title: Comparison of sinonasal quality of life and health status in patients undergoing microscopic and endoscopic transsphenoidal surgery for pituitary lesions: a prospective cohort study.
abstract: OBJECTIVE
  Despite the widespread adoption of endoscopic transsphenoidal surgery for pituitary adenomas, the sinonasal quality of life (QOL) and health status in patients who have undergone this technique have not been compared with these findings in patients who have undergone the traditional direct uninostril microsurgical technique. In this study, the authors compared the sinonasal QOL and patient-reported health status after use of these 2 surgical techniques.
  
  
  METHODS
  The study design was a nonblinded prospective cohort study. Adult patients with sellar pathology and planned transsphenoidal surgery were screened at 4 pituitary centers in the US between October 2011 and August 2013. The primary end point of the study was postoperative patient-reported sinonasal QOL as measured by the Anterior Skull Base Nasal Inventory-12 (ASK Nasal-12). Supplementary end points included patient-reported health status estimated by the 8-Item Short Form Health Survey (SF-8) and EuroQol (EQ)-5D-5L instruments, and sinonasal complications. Patients were followed for 6 months after surgery.
  
  
  RESULTS
  A total of 301 patients were screened and 235 were enrolled in the study. Of these, 218 were analyzed (111 microsurgery patients, 107 endoscopic surgery patients). Demographic and tumor characteristics were similar between groups (p ≥ 0.12 for all comparisons). The most common complication in both groups was sinusitis (7% in the microsurgery group, 13% in the endoscopic surgery group; p = 0.15). Patients treated with the endoscopic technique were more likely to have postoperative nasal debridements (p < 0.001). The ASK Nasal-12 and SF-8 scores worsened substantially for both groups at 2 weeks after surgery, but then returned to baseline at 3 months. At 3 months after surgery, patients treated with endoscopy reported statistically better sinonasal QOL compared with patients treated using the microscopic technique (p = 0.02), but there were no significant differences at any of the other postoperative time points.
  
  
  CONCLUSIONS
  This is the first multicenter study to examine the effect of the transsphenoidal surgical technique on sinonasal QOL and health status. The study showed that surgical technique did not significantly impact these patient-reported measures when performed at high-volume centers. Clinical trial registration no.: NCT01504399 ( clinicaltrials.gov ).
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona;
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Little
authors.affiliation: Brain Tumor Center, John Wayne Cancer Institute, Santa Monica, California;
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kelly
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona;
authors.forename: John
authors.initials: J
authors.lastname: Milligan
authors.affiliation: Brain Tumor Center, John Wayne Cancer Institute, Santa Monica, California;
authors.forename: Chester
authors.initials: C
authors.lastname: Griffiths
authors.affiliation: Department of Neurosurgery, Ohio State University, Columbus, Ohio; and.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Prevedello
authors.affiliation: Department of Neurosurgery, Ohio State University, Columbus, Ohio; and.
authors.forename: Ricardo L
authors.initials: RL
authors.lastname: Carrau
authors.affiliation: Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois.
authors.forename: Gail
authors.initials: G
authors.lastname: Rosseau
authors.affiliation: Brain Tumor Center, John Wayne Cancer Institute, Santa Monica, California;
authors.forename: Garni
authors.initials: G
authors.lastname: Barkhoudarian
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona;
authors.forename: Heidi
authors.initials: H
authors.lastname: Jahnke
authors.affiliation: Brain Tumor Center, John Wayne Cancer Institute, Santa Monica, California;
authors.forename: Charlene
authors.initials: C
authors.lastname: Chaloner
authors.affiliation: Department of Neurosurgery, Ohio State University, Columbus, Ohio; and.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Jelinek
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona;
authors.forename: Kristina
authors.initials: K
authors.lastname: Chapple
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona;
authors.forename: William L
authors.initials: WL
authors.lastname: White
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D010902:Pituitary Gland / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
keywords: ASK Nasal-12 = Anterior Skull Base Nasal Inventory—12; CONSORT = Consolidated Standards for Reporting of Trials; EQ = EuroQol; QOL = quality of life; SF-8 = 8-Item Short Form Health Survey; endoscopic surgery; pituitary adenoma; pituitary surgery; quality of life; sinusitis; transsphenoidal surgery