Quality of Life in Patients Operated for Skull Base Lesions

Introduction: Quality of life issues are receiving increasing attention in outcomes analysis. Detailed knowledge of functional status and social functioning, as seen from the patients' perspective, is important in preoperative decision-making and in postoperative management. Skull base surgery procedures carry significant risks, and at the same time benefits may be uncertain. Expected quality of life may become a pivotal factor in selecting management.

Material and Methods: General health status was assessed using the SF-36 form and the Washington University scale was used as a problem-specific questionnaire. The forms were mailed to 220 patients operated upon for skull base pathology by an interdisciplinary skull base team. Patients' records were reviewed retrospectively and analyzed for correlation between tumor and surgical techniques and quality of life.

Results: Completed questionnaires were returned by 148 patients. Median time from operation to quality of life assessment was 44 months, average 48. In general health assessment by SF-36, the patients showed significant reduction in physical functioning (score 69%) and social functioning (score 64%). A problem-specific questionnaire showed that the patients considered their general health status similar to the status 1 year before diagnosis (average score 3.1). Appearance (score 68%) was the most affected, although the patients did not consider this aspect very important.

Conclusions: Long-term life quality is significantly reduced in patients operated on for skull base pathology. In patients with poor prognosis and high risk of surgical procedure associated with low quality of life, alternative, less aggressive management should be suggested if available. How to present information from such studies to the patients in a comprehensible and useful manner needs further research.