Sinonasal Quality of Life Outcomes After Extended Endonasal Approaches to the Skull Base

Abstract

Introduction Endoscopic endonasal skull base surgery (EESBS) leads to significant alterations in sinonasal anatomy and physiology. However, there is limited data available on quality of life (QOL) outcomes following EESBS. Methods A retrospective review of patients undergoing EESBS from January 2014 to April 2017 was performed. Records were reviewed for clinical history, operative details, and 22-item Sinonasal Outcomes Test (SNOT-22) scores. Unadjusted and adjusted linear regression models were utilized to compare change in SNOT-22 scores from baseline in patients who underwent a simple sella approach (SA) or an extended beyond sella approach (BSA). Results A total of 108 patients were in the SA group, while 61 patients were in the BSA group. SNOT-22 scores were available at baseline and 3 months for 84 patients, while 6-month scores were available for 49 patients. SNOT-22 scores for all patients were not significantly different at 3 months (p = 0.40) or at 6 months (p = 0.58). Unadjusted linear regression model did not show an association between the type of approach and change in SNOT-22 score at 3 months (p = 0.07) and 6 months (p = 0.28). Adjusted regression model showed a significant decrease in SNOT-22 scores at 3 months (p = 0.04) for the BSA group, but there was no significant change in SNOT-22 score at 6 months (p = 0.22). Conclusion Patients undergoing EESBS had no significant change in outcomes at 3 and 6 months. A more extensive BSA was not associated with worse QOL outcomes as measured by SNOT-22.

Comparison of Sinonasal Outcomes in Patients Undergoing Uni-nostril and Bi-nostril Endoscopic Trans-sphenoidal Excision of Pituitary Adenomas: A Prospective Study

“…studies reporting sinonasal outcomes beyond 3 months of surgery do not document any significant further worsening of QoL. 16,28,37,47 Previous Studies on Sinonasal Quality of Life…”

“…Postoperative follow-up at 3-6 months was chosen in the present study as it has been shown to be adequate to achieve complete healing of the nasal cavities and most studies reporting sinonasal outcomes beyond 3 months of surgery do not document any significant further worsening of QoL. 16,28,37,47 Previous studies on sinonasal quality of life Bhenswala et al 48 in a meta-analysis of sinonasal quality of life outcomes after endoscopic endonasal skull base surgery using SNOT-22, demonstrated a temporary worsening of sinonasal QoL at ≤ 4 weeks after surgery in all patients but they returned to their preoperative sinonasal status within 3 months. In patients with impaired preoperative sinonasal QoL, they demonstrated a continued improvement beyond the baseline after 3 months reaching a peak at 1 year postoperatively.…”

“…However, many of these studies are retrospective studies. 16,30,34,40,47,[51][52][53] Our study is a prospective study. Also, most of the studies are focused on the bi-nostril technique.…”

“…Thus, the indications for the endoscopic surgery include both pituitary adenomas and other pathologies such as craniopharyngiomas and meningiomas for which an extended approach is used and typically the resection of nasal mucosa is more extensive. 10,13,15,18,19,30,34,37,39,40,47,51,[53][54][55] The present study is the only prospective study in the literature designed to compare sinonasal outcomes in patients undergoing uni-nostril and bi-nostril endoscopic pituitary surgery, using subjective and objective nasal QoL indicators.…”

SNOT-22 Quality of Life Scores Improve After Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Rhinorrhea

“…Although validated as an outcomes assessment tool specifically for chronic rhinosinusitis (CRS), the SNOT-22 has also been used to assess QOL outcomes in patients undergoing septoplasty, 10 rhinoplasty, 11 and even EESBS for skull base tumors. 12,13 However, no study has evaluated SNOT-22 QOL scores in patients undergoing surgical repair for spontaneous CSF rhinorrhea.…”