Preservation of Multidimensional Quality-of-Life after Endoscopic Resection of Pituitary Adenoma

Objective: Pituitary adenomas are ideally suited to resection by a minimal-access endoscopic technique. Although rates of tumor resection are equivalent to traditional approaches, few studies have investigated the effect of endoscopic surgery on quality of life (QOL). Of these studies, most have relied on generalized QOL measures, and prospective pre- and postintervention data are lacking. Our aims were to (1) assess the impact of endoscopic pituitary adenoma resection on site-specific QOL and sinonasal-related QOL using two validated instruments and (2) to assess the correlation between these measurements.

Methods: Consecutive patients undergoing endoscopic endonasal resection of pituitary adenoma were prospectively enrolled from a tertiary referral center. All patients completed the Anterior Skull Base Questionnaire (ASBQ) and Sinonasal Outcomes Test (SNOT-22) preoperatively and postoperatively at regular intervals. Patients younger than 18 years and those who did not complete pre- and postoperative surveys were excluded from study.

Results: Of 223 consecutive patients, 80 met inclusion criteria for study, with a median follow-up time of 14 months. This cohort included 40 (50.0%) nonsecreting tumors and 40 (50.0%) hormonally active tumors, including 15 (30.0%) with acromegaly and 10 (12.5%) with Cushing's disease. Nasoseptal flap closure was used in 37 (46.3%) cases, and graft harvest from a second surgical field was performed in 43 (53.8%) patients. There was no decline in mean ASBQ score up to 12-weeks postoperatively (P > 0.05), and significant improvement was seen at 6-month follow-up (P = 0.02). Mean SNOT-22 scores transiently worsened at 3 weeks postoperatively ( P < 0.001), returned to baseline at 6 weeks through 6 months postoperatively, and showed significant improvement at 1 year postoperatively (P = 0.008). The presence of a nasoseptal flap or a graft donor site did not contribute to decreased QOL on either scale. Cavernous sinus involvement was present in 20 (25.0%), which was not associated with a difference in ASBQ or SNOT-22 score (P > 0.05). A postoperative CSF leak occurred in one (1.3%) case, which did not require reoperation.

Conclusions: Endoscopic resection of pituitary adenoma is associated with improvements in both sinonasal and site-specific QOL when assessed pre- and postoperatively with validated instruments. Cavernous sinus involvement does not adversely impact postoperative QOL, and a low rate of postoperative CSF leak is achievable.