title: Preservation of multidimensional quality of life after endoscopic pituitary adenoma resection.
abstract: OBJECTIVE
  Pituitary adenomas are well suited to resection by a minimal-access endoscopic technique. Validation of this approach requires prospective outcome studies to determine the impact on quality of life (QOL). This study aims to assess the effect of endoscopic pituitary adenoma resection on site-specific and sinonasal-related QOL before and after endoscopic surgery using validated instruments.
  
  
  METHODS
  Consecutive adult patients undergoing endoscopic endonasal resection of pituitary adenoma were prospectively enrolled from a single tertiary care center. All patients completed the Anterior Skull Base Questionnaire (ASBQ) and the 22-Item Sino-Nasal Outcome Test (SNOT-22) preoperatively and then at regular intervals after surgery to assess their perceived QOL with regard to hormonal, surgical, and anatomical factors.
  
  
  RESULTS
  Eighty-one of 114 patients were eligible for study; median follow-up was 16 months. This cohort included 24 (29.6%) nonsecreting macroadenomas and 57 (70.4%) hypersecreting tumors. There was significant improvement in the mean ASBQ score at 12 weeks, 6 months, and 1 year after surgery (p < 0.05), while postoperative SNOT-22 scores, at the same time points, showed no significant difference from preoperative scores. Both ASBQ and SNOT-22 scores showed transient worsening at 3 weeks postoperatively. Subtotal resection correlated with worse QOL, both overall and among patients with hypersecreting tumors (p < 0.05). Extrasellar tumor extension, intraoperative CSF leakage, and a reconstruction technique during surgery did not impact postoperative QOL. Visual disturbances did not significantly alter QOL. There were no postoperative CSF leaks in this series.
  
  
  CONCLUSIONS
  Endoscopic resection of pituitary adenoma is associated with long-term improvements in site-specific QOL and stability in sinonasal QOL when assessed pre- and postoperatively with validated instruments. Subtotal resection was the only factor that negatively impacted postoperative QOL. Therefore, gross-total resection should be attempted for all patients to optimize QOL after surgery.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Ochsner Medical Center, New Orleans, Louisiana; and.
authors.forename: Edward D
authors.initials: ED
authors.lastname: McCoul
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Maine Medical Center, Portland, Maine.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Bedrosian
authors.affiliation: Department of Neurological Surgery, Sackler Brain and Spine Center; and.
authors.forename: Olga
authors.initials: O
authors.lastname: Akselrod
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery;
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery;|Department of Neurological Surgery, Sackler Brain and Spine Center; and.|Department of Neuroscience, Feil Brain and Mind Institute, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York;
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: ASBQ = Anterior Skull Base Questionnaire; GH = growth hormone; GTR = gross-total resection; IGF-1 = insulin-like growth factor-1; QOL = quality of life; SNOT-22 = 22-Item Sino-Nasal Outcome Test; STR = subtotal resection; endoscopic; outcomes research; pituitary adenoma; pituitary surgery; quality of life; surgery