scholarly journals Long-Term Quality of Life after Endoscopic Pituitary Adenoma Surgery with Nasoseptal Flap Reconstruction

2021 ◽  
Vol 12 (2) ◽  
pp. e0013
Author(s):  
Shadi Shinnawi ◽  
◽  
Ilya Kopaev ◽  
Shorook Na'ara ◽  
Ayelet Eran ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pituitary Adenoma ◽  
Flap Reconstruction ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Entire Cohort ◽  
Surgery Outcome ◽  
Snot 22

Introduction: Endoscopic endonasal transsphenoidal surgery (EETS) on the pituitary gland is considered safe and efficacious. The nasoseptal flap (NSF) is sometimes used to prevent or repair postoperative cerebrospinal fluid (CSF) leaks. Few investigators have quantified long-term quality-of-life (QOL) outcomes regarding sinonasal measures after EETS, with or without involvement of the NSF. This study assesses whether the septal flap affects sinonasal QOL outcomes for patients receiving EETS for pituitary adenoma. Methods and Materials: This is a retrospective study of patients who underwent EETS between 2013 and 2018. A total of 62 adults completed the Sinonasal Outcome Test-22 (SNOT-22) at least one year after the surgery. Outcome measures were compared between patients who underwent EETS with and without septal flap reconstruction. Results: For the entire cohort, there were 14 patients (22.6%) who had septal flap reconstruction and 48 patients (77.4%) who did not. Patient demographics, tumor characteristics, surgical outcomes, and duration between surgery and completion of the questionnaire were similar for both groups. The mean SNOT-22 scores in the no reconstruction (NR) group and the nasoseptal flap reconstruction (NSFR) group were similar (P=0.9). In terms of SNOT-22 subdomains (rhinologic symptoms, extranasal rhinologic symptoms, ear/facial symptoms, psychological dysfunction, and sleep dysfunction), no significant differences were found when comparing the groups. Conclusion: As compared with no reconstructive involvement, NSF utilization does not affect the QOL and nasal symptoms of patients undergoing EETS.

Sinonasal Quality of Life Outcomes after Endoscopic Endonasal Transsphenoidal Surgery with Posterior Septum Free Mucosal Graft Reconstruction

2020 ◽  
Author(s):  
Tara J. Wu ◽  
Angela Chen ◽  
Christine Wells ◽  
Anthony P. Heaney ◽  
Marvin Bergsneider ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Tertiary Care ◽  
Csf Leak ◽  
Multilevel Regression ◽  
Early Recovery ◽  
Endoscopic Endonasal ◽  
Entire Cohort ◽  
Snot 22 ◽  
Posterior Septum

Abstract Objective Quality of life (QoL) outcomes following endoscopic endonasal transphenoidal surgery (EETS) across a variety of reconstructive methods improve by 2 to 6 months. An option for sellar reconstruction, in the absence of a significant intraoperative cerebrospinal fluid (CSF) leak, is a free mucosal graft (FMG) from the posterior septum. We analyze sinonasal QoL outcomes in patients undergoing EETS with FMG reconstruction. Design This study was a retrospective review. Setting This study was conducted at tertiary care academic center. Participants This study group consisted of patients undergoing EETS for pituitary adenomas from 2013 to 2018. Main Outcome Measures Tumor and surgical factors were included, along with postoperative complications. Patients completed Sinonasal Outcome Test-22 (SNOT-22) questionnaires. Pre- and postoperative scores were compared among the entire cohort using linear multilevel regression. A subcohort analysis was performed among patients who completed questionnaires during the preoperative visit and two postoperative visits (within 1 month and between 2 and 3 months, respectively); pre- and postoperative total and individual domain SNOT-22 scores were compared using paired t-tests. Results A total of 243 patients underwent EETS with FMG reconstruction. Four patients (1.6%) developed a postoperative CSF leak requiring reoperation. Among the entire cohort, SNOT-22 scores increased at the first postoperative visit (p < 0.01) but returned to baseline by the second, third, and fourth postoperative visits (p = 0.27, p = 0.18, and p = 0.21). Among 48 patients who completed both preoperative and two postoperative questionnaires, scores increased within the first month (p < 0.01) but returned to baseline at 2 to 3 months (p = 0.67). Conclusion Posterior septum FMG reconstruction of sellar defects is an effective option, demonstrating early recovery of baseline sinonasal QoL by 2 to 3 months.

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

2018 ◽  
Vol 80 (04) ◽  
pp. 416-423 ◽  
Author(s):  
Kevin J. Choi ◽  
Feras Y. Ackall ◽  
Tracy Truong ◽  
Tracy Z. Cheng ◽  
Maragatha Kuchibhatla ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Linear Regression ◽  
Regression Model ◽  
Skull Base ◽  
Clinical History ◽  
Linear Regression Models ◽  
Endoscopic Endonasal ◽  
Significant Change ◽  
Snot 22

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.

scholarly journals Comparison of sexual function and quality of life after pelvic trauma with and without Angioembolization

2015 ◽  
Vol 3 ◽  
pp. 1-6 ◽  
Author(s):  
Naeem Goussous ◽  
Mark D. Sawyer ◽  
Lisa-Ann Wuersmer ◽  
Marianne Huebner ◽  
Molly L. Osborn ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Injury Severity Score ◽  
Sexual Function ◽  
Severity Score ◽  
Injury Severity ◽  
Pelvic Fractures ◽  
Entire Cohort ◽  
National Norms

Abstract Background The aim is to study the safety of Angioembolization on long-term sexual function and quality of life. Methods IRB approval was gained to review the prospectively collected trauma database as well as prospective questionnaires of patients at least 1 year out from pelvic fractures that occurred between 1996 and 2009. Surveys included the SF36v2, Female Sexual Function Index and the International Index of Erectile Function. Values for each domain were compared between patients treated with AE and 2:1 case-matched control patients as well as between the national norms. Values are presented as percentages or means with 95 % CI. P &lt; 0.05 was considered statistically significant. Results Thirty Seven cases and 74 matched controls were identified. 42 patients completed the survey. There were 13 cases (12 males), and 29 controls (22 males). There was a higher ISS (Injury Severity Score) (32 vs 27; p = 0.048) in the cases, but no difference in pelvic AIS (Abbreviated Injury Severity Score) (3 vs 3). Both groups scored similarly in the SF36 in all domains, but the entire cohort scored lower than the national norms in the physical functioning (41.9 (37.8–46.0) vs50), role physical (40.9 (36.2–45.7) vs50), body pain 43.8 (40.7–46.9) vs50), role emotional 46.3 (42.8–49.8) vs50), and physical composite score (42.1 (38.0–46.3) vs50). All domains of the sexual function in both questionnaires showed significant impairment in our cohort compared with norms. Male cases had similar scores to the controls. Conclusion Pelvic fractures portend a worse long-term QOL and sexual function than the general population. AE, however, does not have an additive affect to these indices.

The Impact of Age on Long-Term Quality of Life After Endonasal Endoscopic Resection of Skull Base Meningiomas

Neurosurgery ◽  
2016 ◽  
Vol 79 (5) ◽  
pp. 736-745 ◽  
Author(s):  
Samuel H. Jones ◽  
Andrew F. Iannone ◽  
Kunal S. Patel ◽  
Khalil Anchouche ◽  
Shaan M. Raza ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Skull Base ◽  
Endoscopic Resection ◽  
Endoscopic Surgery ◽  
Endonasal Endoscopic Surgery ◽  
Skull Base Meningiomas ◽  
Ventral Skull Base ◽  
Snot 22

Abstract BACKGROUND: Midline ventral skull base meningiomas may be amenable to an endonasal endoscopic approach, which has theoretical advantages and may help preserve quality of life (QOL) when compared with transcranial approaches. OBJECTIVE: To investigate the effect of age on QOL following endonasal endoscopic surgery, given the documented impact of age on QOL outcomes following transcranial resection of midline ventral skull base meningiomas. METHODS: We reviewed a prospectively acquired database of endonasal endoscopic surgery for meningiomas. Inclusion criteria included patients who had completed long-term postoperative (≥6 months follow-up) QOL questionnaires (Anterior Skull Base Questionnaire [ASBQ] and Sino-Nasal Outcome Test [SNOT-22]). Postoperative QOL scores were also compared with preoperative QOL in a patient subset. RESULTS: Long-term QOL data were available in 34 patients. Average postoperative ASBQ and SNOT-22 scores were 3.39 and 23.0, respectively. Better QOL was statistically associated with age &lt;55 (P =.02). In a subset of patients, preoperative and postoperative ASBQ and SNOT-22 scores were compared. Only SNOT-22 scores significantly increased from 15.9 + 20.8 to 25.9 + 19.5 (P =.04). CONCLUSION: We report the first study specifically evaluating long-term QOL after endonasal endoscopic resection of skull base meningiomas. QOL was decreased postoperatively in patients aged ≥55.

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

2015 ◽  
Vol 123 (3) ◽  
pp. 571-580 ◽  
Author(s):  
Kunal S. Patel ◽  
Shaan M. Raza ◽  
Edward D. McCoul ◽  
Aikaterini Patrona ◽  
Jeffrey P. Greenfield ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Endocrine Function ◽  
Surgical Removal ◽  
Pituitary Macroadenoma ◽  
Invasive Approach ◽  
Medical College ◽  
Sinonasal Outcome Test ◽  
Snot 22

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 23.7 ± 10.8 to 18.4 ± 11.6 (SNOT-22). 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 SNOT-22 (19.6 vs 13.4; 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 craniopharyngiomas even when removed via a minimally invasive approach. These measures should serve as benchmarks for comparison with open transcranial approaches to similar tumors.

scholarly journals Olfactory-Specific Quality of Life Outcomes after Endoscopic Endonasal Surgery of the Sella

2021 ◽  
Vol 12 ◽  
pp. 215265672110450
Author(s):  
Milap D. Raikundalia ◽  
Ryan J. Huang ◽  
Lyndon Chan ◽  
Tracy Truong ◽  
Maragatha Kuchibhatla ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Tumor Size ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Retrospective Case ◽  
Endoscopic Endonasal ◽  
Related Quality ◽  
Snot 22

Objective To assess olfactory outcomes as measured by an olfactory-specific quality of life (QOL) questionnaire in patients undergoing EESBS for sellar lesions. Design Retrospective case series. Setting Tertiary academic medical center. Participants In total, 36 patients undergoing EESBS for lesions limited to the sella were evaluated. Main Outcome Measures The following were performed before and three months after surgery: 22-Item Sinonasal Outcomes Test (SNOT-22), University of Pennsylvania Smell Identification Test (UPSIT), and the Assessment of Self-reported Olfactory Functioning (ASOF), which has three domains: subjective olfactory capability scale (SOC), smell-related problems (SRP), and olfactory-related quality of life (ORQ). Results Median age at surgery was 52.5 years, with a median tumor size of 1.8 cm (range: 0.2 to 3.9 cm). Pre- and postoperative median scores were 35 [34, 36.2] and 34.5 [32, 36] for UPSIT, 21 [7.5, 33.5] and 21.5 [6.8, 35.7] for SNOT-22, 10 [9, 10] and 9 [8, 10] for ASOF-SOC, 5 [4.8, 5] and 4.5 [4, 5] for ASOF-SRP, and 5 [5, 5] and 5 [4.5, 5] for ASOF-ORQ. There was no significant change in the two of the three domains of the ASOF. Correlation between ASOF and UPSIT scores were weak. Older age and larger tumor size were associated with worsened olfaction after surgery. Conclusions Patients did not experience significant changes in olfactory-specific QOL three months after EESBS, as measured by two domains of the ASOF. The ASOF may serve as a useful adjunctive tool for assessing olfaction after surgery. The lack of correlation between UPSIT and ASOF suggests the need for more research in subjective olfactory-related quality of life after surgery.

A Prospective Evaluation of Quality of Life in Patients Undergoing Extended Endoscopic Endonasal Surgery for Benign Pituitary Gland Lesion

2021 ◽  
Author(s):  
Narin Nard Carmel Neiderman ◽  
Anat Wengier ◽  
Omri Dominsky ◽  
Barak Ringel ◽  
Anton Warshavsky ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Tumor Resection ◽  
Pituitary Tumors ◽  
Cerebrospinal Fluid Leak ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Post Surgery ◽  
Snot 22

Abstract Introduction Endoscopic endonasal surgery (EES) has become the preferred approach for pituitary tumor resection. Nevertheless, research on quality of life related to pituitary adenoma surgery is scarce. Objective The aim of the study is to evaluate short-term quality of life in patients after endoscopic endonasal resection of pituitary tumors and to find predictors for poor quality of life (QOL) outcome. Materials and Methods A prospective cohort study was conducted, including all patients who underwent EES for pituitary tumors in a tertiary medical referral center. Recruited patients completed the Anterior Skull Base Disease-Specific QOL (ASBS-Q) questionnaire and the Sinonasal Outcome Test 22 (SNOT-22) questionnaire before surgery, 2 and 4 to 6 months after surgery. Demographic and clinical data was collected. Results Our study included 49 patients. The overall ASBS-Q scores significantly improved 4 to 6 months after surgery (4.46 vs. 4.2, p < 0.05). We found a significant improvement in QOL related to emotional state 2 months post surgery (4.41 vs. 3.87, p < 0.05), which became borderline significant 4 to 6 months post surgery. There was a significant improvement in pain (4.5 vs. 4.08, p < 0.05) and vitality (4.43 vs. 4.16, p < 0.05) domains 4 to 6 months post surgery. SNOT-22 scores did not change significantly postoperatively. Factors such as secreting and non-secreting tumors, tumor size, intraoperative cerebrospinal fluid leak, gross tumor resection, endocrine remission, and the use of nasoseptal flap reconstruction did not have a significant effect on QOL. Conclusion We found that patients after EES reported improved QOL 4 to 6 months post surgery. Specific improvement was noted in the QOL related to pain and vitality.

scholarly journals Preservation of multidimensional quality of life after endoscopic pituitary adenoma resection

2015 ◽  
Vol 123 (3) ◽  
pp. 813-820 ◽  
Author(s):  
Edward D. McCoul ◽  
Jeffrey C. Bedrosian ◽  
Olga Akselrod ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Quality Of Life ◽  
Pituitary Adenoma ◽  
Subtotal Resection ◽  
Reconstruction Technique ◽  
Site Specific ◽  
Significant Difference ◽  
Csf Leakage ◽  
The Impact ◽  
Snot 22

OBJECT Pituitary adenomas are well suited to resection by a minimal-access endoscopic technique. Validation of this approach requires prospective outcome studies to determine the impact on quality of life (QOL). This study aims to assess the effect of endoscopic pituitary adenoma resection on site-specific and sinonasal-related QOL before and after endoscopic surgery using validated instruments. METHODS Consecutive adult patients undergoing endoscopic endonasal resection of pituitary adenoma were prospectively enrolled from a single tertiary care center. All patients completed the Anterior Skull Base Questionnaire (ASBQ) and the 22-Item Sino-Nasal Outcome Test (SNOT-22) preoperatively and then at regular intervals after surgery to assess their perceived QOL with regard to hormonal, surgical, and anatomical factors. RESULTS Eighty-one of 114 patients were eligible for study; median follow-up was 16 months. This cohort included 24 (29.6%) nonsecreting macroadenomas and 57 (70.4%) hypersecreting tumors. There was significant improvement in the mean ASBQ score at 12 weeks, 6 months, and 1 year after surgery (p < 0.05), while postoperative SNOT-22 scores, at the same time points, showed no significant difference from preoperative scores. Both ASBQ and SNOT-22 scores showed transient worsening at 3 weeks postoperatively. Subtotal resection correlated with worse QOL, both overall and among patients with hypersecreting tumors (p < 0.05). Extrasellar tumor extension, intraoperative CSF leakage, and a reconstruction technique during surgery did not impact postoperative QOL. Visual disturbances did not significantly alter QOL. There were no postoperative CSF leaks in this series. CONCLUSIONS Endoscopic resection of pituitary adenoma is associated with long-term improvements in site-specific QOL and stability in sinonasal QOL when assessed pre- and postoperatively with validated instruments. Subtotal resection was the only factor that negatively impacted postoperative QOL. Therefore, gross-total resection should be attempted for all patients to optimize QOL after surgery.

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