Patient Perceptions and Expectations of Endoscopic Skull Base Surgery

Background: In recent years, the endoscopic approach has become the increasingly utilized surgical approach for many skull base pathologies. While the safety and efficacy of this approach have been demonstrated, little is known regarding patients' understanding of the procedure and their expected post-operative course prior to undergoing these surgeries.

Objective: To provide more effective guidance and consent to future patients, the authors of this study aim to understand the expectations that patients have regarding endoscopic skull base surgery.

Methods: Subjects are 21 adult patients who underwent endoscopic skull base procedures for a variety of relevant pathologies. They were enrolled in an IRB approved study in their post operative period after complete healing (>4 months). Qualitative research methodology in forms of a survey was used to assess expectations and experiences regarding the surgery, the risks associated, and the post-operative course. The survey was administered to a cohort of patients (21 subjects) consists of post-operative patients who have undergone endoscopic skull base surgery and who are returning to clinic for follow-up.

Results: Patients were asked to compare their outcome results and risks to their pre-operative expectations. They expressed somewhat less operative time, length of hospitalization, pain, and cosmetic adverse effect. For time to recovery and sinus function, they experienced similar outcomes compared with expected, but for effect on ability to smell, their experiences was somewhat more than expected. In terms of expectations of risks of surgery including stroke, bleeding, vision changes, brain damage, CSF leak, meningitis, infection and overall operative risk, their post-operative perceptions were somewhat less than expectations prior to surgery. When stratified by tumor malignancy, the patients with malignant tumors perceived more effect on cosmesis (p = 0.05), increased risk of stroke (p = 0.04) and vision damage (p = 0.08) compared with those without malignant tumors. Patients who have had previous skull base surgeries also perceived increased risk of infection (p = 0.06) compared with those without prior surgeries. Free response comments from these patients revealed a generally positive perception and experience with the endoscopic skull base procedures.

Conclusion: This is a pilot study to gain a qualitative understanding of the patients' experiences and perceptions about their endoscopic skull base surgery. Overall, patients reported less outcome dysfunctions and risk for complications compared with their pre-operative expectations. However, some patients perceived similar to more negative effect on their ability to smell after their operation. Results of this study have potential benefit for future patients; they can be incorporated into the informed consent for future endoscopic procedures, thus more effectively aligning patient expectations with patient experience.