Comparison of sinonasal quality of life and health status in patients undergoing microscopic and endoscopic transsphenoidal surgery for pituitary lesions: a prospective cohort study (original) (raw)
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International Forum of Allergy & Rhinology, 2011
Endoscopic, endonasal, minimally invasive pituitary surgery (MIPS) has proven to be safe and efficacious. However, there are few data that assess the health-related or sinonasal-specific quality-of-life (QoL) of those undergoing MIPS. Our hypothesis is that patients undergoing MIPS do not have significantly different sinus disability or change in QoL after surgery compared to prior to surgery. This is a retrospective review of patients undergoing MIPS between 2002 and 2009. Rhinosinusitis Disability Index (RSDI) scores, patient demographics, tumor characteristics, surgical outcomes, and intraoperative/postoperative complications were recorded. Preoperative and postoperative mean RSDI scores and the mean absolute change in RSDI were calculated with 95% confidence intervals (CIs). One-way analysis of variance (ANOVA) compared RSDI scores between different tumor subgroups. A total of 50 patients completed the RSDI preoperatively and postoperatively. Analyses revealed no significant difference between preoperative and postoperative scores across all domains (p = 0.84). When the cohort was stratified into functional vs nonfunctional tumor types there was no significant difference between the 2 groups (p = 0.88). Data showed no statistically significant change in RSDI scores postoperatively in all groups. These data show that MIPS with appropriate postoperative care results in little or no long-term sinonasal quality of life defects.
Journal of neurosurgery, 2015
OBJECT Despite the increasing application of endoscopic transsphenoidal surgery for pituitary lesions, the prognostic factors that are associated with sinonasal quality of life (QOL) and nasal morbidity are not well understood. The authors examine the predictors of sinonasal QOL and nasal morbidity in patients undergoing fully endoscopic transsphenoidal surgery. METHODS An exploratory post hoc analysis was conducted of patients who underwent endoscopic pituitary surgery and were enrolled in a prospective multicenter QOL study. End points of the study included patient-reported sinonasal QOL and objective nasal endoscopy findings. Multivariate models were developed to determine the patient and surgical factors that correlated with QOL at 2 weeks through 6 months after surgery. RESULTS This study is a retrospective review of a subgroup of patients studied in the clinical trial "Rhinological Outcomes in Endonasal Pituitary Surgery" (clinical trial no. NCT01504399, clinicaltria...
Sinonasal Quality-of-Life Changes after Endoscopic Pituitary Surgery
Journal of Neurological Surgery Part B: Skull Base, 2012
Conclusion: The transpalpebral "Eyelid" approach is an excellent option to approach lesions of the anterior skull base. The minimally invasive access through an eyelid incision involves dissection in normal tissue planes, preserves frontalis muscle fi bers, avoids injury to the fronto-temporal facial nerve branches, and heals with excellent cosmetic results.
Advances in Clinical and Experimental Medicine, 2020
Background. A pituitary tumor can be reached by a transsphenoidal approach with the use of a microscope or an endoscope. The impact of the surgical technique on the patient's quality of life (QOL) is of great interest to us. Currently, the development of both surgical techniques, especially the endoscopic one, is very rapid. Treatment outcomes are extremely important, especially in terms of patients' QOL after pituitary tumor resection, irrespective of the technical aspects. Objectives. To compare the quality of life between patients who had undergone either transsphenoidal microscopic (MTS) or endoscopic (ETS) non-functioning pituitary adenoma resection. Material and methods. The study population consisted of 32 consecutive patients (21 for the endoscopic and 11 for the microscopic method) who had undergone pituitary adenoma resection. Their QOL was evaluated using the World Health Organization's Quality of Life assessment tool (WHOQOL-BREF), the Sino-Nasal Outcome Test (SNOT-22) and the Visual Functioning Questionnaire (VFQ-25). Questionnaires were collected before and after surgery during the patients' hospital stay and 3 months after the surgery. Results. The patients in the 2 groups did not differ significantly in terms of age, sex, tumor size, length of hospital stay, or QOL before the surgery. Vision-related QOL (VR-QOL) significantly improved in patients undergoing endoscopic surgery (p < 0.001). There were no statistically significant differences in QOL between the study groups at any stage of the trial (p > 0.05). Significantly more patients had improved QOL after endoscopic surgery according to the WHOQOL-BREF (p = 0.005) and the VFQ-25 (p = 0.002). Conclusions. The novel observation in this study is the significant improvement of VR-QOL in patients after endoscopic non-functioning pituitary adenoma resection in comparison to patients having microscopic resection. The microscopic method does not exacerbate rhinological symptoms more than the endoscopic one. Endoscopic surgery seems to be more beneficial for patients with pituitary adenoma, which deteriorates VR-QOL.
Short-Term Quality-of-Life Changes after Endoscopic Pituitary Surgery Rated with SNOT-22
Journal of Neurological Surgery Part B: Skull Base, 2014
Objective Little data exist on short-term quality-of-life (QOL) outcomes, specifically sinonasal measures, after endoscopic pituitary surgery. Design Prospective case series assessed sinonasal QOL before and after the transnasal endoscopic approach to the sella with resection of nasal cavity and sinus tissues. Setting/Participants/Main Outcome Measures A total of 39 adults scheduled to undergo resection for a pituitary mass preoperatively completed the Sinonasal Outcome Test-22 (SNOT-22). Rating various QOL issues, testing repeated postoperatively at 1 month by 37 patients and 3 months by 35 patients, was analyzed (paired Student t test). Results SNOT-22 scores (5-point scale; total: 110) averaged 23.4 preoperatively and 27.6 at 1 month but had significantly improved to 16.2 at 3 months (p ¼ 0.03). Emotional well-being parameters (e.g., sadness, frustration, concentration, productivity, fatigue) significantly improved 3 months postoperatively (p < 0.05). Physiologic parameters (e.g., olfaction, obstruction, postnasal drainage) that had worsened at 1 month (< 0.05) then normalized at 3 months. Conclusion Total ratings for sinonasal QOL shows that SNOT scores were comparable between preoperative and 1-month testing but were improved significantly at 3 months. Individual questions showed marked improvement in emotional well-being and temporary physiologic changes after surgery. Our findings give surgeons information about what patients can expect immediately after transnasal endoscopic pituitary surgery.
Preservation of multidimensional quality of life after endoscopic pituitary adenoma resection
Journal of neurosurgery, 2015
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%) hype...
American Journal of Rhinology & Allergy, 2020
Background Surgical approaches to the pituitary have undergone significant changes from transcranial, sublabial, direct transnasal microscopic, and now endoscopic. This study compares sinonasal outcomes from patients from these techniques. Methods A cross-sectional study of patients who underwent pituitary surgery in a tertiary setting was conducted. Patients were recruited via phone, mail, e-mail, and in person. Surveys with questions on nasal function, subsequent nasal treatment, the Nasal Symptom Score (NSS), Sinonasal Outcome Test-22 (SNOT-22), Chronic Sinusitis Survey (CSS), and Short Form 36 version 2 (SF-36v2) were obtained. Results A total of 252 surveys were sent, of which 165 were returned (65.48% response rate) and 16 were excluded (3 records destroyed, 13 transcranial approach). A total of 149 patients (age 60.10 ± 13.99 years, 47.83% female) were assessed with the following breakdown: sublabial (n = 69), transnasal microscopic (n = 28), and endoscopic (n = 52) approache...
Research Square (Research Square), 2022
Few studies compare the post-operative nasal symptoms, quality of life, and costs in the microscopic vs. endoscopic transsphenoidal approaches for pituitary adenomas, particularly in low/middle-income Latin American populations. This ambispective study correlated the perception of nasal obstruction, quality of life and costs of endoscopic vs. microscopic transsphenoidal pituitary surgery at the Fundación Santa Fe de Bogotá, Colombia between January 2018, and December 2019. A total of 46 patients (mean age: 50.57 years) who underwent pituitary resection for adenomas either by microscopic or endoscopic approach in the Neurosurgery and/or Otolaryngology departments of the Fundación Santa Fe de Bogotá were included. Postoperative perception of nasal obstruction was assessed through the Nasal Obstruction Symptom Evaluation (NOSE) and a visual analog scale (VAS). Quality of life was assessed with the Glasgow Bene t Inventory (GBI). Surgical-related and hospitalization costs were extracted from the hospital's nances database. A median difference of 45 points favoring the microscopic approach was found in the global scores of the NOSE scale. A median difference of 4 points was found in the VAS score (p<0.001 in both interventions). The GBI median scores were 27.78 points (IQR: 55.56), and 25.00 (IQR: 25) for the microscopic and endoscopic approaches, respectively. A negative correlation between the GBI and NOSE was found (ρ=-0.44; 95% CI:-0.684 to-0.095), implying that the less postoperative nasal obstruction, the better quality of life. The difference between median surgical-related costs was $ 437.92 USD, favoring of the microscopic approach (p=0.03). Nasal obstruction and quality of life were correlated, highlighting the impact of sinonasal outcomes in patients' quality of life. Statistically signi cant differences were found in postoperative nasal obstruction symptoms and costs, favoring the microscopic approach.
Neurosurgical Focus, 2011
Object The endoscopic approach for pituitary tumors is a recent innovation and is said to reduce the nasal trauma associated with transnasal transsphenoidal surgery. The authors assessed the temporal changes in the rhinological symptoms following endoscopic transsphenoidal surgery for pituitary lesions, using the General Nasal Patient Inventory (GNPI). Methods The GNPI was administered to 88 consecutive patients undergoing endoscopic transsphenoidal surgery at 3 time points (presurgery, 3–6 months postsurgery, and at final follow-up). The total GNPI score and the scores for the individual GNPI questions were calculated and differences between groups were assessed once before surgery, several months after surgery, and at final follow-up. Results Of a maximum possible score of 135, the mean GNPI score at 3–6 months postsurgery was only 12.9 ± 12 and was not significantly different from the preoperative score (10.4 ± 13) or final follow-up score (10.3 ± 10). Patients with functioning t...
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2015
To evaluate the impact of nasoseptal flap (NSF) elevation on sinonasal quality of life (QOL) in patients with pituitary adenomas who underwent endoscopic endonasal trans-sphenoidal approach (EETSA), the data of 106 eligible patients were included from February 2011 to December 2014. The scores of Sinonasal Outcome Test (SNOT-22) Questionnaire were assessed in case (that received reconstruction with NSF) and control groups preoperatively as well as 1, 3, 6, and more than 12 months postoperatively. Nine most related sinonasal questions were evaluated separately (9Q). There were no significant inter-group differences in the mean SNOT-22, 9Q, and sense of taste/smell scores in preoperative and all postoperative assessments. Within each group, a significant improvement of SNOT-22 and 9Q scores were noted after 12 months of surgery compared to preoperative data. In the NSF group, comparison of the pre- and first postoperative evaluation revealed a significant deterioration in 9Q score (p ...