Quality-of-Life after Anterior Skull Base Surgery: A Systematic Review

Abstract

Background Improved treatment and survival of patients with skull base tumors has made the assessment of quality-of-life (QoL) in this population increasingly important. This article provides a comprehensive systematic review pertaining to QoL assessment in adults undergoing anterior skull base surgery.

Methods We performed a literature search using the electronic databases of Ovid Medline and Embase. Additional articles were identified through a search using the phrase anterior skull base. Further articles were sought through hand-searching relevant journals and reference lists of identified articles.

Results Our search strategy identified 29 articles for inclusion in our systematic review, with considerable variation between studies in population characteristics, methodological design and quality, follow-up length, and outcome assessment. The most commonly used QoL tools were the Karnofsky Performance Status and the Anterior Skull Base Questionnaire. QoL following anterior skull base surgery appears to improve beyond preoperative levels in the months after surgery. For patients undergoing endoscopic skull base surgery, the gain in QoL appears to be greater and may manifest earlier, with no clear long-term deleterious effect on sinonasal outcomes compared with open surgery.

Conclusions QoL after anterior skull base surgery in adults appears to improve within several months of surgery, but earlier and to a larger extent if the endoscopic approach is used. Given the relative paucity and heterogeneity of anterior skull base tumors, large-scale prospective multicentre studies utilizing valid and reliable multidimensional QoL tools are required. This may result in improved patient care, by understanding patients' needs better and facilitating the provision of reliable outcome data for clinical trials.

Keywords

anterior skull base surgery - endoscopic - functional outcomes - quality-of-life - tumor

• References

• 1 Witgert ME, Veramonti T, Hanna E. Instruments for estimation of health-related quality of life in patients with skull base neoplasms. Skull Base 2010; 20 (1) 5-10
• 2 Murphy BA, Ridner S, Wells N, Dietrich M. Quality of life research in head and neck cancer: a review of the current state of the science. Crit Rev Oncol Hematol 2007; 62 (3) 251-267
• 3 Karnofsky DA, Burchenal JH. Present status of clinical cancer chemotherapy. Am J Med 1950; 8 (6) 767-788
• 4 Gil Z, Abergel A, Spektor S , et al. Quality of life following surgery for anterior skull base tumors. Arch Otolaryngol Head Neck Surg 2003; 129 (12) 1303-1309
• 5 Gil Z, Abergel A, Spektor S, Shabtai E, Khafif A, Fliss DM. Development of a cancer-specific anterior skull base quality-of-life questionnaire. J Neurosurg 2004; 100 (5) 813-819
• 6 Gil Z, Abergel A, Spektor S, Khafif A, Fliss DM. Patient, caregiver, and surgeon perceptions of quality of life following anterior skull base surgery. Arch Otolaryngol Head Neck Surg 2004; 130 (11) 1276-1281
• 7 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (7) e1000097
• 8 Raso JL, Gusmão S. Transbasal approach to skull base tumors: evaluation and proposal of classification. Surg Neurol 2006; 65 (Suppl. 01) S1 , 33-1, 37; discussion 1, 37-1, 38
• 9 Tzortzidis F, Elahi F, Wright D, Natarajan SK, Sekhar LN. Patient outcome at long-term follow-up after aggressive microsurgical resection of cranial base chordomas. Neurosurgery 2006; 59 (2) 230-237 ; discussion 230–237
• 10 Di Maio S, Rostomily R, Sekhar LN. Current surgical outcomes for cranial base chordomas: cohort study of 95 patients. Neurosurgery 2012; 70 (6) 1355-1360 ; discussion 1360
• 11 Bassiouni H, Asgari S, Sandalcioglu IE, Seifert V, Stolke D, Marquardt G. Anterior clinoidal meningiomas: functional outcome after microsurgical resection in a consecutive series of 106 patients. Clinical article. J Neurosurg 2009; 111 (5) 1078-1090
• 12 Ichinose T, Goto T, Ishibashi K, Takami T, Ohata K. The role of radical microsurgical resection in multimodal treatment for skull base meningioma. J Neurosurg 2010; 113 (5) 1072-1078
• 13 Roser F, Ebner FH, Ritz R, Samii M, Tatagiba MS, Nakamura M. Management of skull based meningiomas in the elderly patient. J Clin Neurosci 2007; 14 (3) 224-228
• 14 de Almeida JR, Witterick IJ, Gullane PJ , et al. Physical morbidity by surgical approach and tumor location in skull base surgery. Head Neck 2013; 35 (4) 493-499
• 15 Holmes B, Sekhar L, Sofaer S, Holmes KL, Wright DC. Outcomes analysis in cranial base surgery—preliminary results. Acta Neurochir (Wien) 1995; 134 (3–4) 136-138
• 16 Ohba S, Kobayashi M, Horiguchi T , et al. Long-term surgical outcome and biological prognostic factors in patients with skull base meningiomas. J Neurosurg 2011; 114 (5) 1278-1287
• 17 De Jesús O, Sekhar LN, Parikh HK, Wright DC, Wagner DP. Long-term follow-up of patients with meningiomas involving the cavernous sinus: recurrence, progression, and quality of life. Neurosurgery 1996; 39 (5) 915-919 ; discussion 919–920
• 18 Samii A, Gerganov V, Herold C, Gharabaghi A, Hayashi N, Samii M. Surgical treatment of skull base chondrosarcomas. Neurosurg Rev 2009; 32 (1) 67-75 ; discussion 75
• 19 Walch C, Stammberger H, Anderhuber W, Unger F, Köle W, Feichtinger K. The minimally invasive approach to olfactory neuroblastoma: combined endoscopic and stereotactic treatment. Laryngoscope 2000; 110 (4) 635-640
• 20 Fliss DM, Abergel A, Cavel O, Margalit N, Gil Z. Combined subcranial approaches for excision of complex anterior skull base tumors. Arch Otolaryngol Head Neck Surg 2007; 133 (9) 888-896
• 21 Bassiouni H, Asgari S, Stolke D. Olfactory groove meningiomas: functional outcome in a series treated microsurgically. Acta Neurochir (Wien) 2007; 149 (2) 109-121 ; discussion 121
• 22 Lang DA, Honeybul S, Neil-Dwyer G, Evans BT, Weller RO, Gill J. The extended transbasal approach: clinical applications and complications. Acta Neurochir (Wien) 1999; 141 (6) 579-585
• 23 Ransom ER, Doghramji L, Palmer JN, Chiu AG. Global and disease-specific health-related quality of life after complete endoscopic resection of anterior skull base neoplasms. Am J Rhinol Allergy 2012; 26 (1) 76-79
• 24 Rogers SN, Gwanne S, Lowe D, Humphris G, Yueh B, Weymuller Jr EA. The addition of mood and anxiety domains to the University of Washington quality of life scale. Head Neck 2002; 24 (6) 521-529
• 25 Hassan SJ, Weymuller Jr EA. Assessment of quality of life in head and neck cancer patients. Head Neck 1993; 15 (6) 485-496
• 26 Martinez-Devesa P, Barnes ML, Alcock CJ, Kerr RS, Milford CA. Evaluation of quality of life and psychiatric morbidity in patients with malignant tumours of the skull base. J Laryngol Otol 2006; 120 (12) 1049-1054
• 27 Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1 (7905) 480-484
• 28 Blau T. Quality of life, social indicators, and criteria of change. Prof Psychol 1977; 11: 464-473
• 29 Woertgen C, Rothoerl RD, Hosemann W, Strutz J. Quality of life following surgery for malignancies of the anterior skull base. Skull Base 2007; 17 (2) 119-123
• 30 Palme CE, Irish JC, Gullane PJ, Katz MR, Devins GM, Bachar G. Quality of life analysis in patients with anterior skull base neoplasms. Head Neck 2009; 31 (10) 1326-1334
• 31 Pant H, Bhatki AM, Snyderman CH , et al. Quality of life following endonasal skull base surgery. Skull Base 2010; 20 (1) 35-40
• 32 McCoul ED, Anand VK, Schwartz TH. Improvements in site-specific quality of life 6 months after endoscopic anterior skull base surgery: a prospective study. J Neurosurg 2012; 117 (3) 498-506
• 33 McCoul ED, Anand VK, Bedrosian JC, Schwartz TH. Endoscopic skull base surgery and its impact on sinonasal-related quality of life. Int Forum Allergy Rhinol 2012; 2 (2) 174-181
• 34 Abergel A, Cavel O, Margalit N, Fliss DM, Gil Z. Comparison of quality of life after transnasal endoscopic vs open skull base tumor resection. Arch Otolaryngol Head Neck Surg 2012; 138 (2) 142-147
• 35 Sowerby LJ, Gross M, Broad R, Wright ED. Olfactory and sinonasal outcomes in endoscopic transsphenoidal skull-base surgery. Int Forum Allergy Rhinol 2013; 3 (3) 217-220
• 36 Georgalas C, Badloe R, van Furth W, Reinartz S, Fokkens WJ. Quality of life in extended endonasal approaches for skull base tumours. Rhinology 2012; 50 (3) 255-261
• 37 Little AS, Jahnke H, Nakaji P, Milligan J, Chapple K, White WL. The anterior skull base nasal inventory (ASK nasal inventory): a clinical tool for evaluating rhinological outcomes after endonasal surgery for pituitary and cranial base lesions. Pituitary 2012; 15 (4) 513-517
• 38 Little AS, Kelly D, Milligan J , et al. Prospective validation of a patient-reported nasal quality-of-life tool for endonasal skull base surgery: The Anterior Skull Base Nasal Inventory-12. J Neurosurg 2013; 119 (4) 1068-1074
• 39 Bohman LE, Stein SC, Newman JG , et al. Endoscopic versus open resection of tuberculum sellae meningiomas: a decision analysis. ORL J Otorhinolaryngol Relat Spec 2012; 74 (5) 255-263
• 40 Mohsenipour I, Deusch E, Gabl M, Hofer M, Twerdy K. Quality of life in patients after meningioma resection. Acta Neurochir (Wien) 2001; 143 (6) 547-553
• 41 Shah JP. Quality of life after skull base surgery: the patient's predicament. Skull Base 2010; 20 (1) 3-4
• 42 DeMonte F. Functional outcomes in skull base surgery. What is acceptable?. Clin Neurosurg 2001; 48: 340-350
• 43 Levine NB, Demonte F. Functional outcome in the neurosurgical patient and its impact on quality of life. Skull Base 2010; 20 (1) 19-22
• 44 Gil Z. Quality of life in patients with skull base tumors. Skull Base 2010; 20 (1) 1
• 45 Amit M, Abergel A, Fliss DM, Gil Z. The clinical importance of quality-of-life scores in patients with skull base tumors: a meta-analysis and review of the literature. Curr Oncol Rep 2012; 14 (2) 175-181
• 46 Deschler DG, Walsh KA, Friedman S, Hayden RE. Quality of life assessment in patients undergoing head and neck surgery as evaluated by lay caregivers. Laryngoscope 1999; 109 (1) 42-46
• 47 Sneeuw KC, Aaronson NK, Osoba D , et al. The use of significant others as proxy raters of the quality of life of patients with brain cancer. Med Care 1997; 35 (5) 490-506
• 48 Movsas B. Exploring the role of the radioprotector amifostine in locally advanced non-small cell lung cancer: Radiation Therapy Oncology Group trial 98-01. Semin Radiat Oncol 2002; 12 (1) (Suppl. 01) 40-45
• 49 Langendijk H, Aaronson NK, de Jong JM, ten Velde GP, Muller MJ, Wouters M. The prognostic impact of quality of life assessed with the EORTC QLQ-C30 in inoperable non-small cell lung carcinoma treated with radiotherapy. Radiother Oncol 2000; 55 (1) 19-25
• 50 Gil Z, Smith DB, Marouani N, Khafif A, Fliss DM. Treatment of pain after head and neck surgeries: control of acute pain after head and neck oncological surgeries. Otolaryngol Head Neck Surg 2006; 135 (2) 182-188
• 51 Gil Z, Fliss DM. Quality of life in patients with skull base tumors: current status and future challenges. Skull Base 2010; 20 (1) 11-18
• 52 Patel SG. Internet-based multi-institutional clinical research: a new method to conduct and manage quality of life studies. Skull Base 2010; 20 (1) 23-26
• 53 Patel SG, Singh B, Polluri A , et al. Craniofacial surgery for malignant skull base tumors: report of an international collaborative study. Cancer 2003; 98 (6) 1179-1187