Sinonasal Quality of Life Outcomes after Endoscopic Endonasal Transsphenoidal Surgery with Posterior Septum Free Mucosal Graft Reconstruction

Tara J Wu; Angela Chen; Christine Wells; Anthony P Heaney; Marvin Bergsneider; Marilene B Wang

doi:10.1055/s-0040-1716678

Sinonasal Quality of Life Outcomes after Endoscopic Endonasal Transsphenoidal Surgery with Posterior Septum Free Mucosal Graft Reconstruction

J Neurol Surg B Skull Base. 2021 Oct;82(5):528-533. doi: 10.1055/s-0040-1716678. Epub 2020 Sep 10.

Authors

Tara J Wu¹, Angela Chen¹, Christine Wells², Anthony P Heaney³, Marvin Bergsneider⁴, Marilene B Wang¹

Affiliations

¹ Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, California, United States.
² Institute of Digital Research and Education (IDRE) Statistical Consulting Group, University of California, Los Angeles (UCLA) Institute for Digital Research and Education, Los Angeles, California, United States.
³ Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, California, United States.
⁴ Department of Neurosurgery, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, California, United States.

Abstract

Objective Quality of life (QoL) outcomes following endoscopic endonasal transphenoidal surgery (EETS) across a variety of reconstructive methods improve by 2 to 6 months. An option for sellar reconstruction, in the absence of a significant intraoperative cerebrospinal fluid (CSF) leak, is a free mucosal graft (FMG) from the posterior septum. We analyze sinonasal QoL outcomes in patients undergoing EETS with FMG reconstruction. Study Design This study was a retrospective review. Setting This study was conducted at tertiary care academic center. Participants This study group consisted of patients undergoing EETS for pituitary adenomas from 2013 to 2018. Main Outcome Measures Tumor and surgical factors were included, along with postoperative complications. Patients completed Sinonasal Outcome Test-22 (SNOT-22) questionnaires. Pre- and postoperative scores were compared among the entire cohort using linear multilevel regression. A subcohort analysis was performed among patients who completed questionnaires during the preoperative visit and two postoperative visits (within 1 month and between 2 and 3 months, respectively); pre- and postoperative total and individual domain SNOT-22 scores were compared using paired t -tests. Results A total of 243 patients underwent EETS with FMG reconstruction. Four patients (1.6%) developed a postoperative CSF leak requiring reoperation. Among the entire cohort, SNOT-22 scores increased at the first postoperative visit ( p < 0.01) but returned to baseline by the second, third, and fourth postoperative visits ( p = 0.27, p = 0.18, and p = 0.21). Among 48 patients who completed both preoperative and two postoperative questionnaires, scores increased within the first month ( p < 0.01) but returned to baseline at 2 to 3 months ( p = 0.67). Conclusion Posterior septum FMG reconstruction of sellar defects is an effective option, demonstrating early recovery of baseline sinonasal QoL by 2 to 3 months.

Keywords: endoscopic endonasal transphenoidal surgery; free mucosal graft; quality of life; sellar reconstruction; sinonasal morbidity; sinonasal outcome test-22.