Affective Disorders in Skull Base Surgery: A Comparison between Endonasal and Open Transcranial Approaches

Objective: To evaluate the influence of the surgical approach (open vs. endonasal) on the development of affective disorders and changes in quality of life following skull base surgery.

Methods: A prospective study of patients undergoing elective skull base surgery was performed. Evaluation for depression (ADS-K score), posttraumatic stress disorder (PTSS-10) and anxiety (STAI-S, STAI-T) were done before and three months after surgery. In addition SF-36 physical composite score (PCS) was completed before surgery and three month postoperatively.

Results: There were 10 (43%) patients in the endonasal and 13 (56%) patients in the open transcranial group. In the endonasal group abnormal STAI-S, STAI-T, PTSS and ADS-K scores were encountered in 78, 45, 60, and 35% of cases and in 69, 45, 31, and 56% of cases in the open transcranial group before surgery, respectively. These differences were statistically significant (p = 0.002). At 3 months of follow-up, abnormal STAI-S, STAI-T, PTSS, and ADS-K scores were encountered in 54, 34, 20, and 11% in the endonasal group and in 51, 35, 46, and 35% in the craniotomy group, respectively. These differences were also statistically significant (p = 0.004). However, there were no differences in quality of life before surgery and at three months follow up between both groups.

Conclusions: In skull base surgery, the endonasal approach is associated with lower rates of affective disorders than with open craniotomy. However, there is no difference in quality of life between both groups.