Article
Comparison of quality of life and emotional burden after transnasal versus transcranial anterior skull base surgery
Vergleich von Lebensqualität und emotionaler Belastung nach transnasalen und transkraniellen Eingriffen der vorderen Schädelbasis
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Authors
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Arthur Wagner
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik, München, Deutschland
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Youssef Shiban
- Private Hochschule Göttingen, Göttingen, Deutschland
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Verena Kammermeier
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik, München, Deutschland
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Ann-Kathrin Joerger
- Klinikum rechts der Isar, Neurochirurgische Klinik, München, Deutschland
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Nicole Lange
- Klinikum rechts der Isar, Neurochirurgische Klinik, München, Deutschland
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Ute Hoffmann
- Klinikum rechts der Isar, Neurochirurgische Klinik, München, Deutschland
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Bernhard Meyer
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik, München, Deutschland
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Ehab Shiban
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik, München, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: To compare differences in psychopathological outcome and health-related quality of life (QOL) between cohorts of patients undergoing transcranial or transnasal anterior skull base surgery.
Methods: A prospective study of patients undergoing elective surgery for various entities of the anterior skull base was performed. Evaluation for depression (ADS-K score) and anxiety (PTSS, STAI-S, STAI-T and ASI-3 scores) were done before surgery, at 3 and 12 months after surgery. The correlation between preoperative psychological burden and postoperative quality of life as measured by the SF-36 and EuroQol questionnaires was analysed. Incidence and influence of these psychiatric comorbidities on clinical outcome were examined and compared between transnasal and transcranial subgroups.
Results: 64 patients undergoing anterior skull base surgery were included, of which 50 (78.1%) completed follow up interviews after 3 and 12 months. There were 29 (58.0%) female patients, median age was 57 years. Most common diagnoses were meningioma (46.0%) and adenoma (34.0%), 20.0% had diagnoses such as clival chordomas, three anterior skull base defects, two metastatic carcinomas and finally one lymphoma, hemangioma and fibrous dysplasia. Proportion of pathological anxiety scores significantly decreased from 74.0% to 46.0% (p=0.001). After 3 months, mean EuroQol VAS score significantly increased by 0.084 (p=0.02) across the entire cohort without significant difference between transcranial and transnasal subgroups. The transnasal cohort generally scored higher in ASI-3, STAI-T and PTSS-10 scores (p=0.411; p=0.659; p=0.453), whereas the transcranial cohort had higher scores in ADS-K (p=0.440). The individually declared emotional burden significantly decreased from 6.6 to 4.3 on the ten point Likert scale (p<0.001), although equally for both subgroups (transnasal: -2.15; transcranial: -2.50; p=0.609). On last examination, about half of the patients in each subgroup (47.6% vs. 48.3%; p=0.963) expressed a considerable recovery of preoperative bodily complaints such as headaches, dizziness and unrest.
Conclusion: Our results confirm the justification of employing endoscopic transnasal approaches for amenable lesions of the anterior skull base, with the prospect of achieving QOL and psychopathological outcomes that seem to be no inferior to the established strategies.
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