBQ outcomes after craniotomy published in the literature. Both questionnaires were filled out by the patient, either in the office or through a phone interview.…”

Section: Quality Of Life Assessmentmentioning

confidence: 99%

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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“…While the validation cohort was treated exclusively via open, nonendoscopic surgical approaches, the ASBQ has recently been validated for endoscopic approaches as well. 4 Multiple studies have demonstrated the validity of the ASBQ for anterior skull base surgery and the association of ASBQ scores with outcomes and other factors including pathology, approach, age, and degree of resection.…”

Section: Methodsmentioning

confidence: 99%

“…Previous research has validated the use of the ASBQ to assess endoscopic surgical outcomes, with 75% of cases reporting improvement or no change in overall QOL. 4 Reconstruction of the postoperative skull base defect is an important consideration in all cases regardless of surgical approach. Achieving low rates of postoperative CSF leak following endoscopic surgery has been well demonstrated with more recent publications in the literature.…”

mentioning

confidence: 99%

Preservation of multidimensional quality of life after endoscopic pituitary adenoma resection

McCoul

Bedrosian

Akselrod

et al. 2015

JNS

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T he endoscopic endonasal transsphenoidal approach to the pituitary gland is gaining popularity as an alternative to traditional microscope-assisted techniques. Although still a matter of debate, the endoscopic approach appears to be superior to the microscopic technique with regard to extent of resection, specifically for macroadenomas, 5,12,18 and also offers benefits for nasal function and morbidity. 5,20,21 Increased rates of resection can be explained by the improved visualization offered by the endoscope, which is advanced into the nasal cavity to provide a wide panoramic view and a lateral view through the use of straight and angled scopes. Morbidity is theoretically decreased by preserving nasal mucosa, opening the sinuses to permit drainage, avoiding superficial mucosal incisions, and eliminating use of the retractor. 5,18,20,21 However, controversy remains regarding sinonasal morbidity abbreviatioNs ASBQ = Anterior Skull Base Questionnaire; GH = growth hormone; GTR = gross-total resection; IGF-1 = insulin-like growth factor-1; QOL = quality of life; SNOT-22 = 22-Item Sino-Nasal Outcome Test; STR = subtotal resection. submitted March 13, 2014. accepted November 12, 2014. iNclude wheN citiNg Published online June 5, 2015; DOI: 10.3171/2014.11.JNS14559. disclosure The authors report no conflict of interest concerning the material or methods used in this study or the findings specified in this paper. Dr. Schwartz has stock options in Visionsense. . This study aims to assess the effect of endoscopic pituitary adenoma resection on site-specific and sinonasal-related QOL before and after endoscopic surgery using validated instruments. methods Consecutive adult patients undergoing endoscopic endonasal resection of pituitary adenoma were prospectively enrolled from a single tertiary care center. All patients completed the Anterior Skull Base Questionnaire (ASBQ) and the 22-Item Sino-Nasal Outcome Test (SNOT-22) preoperatively and then at regular intervals after surgery to assess their perceived QOL with regard to hormonal, surgical, and anatomical factors. results Eighty-one of 114 patients were eligible for study; median follow-up was 16 months. This cohort included 24 (29.6%) nonsecreting macroadenomas and 57 (70.4%) hypersecreting tumors. There was significant improvement in the mean ASBQ score at 12 weeks, 6 months, and 1 year after surgery (p < 0.05), while postoperative SNOT-22 scores, at the same time points, showed no significant difference from preoperative scores. Both ASBQ and SNOT-22 scores showed transient worsening at 3 weeks postoperatively. Subtotal resection correlated with worse QOL, both overall and among patients with hypersecreting tumors (p < 0.05). Extrasellar tumor extension, intraoperative CSF leakage, and a reconstruction technique during surgery did not impact postoperative QOL. Visual disturbances did not significantly alter QOL. There were no postoperative CSF leaks in this series. coNclusioNs Endoscopic resection of pituitary adenoma is associated with long-term improvements in sit...

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Quality of Life Following Endoscopic Resection of Skull Base Tumors

Cited by 37 publications

References 18 publications

Quality of life following endoscopic endonasal resection of anterior skull base cancers

Quality of life following endoscopic endonasal resection of anterior skull base cancers

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

Preservation of multidimensional quality of life after endoscopic pituitary adenoma resection

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