title: Expanded endonasal approach using vascularized septal flap reconstruction for skull base tumors has a negative impact on sinonasal symptoms and quality of life.
abstract: BACKGROUND
  Endoscopic transsphenoidal surgery is currently the optimal treatment for skull base tumors. This study was designed to assess patient's sinonasal symptoms and quality of life (QoL) after resection of pituitary adenoma or skull base tumors using vascularized septal flap (VSF) reconstruction.
  
  
  METHODS
  Patients with pituitary adenoma underwent the transnasal transsphenoidal endoscopic approach (TTEA; n = 38), and patients with other benign parasellar tumors underwent the expanded endonasal approach (EEA; n = 17) with VSF. Assessment of sinonasal symptoms and QoL by the 36-item Short-Form (SF-36) and the 31-item Rhinosinusitis Outcome Measure (RSOM-31) were performed before and 3 months after surgery.
  
  
  RESULTS
  At baseline, the total seven-sinonasal symptom score (T7SSS) was similar between both groups. After surgery, T7SSS significantly increased in EEA but not in TTEA patients. EEA patients reported more smell loss (40.1 ± 26.2; p < 0.05) and posterior nasal discharge (49.3 ± 30.1; p < 0.05) than TTEA patients (21.6 ± 30.9 and 22.5 ± 27.5, respectively). At baseline, both groups had poorer SF-36 compared with the general population. TTEA patients had poorer QoL (on general health, vitality, and mental health) than EEA patients. After surgery, TTEA patients showed impaired physical role and bodily pain compared with baseline, and EEA patients showed impaired physical role and mental health. At baseline, RSOM scores were similar in TTEA and EEA groups. After surgery, EEA but not TTEA patients reported poorer nasal and general symptoms.
  
  
  CONCLUSIONS
  The EEA with VSF produces more sinonasal symptoms than pituitary surgery, surgery for skull base and pituitary tumors has negative impact on QoL, and functioning tumors have no further negative effect on sinonasal symptoms and QoL.
authors.affiliation: Rhinology Unit and Smell Clinic, Ear, Nose, and Throat Department, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Isam
authors.initials: I
authors.lastname: Alobid
authors.forename: Joaquim
authors.initials: J
authors.lastname: Enseñat
authors.forename: Franklin
authors.initials: F
authors.lastname: Mariño-Sánchez
authors.forename: Elena
authors.initials: E
authors.lastname: Rioja
authors.forename: Matteo
authors.initials: M
authors.lastname: de Notaris
authors.forename: Joaquim
authors.initials: J
authors.lastname: Mullol
authors.forename: Manuel
authors.initials: M
authors.lastname: Bernal-Sprekelsen
mesh_terms: D000236:Adenoma / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000473:pathology* / Q000601:surgery; D009300:Nasal Septum / Q000601:surgery*; D010256:Paranasal Sinuses / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps / Q000706:statistics & numerical data*; D016896:Treatment Outcome