Site-Specific Quality of Life after Endoscopic Anterior Skull Base Surgery

Abstract

Objective: Endoscopic anterior skull base surgery (ASBS) is gaining acceptance as an alternative to craniotomy for management of a variety of neoplasms. Potential advantages of this approach include shorter operative time and decreased mortality and morbidity. In addition, it may enable quicker recovery with successful early wound healing. To date, there have been no prospective reports on the effect on quality of life (QOL) for patients undergoing endoscopic ASBS. Our aim was to assess the outcomes of ASBS using two validated QOL measures. Methods: Patients undergoing transnasal endoscopic ASBS were enrolled prospectively from a tertiary medical center. Patients younger than 18 years, those receiving concurrent craniotomy, and those with acute sinusitis were excluded. Preoperative evaluation included computerized tomography of the paranasal sinuses, acoustic rhinometry, and an assessment of olfactory function. The Sinonasal Outcomes Test-22 (SNOT-22) and Anterior Skull Base Surgery-35 (ASBS-35) instruments were completed by each patient before surgery, and again at 3 weeks and 12 weeks following surgery. Objective assessment with nasal endoscopy was also made preoperatively and postoperatively. Results: Seventy-six cases from a series of 360 patients were prospectively studied. Of these, 55.6% were male with a mean age of 58.5 years. Median follow-up time was 15 months. Nasoseptal flap closure and gasket-seal closure were each used in eight (29.6%) patients, and four (14.8%) patients had bilateral nasoseptal flaps. Graft harvest from a second surgical field was performed in 15 (55.6%) patients. Mean operative time was 158 minutes, and the median hospital stay was 2 days. The mean baseline SNOT-22 score was 20, with no significant deterioration at 3 or 12 weeks postoperatively. Improvement was observed in mean ASBS-35 scores as early as 3 weeks postoperatively. Postoperative complications included cerebrospinal fluid leak in 1 (3.7%) patient and sinusitis in 1 (3.7%) patient. Nasal endoscopy demonstrated good postoperative healing in all cases. Conclusions: The effect of endoscopic ASBS on patient QOL is favorable. The endoscopic approach has low overall morbidity and utilization of resources, and represents a viable alternative to traditional neurosurgical approaches.