Endoscopic skull base surgery and its impact on sinonasal-related quality of life

Endoscopic skull base surgery (ESBS) is considered a minimally-invasive surgical modality with less morbidity and patient discomfort. Quality-of-life (QOL) assessments provide a patient-reported estimate of well-being that may be clinically relevant. Although the sinonasal tract is integral to ESBS, the change in sinonasal-related QOL with ESBS has not been well studied. The aim of this study was to prospectively assess QOL before and after ESBS using validated outcome measures.

Consecutive adult patients undergoing ESBS for anterior skull base lesions were prospectively enrolled from a tertiary referral center. Each patient was asked to complete the 22-item Sinonasal Outcome Test (SNOT-22) and the Anterior Skull Base Questionnaire (ASBQ) preoperatively, and again at 3 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperatively.

Eighty-five patients were included for study, 44.7% of whom underwent ESBS for nonpituitary pathology. Mean SNOT-22 scores transiently worsened in the early postoperative period, and significantly improved at 1 year after surgery (p < 0.01). Gross-total tumor resection and use of autologous grafting materials were associated with improved SNOT-22 scores at later time points (p < 0.05). Type of reconstruction, tumor pathology, and functionality did not affect QOL scores. Correlation between SNOT-22 and ASBQ scores was good at all time points (r < -0.50). Cerebrospinal fluid leak and other complications were uncommon.

ESBS does not have a detrimental long-term effect and is associated with ultimate improvement in sinonasal-related QOL. Short-term impairments of sinonasal-related QOL are predictable and self-limited. Prospective assessment using sinonasal-related and site-specific QOL instruments provide complementary information about ESBS outcomes.