Related Experiment Video
Updated: Jun 1, 2025
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Multi-Institutional Comparison of Quality of Life Between Open Versus Endoscopic Skull Base Approaches
John R de Almeida1,2, Katrina Hueniken3, Michael Xie1
1Department of Otolaryngology Head and Neck Surgery University Health Network/Princess Margaret Cancer Center, University of Toronto Toronto Ontario Canada.
Objectives:
The primary objective of this prospective review was to compare quality of life between patients undergoing endoscopic and open skull base approaches.
Study Type And Design:
Prospective Review.
Methods:
Five centers recruited consecutive patients treated surgically for skull base neoplasms between 2012 to 2018. The Skull Base Inventory (SBI), Anterior Skull Base (ASB), and Sinonasal Outcome Test (SNOT-22) were administered up to 12 months post-operatively. Mean change from baseline scores were compared with univariable and multivariable analyses.
Results:
A total of 180 patients were included: 108 (60%) F and 72 (40%) M, of whom 126 (70%) underwent endoscopic and 54 (30%) underwent open approaches. Patients undergoing endoscopic approaches were more likely to have sellar or clival pathology (68 vs. 15%, p < 0.001). Those undergoing endoscopic approaches had better disease-specific quality of life at one year using the SBI and ASB (mean change from baseline = 7.2 vs. 0.69, p = 0.004; 5.8 vs. -1.1, p = 0.002), respectively. On multivariable analysis, endoscopic approach was associated with greater improvement in overall quality of life (mean difference in change scores from baseline = 6.5, p = 0.009), as well as endocrine (mean difference = 8.3, p = 0.011), neurologic (mean difference = 8.3, p = 0.012), visual (mean difference = 7.9; p = 0.032), financial (mean difference = 9.7, p = 0.03), and spiritual domain scores (mean difference = 4.0, p = 0.035). Subgroup analyses of pituitary and non-pituitary histopathologies demonstrated trends towards greater quality of life at 1-year compared to baseline in the endoscopic approach compared to the open group.
Conclusions:
Endoscopic approaches are associated with better quality of life compared to open approaches. However, baseline differences in histopathology between the group limit the direct comparison of the open and endoscopic approaches. Future studies with larger and more homogenous samples are required.
Level Of Evidence:
Level IV evidence.
