Quality-of-Life after Endoscopic Endonasal Approach for Anterior Skull Base Meningioma

Introduction: Endoscopic endonasal approaches (EEA) for resection of anterior skull base meningiomas are gaining widespread acceptance as the literature has shown comparable rates of complications and morbidity relative to open craniotomy approaches. However, insufficient data have been published thus far on patient reported outcomes on quality of life (QOL) measures, specifically focusing on their wellbeing. Given that QOL measures are critically informative for patient-centered decision making in surgical care, we report our institutional series of prospectively collected QOL data from patients who have undergone EEA for anterior skull base meningiomas.

Methods: We prospectively collected data using the Sino-Nasal Outcome Test (SNOT-22) Questionnaire and the 36-Item Short Form Survey (SF-36) version 2 in patients undergoing EEA for anterior skull base meningiomas both before and after their surgeries in our pre- and postoperative clinics from 2013 to 2020. We included only patients who have completed every question in both surveys both before and after the surgery. Paired Wilcoxon's ranked-sum tests were used to compare survey results for each question before and after surgery. Statistical significance was defined as p < 0.05.

Results: We identified 12 patients in our study, which included 10 patients who had tuberculum sella meningioma, 1 patient with planum sphenoidale meningioma, and 1 patient with a sellar meningioma with extension into suprasellar space. These patients completed their postop surveys between 3 and 72 days (median: 24 days) after surgery. Comparing the pre and postop SF36 results, we found no significant differences in 35 out of 36 questions regarding their daily physical activities as limited by their health or by any emotional problems, or regarding how they felt in general. We only found a significant decrease in “feeling full of pep” during postop visit compared with preop visit (p = 0.03). Comparing the SNOT-22 preop and postop results, we found an overall increase in the total SNOT-22 scores. Not surprisingly, the significant increases were in the sinonasal domains. However, we found that there were no significant differences in self-reported problems with cough, dizziness, ear pain, reduced productivity, reduced concentration, and feeling frustrated/restless/irritable.

Conclusion: For patients undergoing EEA for resection of anterior skull base meningiomas, their overall physical and emotional health did not seem to be significantly affected as reflected by their SF36 results. However, there were expected short-term increases in sinonasal specific symptoms and related QOL changes, with few exceptions, as shown by their SNOT-22 results. Our data can be used to inform patients that their overall physical and emotional health is not expected to change dramatically. However, they can expect some QOL changes as a result of sinonasal-specific symptoms from the surgery, during the early postoperative period.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021