Sinonasal Symptom Outcomes following Endoscopic Anterior Cranial Base Surgery in the Pediatric Population

Objectives: Endoscopic anterior cranial base surgery in the pediatric population has been shown to be safe and feasible without significant morbidity. Most studies to date have focused on outcomes related to complications such as CSF leak, endocrinopathy, epistaxis, and hyposmia, as well as impact on craniofacial development. The objective of this study was to evaluate the impact of endoscopic anterior cranial base surgery on sinonasal symptoms in the pediatric population utilizing the Sino-Nasal Outcome Test (SNOT)-22 questionnaire.

Design: Retrospective review.

Setting: Tertiary academic medical center.

Participants:: Thirty-four consecutive patients, age <18 years, underwent endoscopic anterior cranial base surgery from July 2008 to August 2019. The age range was 6 to 17 years, 13 males and 21 females. The most common surgical pathologies included are pituitary adenoma (12), craniopharyngioma (7), and Rathke’s cleft cyst (6). Ten patients had baseline and a minimum of two subsequent postoperative (SNOT)-22 questionnaires available for analysis. Historical data previously published by our institution regarding adult (SNOT)-20 and (SNOT)-22 scores, in the setting of endoscopic anterior cranial base surgery, was used for comparison.

Main Outcome Measures: Baseline and postoperative (SNOT)-22 scores were compared. The mean change between baseline and postoperative sinonasal symptom scores in the pediatric and adult cohorts were compared.

Results: The mean baseline (SNOT)-22 score for our 10-patient pediatric cohort was 0.46 for each of the first 10 sinonasal symptom–specific (rhinologic, extranasal rhinologic, and ear/facial) questions, and 1.08 for the 12 quality of life (psychological and sleep dysfunction) questions. The mean sinonasal symptom score worsened slightly to 1.69 and the mean quality-of-life score improved slightly to 0.91, at an average of 37 days postoperative. At an average of 82 days postoperative, the mean sinonasal symptom score improved to near baseline, at 0.7, and the mean quality-of-life score improved to better than baseline, at 0.6. The mean changes from baseline for the following specific items at an average of 87 days postoperatively in our pediatric cohort were as follows: (1). need to blow nose, 0.5; (2) runny nose, 1; (3) postnasal discharge, 0.2; (4) thick nasal discharge, 0.1; (5) wake up at night, −0.5; (6) reduced concentration, −0.6; and (7) frustrated/restless/irritable, −0.5, respectively. These mean changes were similar to those found in our historical adult cohort scores at 3 months postoperatively. All but two patients were able to undergo postoperative sinonasal debridement in clinic. The following complications occurred in our 34-patient pediatric cohort: postoperative CSF leak, 2 (5.8%); new postoperative diabetes insipidus, 7 (20.6%); new postoperative pituitary dysfunction, 6 (17.6%); DVT/PE, 1 (3%); fat graft site hematoma, 1 (3%).

Conclusion: Endoscopic anterior cranial base surgery in the pediatric population results in increased sinonasal symptom morbidity in the early postoperative period; however, symptoms return to near baseline by ∼3 months. Most pediatric patients tolerate postoperative sinus care well, including debridements in clinic.

 

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No conflict of interest has been declared by the author(s).