Sinonasal Quality-of-Life Outcomes after Extended Endonasal Approaches to the Skull Base

Background The endonasal endoscopic approach (EEA) to the skull base has expanded beyond the sella to include transpterygoid, transplanar, transclival, and transcribriform approaches. Such approaches lead to significant alterations in sinonasal anatomy and physiology. However, only a few studies thus far have reported quality-of-life (QOL) outcomes in these patients. This study looked to compare outcomes in patients undergoing EEA. QOL was measured using the 22-Item Sinonasal Outcomes Test (SNOT-22), which is a widely used and validated instrument.

Methods This is a single-institution retrospective study of patients undergoing EEA from January 2014 to April 2017. Electronic medical records were reviewed to extract data regarding clinical history and operative details. In addition, preoperative baseline and postoperative SNOT-22 scores obtained at 3 and 6 months were collected. Unadjusted and adjusted linear regression models were implemented to compare change in SNOT-22 scores from baseline in patients who underwent a simple sella approach (SA) to the pituitary, and patients who underwent an approach beyond the sella (BSA). Covariates included age, gender, tumor size, smoking history, radiation history, and nasoseptal flap reconstruction.

Results A total of 169 patients were included: 108 patients were in the SA group, while 61 patients were in the BSA group. The BSA group included transpterygoid (n = 19), transplanar (n = 15), transethmoid/cribriform (n = 31), transclival (n = 19), and transmaxillary (n = 4). SNOT-22 scores were available at baseline and 3 months for 84 patients, while the scores were available at 6 months and baseline for only 49 patients. Compared with baseline, SNOT-22 scores for all patients were not significantly different at 3 months (p = 0.40, 95% CI = −5.75, 2.32) with a mean difference of −1.70, or at 6 months (p = 0.58, 95% CI = −8.41, 4.78) with a mean difference of −1.82. Unadjusted linear regression model did not show an association between the type of approach and change in SNOT-22 score at 3 months (−7.4; 95% CI = −15.36, 0.57; p = 0.07) and 6 months (−7.22; 95% CI = −20.06, 5.61; p = 0.28). Adjusted regression model showed a significant decrease in SNOT-22 scores at 3 months (−9.92; 95% CI = −19.04, −0.8; p = 0.04) for the BSA group compared with the SA group, but there was no significant change in SNOT-22 score at 6 months (−11.17; 95% CI = −28.51, 6.18; p = 0.22) while controlling for covariates.

Conclusion Overall, patients undergoing endonasal endoscopic skull base surgery had no significant change in outcomes at 3 and 6 months, as compared with baseline. A more extensive endonasal approach beyond the sella was not associated with worse QOL outcomes as measured by the SNOT-22 instrument.