Sinonasal quality of life after endoscopic resection of malignant sinonasal and skull base tumors

Glicksman, Jordan T.; Parasher, Arjun K.; Brooks, S.C.; Workman, Alan D.; Lambert, Justina L.; Bergman, Jenna; Palmer, James N.; Adappa, Nithin D.

doi:10.1002/lary.26833

Cited by 35 publications

(52 citation statements)

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“…Glicksman et al found contradictory results. These authors followed 145 patients who underwent endoscopic resection of benign and malignant sinonasal tumors for 2 years postoperatively and found that SNOT‐22 scores were significantly improved from baseline at 3 months and that the improvement was sustained for the 2‐year follow‐up period . However, QOL scores were worse at all time points for patients with malignant disease relative to those with benign tumors.…”

Section: Discussionmentioning

confidence: 99%

Long‐term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction

et al. 2018

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Objectives The utilization of the nasoseptal flap (NSF) in endoscopic anterior skull base surgery (EASB) has resulted in reduced rates of postoperative cerebrospinal fluid leak (CSF). The long‐term impact on sinonasal function after surgery remains incompletely defined. Methods A consecutive series of patients undergoing EASB with NSF and with at least 3 years follow‐up was prospectively evaluated. Patient demographics, pre‐ and postoperative Sino‐nasal Outcome Test‐22 (SNOT‐22) scores, Lund‐Mackay scores (LMS), CSF leak, and sinonasal complications were analyzed. Results A total of 46 patients undergoing EASB with NSF met inclusion criteria. The mean follow‐up was 67.4 months (range 39–90, standard deviation [SD] 14.2 months). No statistically significant differences were noted between the mean overall pre‐ (16) and postoperative SNOT‐22 scores (18). SNOT‐22 scores improved in 27 patients (58.7%), deteriorated in 17 patients (37.0%) and stayed the same in two patients (4.3%). Deterioration in SNOT‐22 scores was greater in younger (mean change + 7.2 [SD17.4] vs. older patients −3.4 [SD 7.5], P = 0.010). A statistically significant increase in LMS was noted (mean preoperative LMS0.9 vs. mean postoperative LMS 2.2, P = 0.001). The LMS decreased in nine patients (19.6%), increased in 22 patients (47.8%), and remained the same in 15 patients (32.6%). One patient (2.2%) developed a postoperative CSF leak following resection of metastatic skull base lesion and was successfully treated with placement of a lumbar drain, Foley catheter balloon, and strict bed rest. One patient (2.2%) developed a postoperative mucocele requiring decompression 3 years after initial surgery. Conclusion Whereas long‐term sinonasal quality of life is overall improved in the majority of patients following NSF use for EASB, younger patients show higher incidence of deterioration. Increased sinus opacification on imaging is generally noted and may require continued follow‐up and management. The incidence of reoperation for symptomatic mucocele formation is low. Level of Evidence 4 Laryngoscope, 129:1035–1040, 2019

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Section: Discussionmentioning

confidence: 99%

Long‐term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction

et al. 2018

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“…However, none of these studies specifically reported the indications and impact on outcomes of the packing. Moreover, several other large series do not mention nasal packing, whereas 1 of the largest studies, with over 1000 patients, reported not using nasal packing unless copious bleeding was encountered …”

Section: Intraoperative Considerationsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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“…Intranasal postoperative morbidities following EES of the skull base are well recognized [6][7][8][9][10][11] ; however, cosmetic external deformities are less widely reported and until now, have only been anecdotal or retrospectively reported. 12 In this study, we prospectively analyzed patients' nasal architecture with both objective and subjective measures, demonstrating that external nasal deformities following EES of the skull base are more common than previously acknowledged.…”

Section: Discussionmentioning

confidence: 99%

“…Though EES oftentimes affords many benefits, including similar or improved outcomes as compared to traditional open approaches, improved visualization, decreased perioperative complications and length of stay, the use of the sinonasal corridor introduces additional morbidity. Well‐characterized effects of EES on sinonasal QOL include nasal crusting, nasal obstruction, and changes in olfaction …”

mentioning

confidence: 99%

“…Well-characterized effects of EES on sinonasal QOL include nasal crusting, nasal obstruction, and changes in olfaction. [6][7][8][9][10][11] Beyond changes in sinonasal function, we previously retrospectively described the incidence of objective postoperative nasal deformities in a large cohort of patients undergoing EES. 12 Deformities were characterized as nasal dorsum collapse, new septal deviations, or new postoperative nasal septal perforations.…”

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confidence: 99%

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Prospective characterization of postoperative nasal deformities in patients undergoing endoscopic endonasal skull‐base surgery

Rowan

Valappil

Chen

et al. 2019

Int Forum Allergy Rhinol

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Background Surgeons have become increasingly aware of the impact of endoscopic endonasal surgery (EES) of the skull base on sinonasal‐related quality of life. Prior retrospective investigation described a correlation between nasoseptal flap (NSF) reconstruction in EES with postoperative nasal deformities, such as nasal dorsum collapse. The primary objective of this study was to prospectively evaluate the incidence of, and contributing factors to, postoperative changes in nasal structure following EES. Secondary goals included assessing subjective changes in nasal appearance as well as objective nasal analysis. Methods Clinical demographics and detailed perioperative information was prospectively collected for patients undergoing transsellar/suprasellar EES for skull‐base tumors. Preoperatively, 1‐month and 6‐month photographs were completed for objective photographic nasal analysis and blinded assessment by surgeons. Subjective patient feedback was also solicited. Results Overall, 14.7% (5/34) of patients subjectively reported postoperative nasal deformities, whereas both blinded‐surgeon and objective nasal measurements identified deformities in 12.9% (4/31) of patients. Patients with postoperative deformities were more likely to have skull‐base reconstruction with an NSF (p = 0.01) and trended toward an increased incidence in patients with nonpituitary neoplasms (p = 0.07). There were no other associations between clinical or operative characteristics and external deformities. No patients planned to undergo corrective repair. Conclusion External nasal deformities following EES are more frequent than previously acknowledged. Postoperative deformities appear to be associated with NSF reconstruction and may be associated with surgery for nonpituitary neoplasms. Patients should be counseled on this potential outcome, and future studies should investigate how to minimize postoperative sequela.

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Sinonasal quality of life after endoscopic resection of malignant sinonasal and skull base tumors

Abstract: 2b. Laryngoscope, 128:789-793, 2018.

Cited by 35 publications

References 20 publications

Long‐term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction

Long‐term sinonasal outcomes after endoscopic skull base surgery with nasoseptal flap reconstruction

ICAR: endoscopic skull‐base surgery

Prospective characterization of postoperative nasal deformities in patients undergoing endoscopic endonasal skull‐base surgery

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