Sino-Nasal Quality of Life before and after Endoscopic Transsphenoidal Skull Base Surgery

Background: Endoscopic transsphenoidal surgery (ETSS) is now considered the gold standard approach for resection of pituitary adenomas and other midline anterior skull base lesions. Our standard surgical technique, done since 1993, often involves the partial resection of the middle turbinates bilaterally, a wide posterior septectomy along with a wide sphenoid opening to allow for adequate bi-nostril instrumentation. For extended ETSS, additional sinus cavities are opened where the entire skull base and orbit are skeletonized. Concern has been raised over the last few years whether the resection of these normal sinonasal structures results in significant nasal morbidity in the post-operative period. Objective: The purpose of this study was to examine whether our standard ETSS technique as well as the extended ETSS approach affected patient specific sinonasal quality of life (QoL) as measured by the validated 22-question Sino-Nasal Outcome Test (SNOT-22). Methods: Single-center retrospective chart review with prospective collection of SNOT-22 questionnaires in patients who underwent ETSS by the same skull base team between January 1st 2012 to June 30th 2016. Patients were identified if they had any completed SNOT-22. Only patients who completed both pre-operative and post-operative SNOT-22 in their entirety were included for data analysis. Primary outcome was SNOT-22 scores at all follow-up points (preoperative, 0–1 month, 2–4 months, >5 months). Age, sex, tumor pathology, and surgical procedure (including extent of ETSS and intraoperative CSF leak repair) were also extracted. Results: 249 ETSS were performed during the study period. Of these, 148 (59%) patients had at least one completed SNOT-22 score, with 45 (30%) meeting the inclusion criteria. The mean age was 54 ± 15 years. Twenty-seven (27) patients (60%) were male and 11 (24%) underwent an extended ETSS – with additional skull-base resection. There were 20 patients (44%) who had an intraoperative CSF leak with repair and 11 patients (24%) previously had nasal surgery. Twenty-six (26) patients (58%) had pituitary adenomas. Across all patients, SNOT-22 at the 0- to 1-month follow-up was significantly higher than baseline ( p < 0.05), but decreased to baseline levels at 2 to 4 months ( p > 0.05), and remained at that level at >5 months ( p > 0.05). The findings were similar for sinonasal specific outcomes and olfactory function. Moreover, the extent of ETSS surgery, having previous nasal surgery, repairing an intraoperative CSF leak, and the tumor pathology, all did not affect SNOT-22 scores at all follow-up intervals ( p > 0.05). Conclusion: In our series, sinonasal QoL as measured by the SNOT-22 worsened immediately after ETSS at the 0- to 1-month follow-up. However, the total SNOT-22 score, sinonasal specific items, and olfaction all returned to baseline levels at 2 to 4 months and remained sustained at >5 months. These data will allow us to educate our patients that the anticipated nasal morbidity following ETSS is usually only transient and should be expected to recover to pre-operative levels.

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