Expanded Endonasal Approach using Vascularized Septal Flap Reconstruction for Skull Base Tumors has a Negative Impact on Sinonasal Symptoms and Quality of Life

Abstract

Background

Endoscopic transsphenoidal surgery is currently the optimal treatment for skull base tumors. This study was designed to assess patient's sinonasal symptoms and quality of life (QoL) after resection of pituitary adenoma or skull base tumors using vascularized septal flap (VSF) reconstruction.

Methods

Patients with pituitary adenoma underwent the transnasal transsphenoidal endoscopic approach (TTEA; n = 38), and patients with other benign parasellar tumors underwent the expanded endonasal approach (EEA; n = 17) with VSF. Assessment of sinonasal symptoms and QoL by the 36-item Short-Form (SF-36) and the 31-item Rhinosinusitis Outcome Measure (RSOM-31) were performed before and 3 months after surgery.

Results

At baseline, the total seven-sinonasal symptom score (T7SSS) was similar between both groups. After surgery, T7SSS significantly increased in EEA but not in TTEA patients. EEA patients reported more smell loss (40.1 ± 26.2; p < 0.05) and posterior nasal discharge (49.3 ± 30.1; p < 0.05) than TTEA patients (21.6 ± 30.9 and 22.5 ± 27.5, respectively). At baseline, both groups had poorer SF-36 compared with the general population. TTEA patients had poorer QoL (on general health, vitality, and mental health) than EEA patients. After surgery, TTEA patients showed impaired physical role and bodily pain compared with baseline, and EEA patients showed impaired physical role and mental health. At baseline, RSOM scores were similar in TTEA and EEA groups. After surgery, EEA but not TTEA patients reported poorer nasal and general symptoms.

Conclusion

The EEA with VSF produces more sinonasal symptoms than pituitary surgery, surgery for skull base and pituitary tumors has negative impact on QoL, and functioning tumors have no further negative effect on sinonasal symptoms and QoL.

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References

Nasseri

S.S.

Kasperbauer

J.L.

Strome

S.E.

Endoscopic transnasal pituitary surgery: Report on 180 cases.

Am J Rhinol 15: 281–287, 2001.

Cappabianca

Cavallo

L.M.

Colao

Endonasal transsphenoidal approach: Outcome analysis of 100 consecutive procedures.

Minim Invasive Neurosurg 45: 193–200, 2002.

Cappabianca

and de Divitiis

Endoscopy and transsphenoidal surgery.

Neurosurgery 54: 1043–1050, 2004.

Hadad

Bassagasteguy

Carrau

R.L.

A novel reconstructive technique after endoscopic expanded endonasal approaches: Vascular pedicle nasoseptal flap.

Laryngoscope 116: 1882–1886, 2006.

Lund

V.J.

Stammberger

Nicolai

European position paper on endoscopic management of tumours of the nose, paranasal sinuses and skull base.

Rhinology 22(suppl): 1–143, 2010.

Dekkers

O.M.

van der Klaauw

A.A.

Pereira

A.M.

Quality of life is decreased after treatment for nonfunctioning pituitary macroadenoma.

J Clin Endocrinol Metab 91: 3364–3369, 2006.

de Almeida

J.R.

Snyderman

C.H.

Gardner

P.A.

Nasal morbidity following endoscopic skull base surgery: A prospective cohort study.

Head Neck 33: 547–551, 2011.

Bleier

B.S.

Wang

E.W.

Vandergrift

3rd , and Schlosser

R.J.

Mucocele rate after endoscopic skull base reconstruction using vascularized pedicled flaps.

Am J Rhinol Allergy 25: 186–187, 2011.

McKenna

S.P.

Doward

L.C.

Alonso

The QoL-AGHDA: An instrument for the assessment of quality of life in adults with growth hormone deficiency.

Qual Life Res 8: 373–383, 1999.

10.

Herschbach

Henrich

Strasburger

C.J.

Development and psychometric properties of a disease-specific quality of life questionnaire for adult patients with growth hormone deficiency.

Eur J Endocrinol 145: 255–265, 2001.

11.

Gil

Abergel

Spektor

Development of a cancer-specific anterior skull base quality of life questionnaire.

J Neurosurg 100: 813–819, 2004.

12.

McMillan

C.V.

Bradley

Gibney

Preliminary development of the new individualized HDQoL questionnaire measuring quality of life in adult hypopituitarism.

J Eval Clin Pract 12: 501–514, 2006.

13.

Webb

S.M.

Badia

and Surinach

; Spanish AcroQol Study Group. Validity and clinical applicability of the acromegaly quality of life questionnaire, AcroQoL: A 6-month prospective study. Eur J Endocrinol 155: 269–277, 2006.

14.

Kan

and Cusimano

Validation of a quality-of-life questionnaire for patients with pituitary adenoma.

Can J Neurol Sci 33: 80–85, 2006.

15.

Webb

S.M.

Badia

Barahona

M.J.

Evaluation of health-related quality of life in patients with Cushing's syndrome with a new questionnaire.

Eur J Endocrinol 158: 623–630, 2008.

16.

Lovas

Curran

Oksnes

Development of a disease-specific quality of life questionnaire in Addison's disease.

J Clin Endocrinol Metab 95: 545–551, 2010.

17.

Little

A.S.

Jahnke

Nakaji

The anterior skull base nasal inventory (ASK nasal inventory): A clinical tool for evaluating rhinological outcomes after endonasal surgery for pituitary and cranial base lesions.

Pituitary 15: 513–517, 2012.

18.

de Almeida

J.R.

Witterick

I.J.

Gullane

P.J.

Quality of life instruments for skull base pathology: Systematic review and methodologic appraisal.

Head Neck 2012. (Epub ahead of print, DOI: 10.1002/hed.23120.)

19.

Ware

J.E.

and Sherbourne

C.D.

The MOS 36-item short form health survey. I. Conceptual framework and item selection.

Med Care 30: 473–483, 1992.

20.

Piccirillo

J.F.

Edwards

Haiduk

Psychometric and clinometric validity of the 31-item rhinosinusitis outcome measure (RSOM-31).

Am J Rhinol 9: 297–306, 1995.

21.

Johnson

M.D.

Woodburn

C.J.

and Vance

M.L.

Quality of life in patients with a pituitary adenoma.

Pituitary 6: 81–87, 2003.

22.

Baird

Sullivan

Zafar

and Rock

Quality of life in patients with pituitary tumors: A preliminary study.

Qual Manag Health Care 12: 97–105, 2003.

23.

Ohashi

Nakai

Ikeoka

Regeneration of nasal mucosa following mechanical injury.

Acta Otolaryngol 486: 193–201, 1991.

24.

Fokkens

Lund

Mullol

EP3OS 2007: European position paper on rhinosinusitis and nasal polyps.

Rhinology 20(suppl): 1–136, 2007.

25.

Alonso

Prieto

Ferrer

Testing the measurement properties of the Spanish version of the SF-36 Health Survey among male patients with chronic obstructive pulmonary disease. Quality of life in COPD study group.

J Clin Epidemiol 51: 1087–1094, 1998.

26.

Alobid

Benitez

Bernal-Sprekelsen

Nasal polyposis and its impact on quality of life. Comparison between the effects of medical and surgical treatments.

Allergy 125: 215–219, 2005.

27.

Alonso

Regidor

Barrio

Population reference values of the Spanish version of the Health Questionnaire SF-36.

Med Clin (Barc) 111: 410–416, 1998.

28.

Ikeda

Watanabe

Suzuki

Nasal airway resistance and olfactory acuity following transsphenoidal pituitary surgery.

Am J Rhinol 13: 45–48, 1999.

29.

Zada

Kelly

Cohan

Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: An assessment of efficacy, safety, and patient impressions.

J Neurosurg 98: 350–358, 2003.

30.

Dusick

Esposito

Mattozo

Endonasal transsphenoidal surgery: The patient's perspective—Survey results from 259 patients.

Surg Neurol 65: 332–342, 2006.

31.

Higgins

T.S.

Courtemanche

Karakla

Analysis of transnasal endoscopic versus transseptal microscopic approach for excision of pituitary tumors.

Am J Rhinol 22: 649–652, 2008.

32.

Tan

L.K.

and Jones

R.A.

Nasal complications of the direct transnasal approach to the pituitary fossa.

Br J Neurosurg 9: 739–742, 1995.

33.

Koren

Hadar

Rappaport

Z.H.

and Yaniv

Endoscopic transnasal transsphenoidal microsurgery versus the sublabial approach for the treatment of pituitary tumors: Endonasal complications.

Laryngoscope 109: 1838–1840, 1999.

34.

Tam

Duggal

and Rotenberg

B.W.

Olfactory outcomes following endoscopic pituitary surgery with or without septal flap reconstruction: A randomized controlled trial.

Int Forum Allergy Rhinol 3: 62–65, 2013.

35.

Page

R.C.

Hammersley

M.S.

Burke

C.W.

An account of the quality of life of patients after treatment for non-functioning pituitary tumours.

Clin Endocrinol (Oxf) 46: 401–406, 1997.

36.

Lindsay

J.R.

Nansel

Baid

Long-term impaired quality of life in Cushing's syndrome despite initial improvement after surgical remission.

J Clin Endocrinol Metab 91: 447–453, 2006.

37.

Karabatsou

O'Kelly

Ganna

Outcomes and quality of life assessment in patients undergoing endoscopic surgery for pituitary adenomas.

Br J Neurosurg 22: 630–635, 2008.

38.

Nielsen

E.H.

Lindholm

Laurberg

Nonfunctioning pituitary adenoma: Incidence, causes of death and quality of life in relation to pituitary function.

Pituitary 10: 67–73, 2007.

39.

Biermasz

N.R.

van Thiel

S.W.

Pereira

A.M.

Decreased quality of life in patients with acromegaly despite long-term cure in growth hormone excess.

J Clin Endocrinol Metab 89: 5369–5376, 2004.

40.

van Aken

M.O.

Pereira

A.M.

Biermasz

N.R.

Quality of life in patients after long-term biochemical cure of Cushing's disease.

J Clin Endocrinol Metab 90: 3279–3286, 2005.

41.

Graham

S.M.

Iseli

T.A.

Karnell

L.H.

Endoscopic approach for pituitary surgery improves rhinologic outcomes.

Ann Otol Rhinol Laryngol 118: 630–635, 2009.

42.

Suberman

T.A.

Zanation

A.M.

Ewend

M.G.

Sinonasal quality-of-life before and after endoscopic, endonasal, minimally invasive pituitary surgery.

Int Forum Allergy Rhinol 1: 161–166, 2011.

43.

Pant

Bhatki

A.M.

Snyderman

C.H.

Quality of life following endonasal skull base surgery.

Skull Base 20: 35–40, 2010.

44.

McCoul

E.D.

Anand

V.K.

and Schwartz

T.H.

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

J Neurosurg 117: 498–506, 2012.

45.

Ransom

E.R.

Doghramji

Palmer

J.N.

and Chiu

A.G.

Global and disease-specific health-related quality of life after complete endoscopic resection of anterior skull base neoplasms.

Am J Rhinol Allergy 26: 76–79, 2012.

46.

Sowerby

L.J.

Gross

Broad

Olfactory and sinonasal outcomes in endoscopic transsphenoidal skull-base surgery.

Int Forum Allergy Rhinol 3: 217–220, 2013.

47.

Georgalas

Badloe

van Furth

Quality of life in extended endonasal approaches for skull base tumours.

Rhinology 50: 255–261, 2012.

48.

Pereira-Neto

Borba

A.M.

Mello

P.A.

Mean intrasellar pressure, visual field, headache intensity and quality of life of patients with pituitary adenoma.

Arq Neuropsiquiatr 68: 350–354, 2010.