title: Long-term quality of life after endonasal endoscopic resection of adult craniopharyngiomas.
abstract: OBJECTIVE
  Craniopharyngiomas are benign parasellar tumors for which surgical removal, although potentially curative, often leads to morbidity with resulting decreases in quality of life (QOL). The endonasal endoscopic approach is a minimal-access technique for removing these tumors and may reduce postoperative morbidity. The QOL following this method for resection of craniopharyngiomas has not been documented.
  
  
  METHODS
  The authors reviewed a database of consecutive endonasal endoscopic surgeries done at Weill Cornell Medical College. Adult patients with histologically proven craniopharyngiomas were included who had completed either only postoperative (> 9 months) or both pre- and postoperative QOL forms, the Anterior Skull Base Quality of Life (ASBQ) questionnaire, and the 22-Item Sinonasal Outcome Test (SNOT-22). Rates of gross-total resection (GTR), complications, and visual and endocrine function were collected. Retrospective independence (Wen score) was also assigned. A contemporaneous group of patients undergoing endonasal endoscopic pituitary macroadenoma resection was used as a control.
  
  
  RESULTS
  This study included 33 procedures performed in 31 patients. The average postoperative ASBQ score was 3.35 and the SNOT-22 score was 19.6. Better QOL was associated with GTR and postoperative radiation. Worse QOL was associated with persistent visual defects, hypopituitarism, tumor recurrence, increase in body mass index, and worsening Wen score. In a subset of 10 patients, both pre- and postoperative (> 9 months) QOL scores were obtained. Both ASBQ and SNOT-22 scores showed stability and a trend toward improvement, from 2.93 ± 0.51 to 2.96 ± 0.47 (ASBQ) and 23.7 ± 10.8 to 18.4 ± 11.6 (SNOT-22). Compared with 62 patients undergoing endoscopic pituitary macroadenoma resection, patients with craniopharyngiomas had worse postoperative QOL on the ASBQ (3.35 vs 3.80; p = 0.023) and SNOT-22 (19.6 vs 13.4; p = 0.12).
  
  
  CONCLUSIONS
  This report of validated site-specific QOL following endoscopic surgery for craniopharyngiomas shows an overall maintenance of postoperative compared with preoperative QOL. Better QOL could be seen in patients with GTR and radiation therapy, and worse QOL was found in patients with visual or endocrine deficits. Nevertheless, patients with craniopharyngiomas still had worse QOL than those undergoing similar surgery for pituitary macroadenomas, confirming the worse prognosis of craniopharyngiomas even when removed via a minimally invasive approach. These measures should serve as benchmarks for comparison with open transcranial approaches to similar tumors.
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: Kunal S
authors.initials: KS
authors.lastname: Patel
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: Shaan M
authors.initials: SM
authors.lastname: Raza
authors.affiliation: Otolaryngology, and.
authors.forename: Edward D
authors.initials: ED
authors.lastname: McCoul
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Patrona
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Greenfield
authors.affiliation: Departments of 1 Neurological Surgery.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Souweidane
authors.affiliation: Otolaryngology, and.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
authors.affiliation: Departments of 1 Neurological Surgery.|Otolaryngology, and.|Neuroscience, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York.
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003397:Craniopharyngioma / Q000523:psychology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000523:psychology*; D017060:Patient Satisfaction; D010911:Pituitary Neoplasms / Q000523:psychology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: ASBQ = Anterior Skull Base Quality of Life; BMI = body mass index; GTR = gross-total resection; QOL = quality of life; SNOT-22 = 22-Item Sinonasal Outcome Test; craniopharyngioma; endonasal; endoscopic; quality of life