Improvements in site-specific quality of life 6 months after endoscopic anterior skull base surgery: a prospective study

McCoul, Edward D.; Anand, Vijay K.; Schwartz, Theodore H.

doi:10.3171/2012.6.jns111066

Cited by 83 publications

(97 citation statements)

References 28 publications

(28 reference statements)

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“…Finally, McCoul and colleagues compared preoperative with postoperative SNOT-22 scores in a series of 66 patients and found a transient worsening at 3 weeks that returned to baseline values afterward. 28,29 Our data are consistent with these previous reports; no significant change in SNOT-22 scores was found > 9 months after surgery. These data indicate that long-term nasal function is as unchanged for extended craniopharyngioma surgery as it is for pituitary macroadenoma surgery.…”

Section: Discussionsupporting

confidence: 83%

“…McCoul et al recently showed that, in contrast to open surgery, endonasal endoscopic skull base surgery results in site-specific increases in QOL at 12 weeks and 6 months postoperatively compared with preoperative assessments; however, the majority of these cases were pituitary adenomas. 29 This study raised the possibility that minimally invasive endonasal endoscopic surgery may be better tolerated than open surgery with respect to QOL.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

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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“…10,12,16,[19][20][21]23,25 These studies have at least 1 of several important limitations, including retrospective analysis of data, interpretation of unpaired postoperative data, use of nonvalidated outcome measures, and application of scales developed for other disease entities in unrelated patient populations. In this study, we sought to address the latter 2 limitations.…”

Section: Discussionmentioning

confidence: 99%

“…4,10,20,21 Current reports are limited by the use of QOL scales that either do not assess nasal complaints 13 or were not developed or validated for endonasal skull base surgery. 13,17,22 Furthermore, neurosurgeons should be familiar with the nasal morbidity of these techniques to aid in preoperative and postoperative patient counseling and to help place their approach-related morbidity in the context of open skull base techniques.…”

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confidence: 99%

Prospective validation of a patient-reported nasal quality-of-life tool for endonasal skull base surgery: The Anterior Skull Base Nasal Inventory-12

Little

Kelly

Milligan

et al. 2013

JNS

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Object Patient-reported quality-of-life (QOL) end points are becoming increasingly important health care metrics. To date, no nasal morbidity instrument specifically designed for patients undergoing endonasal skull base surgery has been developed. In this study, the authors describe the development and validation of a site-specific nasal morbidity instrument to assess patient-reported rhinological outcomes following endonasal skull base surgery. Methods Eligible patients included those with planned endonasal transsphenoidal surgery for sellar pathology identified in outpatient neurosurgical clinics of 3 skull base centers from October 2011 to July 2012. An initial 23-question pool was developed by subject matter experts, review of the literature, and from the results of a previous validation study to assess for common rhinological complaints. Symptoms were ranked by patients from “No Problem” to “Severe Problem” on a 6-point Likert scale. Exploratory factor analysis, change scores, and importance rank were calculated to define the final instrument consisting of 12 items (The Anterior Skull Base Nasal Inventory-12, or ASK Nasal-12). Psychometric validation of the final instrument was performed using standard statistical techniques. Results One hundred four patients enrolled in the study. All patients completed the preoperative survey and 100 patients (96%) completed the survey 2–4 weeks after surgery. Internal consistency of the final instrument was 0.88. Concurrent validity measures demonstrated a strong correlation between overall nasal functioning and total scores (p < 0.001). Test-retest reliability measures demonstrated a significant intraclass correlation between responses (p < 0.001). Effect size as calculated by standardized response mean suggested a large effect (0.84). Discriminant validity calculations demonstrated that the instrument was able to discriminate between preoperative and postoperative patients (p < 0.001). Conclusions This prospective study demonstrates that the ASK Nasal-12 is a validated, site-specific, unidimensional rhinological outcomes tool sensitive to clinical change. It can be used in conjunction with multidimensional QOL instruments to assess patient-reported nasal perceptions in endonasal skull base surgery. This instrument is being used as a primary outcome measure in an ongoing multicenter nasal morbidity study. Clinical trial registration no.: NCT01504399 (ClinicalTrials.gov).

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“…Graham et al [17] compared the nasal symptoms in patients undergoing endoscopic or open surgery, noting that patients in the endoscopic surgery group had a lower score of nasal symptoms. Pant & McCoul et al [18,19] showed that the SNOT-22 scores and nasal symptoms increased moderately in the immediate postoperative period but subsequently returned to their preoperative values. Following the same line of study, Balaker et al [16] found that nasal symptoms were significantly improved over time but posterior rhinorrhea persisted in time until at least one year after surgery.…”

Section: Sinonasal Symptomsmentioning

confidence: 99%

Postoperative Findings in Endoscopic Endonasal Surgery of The Skull Base

Langdon

Santamaría

Forner-Cordero

et al. 2017

JOENTR

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Since the introduction of endonasal endoscopic skull base surgery the exclusive purpose in the management of skull base neoplasms has been to increase survival rates. Recently, given the improved prognosis achieved, more attention has been focused on the functional outcomes such as nasal symptoms and quality of life (QOL). The purpose of this review is to assess the functional outcomes after endonasal endoscopic skull base surgery.

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Improvements in site-specific quality of life 6 months after endoscopic anterior skull base surgery: a prospective study

Cited by 83 publications

References 28 publications

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

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

Prospective validation of a patient-reported nasal quality-of-life tool for endonasal skull base surgery: The Anterior Skull Base Nasal Inventory-12

Postoperative Findings in Endoscopic Endonasal Surgery of The Skull Base

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