Comparative analysis of quality-of-life metrics after endoscopic surgery for sinonasal neoplasms Nathan A. Deckard, M.D.,1 Brian R. Harrow, M.S.I.I.I.,2 Samuel L. Barnett, M.D.,3 and Pete S. Batra, M.D., F.A.C.S.4

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ABSTRACT

Background: The objective of this study was to evaluate the postoperative quality of life (QOL) after endoscopic resection of sinus and skull base neoplasms using validated outcomes measures and to perform correlation of the various metrics to better discern their efficacy. Prospective QOL data collection and retrospective chart review were performed. Methods: QOL data were collected using the 20-item Sino-Nasal Outcome Test (SNOT-20), Anterior Skull Base Questionnaire (ASBQ), European Quality-of-Life–5 Dimension (EQ-5D) questionnaire, and Lund–Kennedy endoscopic (LKE) score in 71 patients with sinonasal and skull base tumors. Results: The mean age was 53 years and mean follow-up was 14.5 months at the time QOL data were collected. Benign and malignant tumors represented 39 (54.9%) and 32 (45.1%) cases, respectively. Twenty malignancies (62.5%) were stage T3 or T4, and 23 required postoperative chemotherapy and radiation (CRT). Factors indicating worsened postoperative QOL included malignant histopathology, T3 or T4 tumors, and the use of postoperative CRT (p ⬍ 0.05). There was a strong correlation of ASBQ with EQ-5D and SNOT-20 scores (r ⬍ ⫺0.5) and a moderate correlation between the SNOT-20 and EQ-5D (r ⬎ 0.3), and the LKE had moderate correlation with SNOT-20 (r ⬎ 0.3) and weak correlation to the ASBQ (r ⬎ ⫺0.3) and EQ-5D (r ⬍ 0.3). Conclusion: Patients who have undergone endoscopic resection of sinonasal tumors have quantifiable QOL changes as measured by various validated metrics. This study shows that concurrent use of these instruments may better discern QOL outcomes after endoscopic tumor surgery. (Am J Rhinol Allergy 29, 151–155, 2015; doi: 10.2500/ajra.2015.29.4137)

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urgical management of sinonasal and skull base neoplasms remains a significant challenge in the modern era of skull base surgery. The narrow paranasal sinus confines, proximity to critical structures, and the frequent advanced stage at presentation add to the management dilemma. Traditionally, surgical treatment has included open craniofacial resection using transfacial approaches combined with a bifrontal craniotomy.1 The emergence of advanced endoscopic techniques has facilitated a paradigm shift in the management of these tumors. The endoscopic route allows for a minimally invasive approach, often obviating the need for craniotomy, with comparable oncologic outcomes and decreased functional morbidity.2,3 Although technical feasibility and surgical outcomes of minimally invasive endoscopic resection (MIER) has been studied extensively over the past 10 years, there is a relative paucity of data on quality of life (QOL) in this patient group.4–11 Published studies also vary significantly in metrics used to report QOL in this patient population, from the traditional rhinologic evaluation such as the 20-item SinoNasal Outcome Test (SNOT-20) or the more cancer-specific Anterior Skull Base Quality-of-Life Questionnaire (ASBQ). The objective of the current study was to evaluate the postoperative QOL after MIER in patients with sinonasal and skull base neoplasms using four validated tools, including SNOT-20, ASBQ, European Quality-of-Life–5 Dimensions (EQ-5D; a measurement of general health-related QOL) ques-

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From the 1Division of Otolaryngology–Head and Neck Surgery, Cooper University Hospital, Camden, New Jersey, 2University of Texas Southwestern Medical School and 3 Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, and 4Department of Otorhinolaryngology–Head and Neck Surgery and Rush Center for Skull Base and Pituitary Surgery, Rush University Medical Center, Chicago, Illinois Presented as an oral presentation at the Combined Otolaryngology Spring Meeting of the American Rhinologic Society, Orlando, Florida, April 12–13, 2013 PS Batra is a consultant for Medtronic and is on the Scientific Advisory Board for Merck. The remaining authors have no conflicts of interest to declare pertaining to this article Address correspondence to Pete S. Batra, M.D., F.A.C.S., Rush Center of Skull Base and Pituitary Surgery, Department of Otorhinolaryngology–Head and Neck Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 550, Chicago, IL 60612 E-mail address: [email protected] Copyright © 2015, OceanSide Publications, Inc., U.S.A.

tionnaire, and Lund–Kennedy endoscopic (LKE) score. Correlation of the various QOL measures was performed to better understand their efficacy for sinonasal and skull base tumors.

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METHODS Analysis was performed on a consecutive series of patients presenting with sinonasal and skull base neoplasms to the University of Texas Southwestern Medical Center between January 2009 and August 2012. Three QOL questionnaires were concurrently collected prospectively after enrollment in the study ⱖ3 months after surgical treatment, including SNOT-20, ASBQ, and EQ-5D. In addition, the senior author (PSB) calculated the LKE based on the endoscopic examination during the same visit. Patient records were then retrospectively reviewed for salient information, including demographics, surgical data (including use of endoscopic, endoscopic-assisted, or open resection), and final histopathological diagnosis. TNM stage and use of pre- or postoperative treatment with chemotherapy and/or radiation (CRT) was determined for malignant tumors. Approval was obtained from the University of Texas Southwestern Medical Center Institutional Review Board before commencing the study.

QOL Assessment Tools The SNOT-20 is a well-validated instrument used frequently over the past 10 years in the disease-specific evaluation of QOL in patients with rhinosinusitis.12 This questionnaire comprises 20 questions evaluating four specific domains, including rhinologic, ear/facial, sleep, and psychological function. The SNOT-20 is scored on an (0–5) ordinal scale, with “0” representing “no problem” and “5” representing “problem as bad as it can be.” This study reports SNOT-20 data as a composite 0–5 score for all 20 questions. The ASBQ was designed as a disease-specific QOL assessment for patients undergoing skull base tumor surgery.13 The questionnaire comprises 35 questions in six relevant domains, including role of performance, physical function, vitality, pain, specific symptoms, and impact on emotions. Responses are recorded on a 1–5 ordinal scale with composite score ranging from 35 to 175, with high values being considered excellent and low values considered poor.14 The EQ-5D is a nondisease-specific instrument designed as a general measure of health-related QOL. This index is a two-part instrument. Part 1 is composed of five domains: mobility, self-care, usual

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Table 1 Histology of the 71 benign and malignant sinonasal and skull base neoplasms Benign

No. (%)

Malignant

No. (%)

Inverted papilloma JNA Oncocytic papilloma Schwannoma Pituitary adenoma Dermoid cyst Ossifying fibroma Cementifying fibroma Chondromyxoid fibroma Venous hemangioma Fibrous dysplasia Hemangiopericytoma Osteoma Arteriovenous malformation Total

15 (38.5%) 8 (20.5%) 3 (7.7%) 2 (5.1%) 2 (5.1%) 1 (2.6%) 1 (2.6%) 1 (2.6%) 1 (2.6%) 1 (2.6%) 1 (2.6%) 1 (2.6%) 1 (2.6%) 1 (2.6%) 39 (100%)

Squamous cell carcinoma Olfactory neuroblastoma Adenocarcinoma Adenoid cystic carcinoma Basal cell carcinoma Mucosal melanoma Sarcoma SNUC Plasmacytoma IP with CIS Nasopharyngeal carcinoma Clear cell carcinoma Mucoepidermoid carcinoma Chordoma Total

6 (18.8%) 4 (12.5%) 4 (12.5%) 4 (12.5%) 2 (6.3%) 2 (6.3%) 2 (6.3%) 2 (6.3%) 1 (3.1%) 1 (3.1%) 1 (3.1%) 1 (3.1%) 1 (3.1%) 1 (3.1%) 32 (100%)

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JNA ⫽ juvenile nasopharyngeal angiofibroma; SNUC ⫽ sinonasal undifferentiated carcinoma; IP with CIS ⫽ inverted papilloma with carcinoma in situ.

activities, pain/discomfort, and anxiety/depression. Each domain is divided into three levels of severity: no problem (1), some problem (2), and extreme problem (3). As such, total scores range from 5 to 15, where lower scores are preferable to higher ones. Part 2 is a visual analog scale designed for self-rating of the patient’s current overall health with scores from 0 (worst imaginable) to 100 (best imaginable). This instrument has been used in a variety of disease states, is relatively easy to use, and allows reliable group comparisons.15–17 The LKE is an objective grading system that quantifies endoscopic appearance of the patient’s nose and paranasal sinuses. The presence of polyps, discharge, edema, scarring, and adhesions are each rated on a scale of 0 (none), 1 (some), or 2 (severe) for each side. The composite score ranges from 0 to 20 for both sides.18

Statistical Analysis

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RESULTS

A total of 71 consecutive patients were enrolled in this study. The mean age was 53 years and the male/female ratio was 1.3:1. Benign and malignant tumors represented 39 (54.9%) and 32 (45.1%) cases, respectively (Table 1). The primary surgical method included endoscopic approach in 56 (78.8%) and open/endoscopic-assisted approach in 15 (21.1%) cases. The most common open procedures used included orbitotomy (5), myocutaneous free flap reconstruction (4), open craniofacial approach (3), orbital exenteration (2), osteoplastic flap (2), and bifrontal craniotomy (1). Preoperative radiation and concurrent chemoradiation were used in 11 and 7 cases, respectively. Surgical extirpation of the tumor included formal skull base resection in 45 (63.4%) cases, with planned repair of resulting intraoperative cerebrospinal fluid leak in 25 (35.2%) cases. Postoperative radiation, concurrent chemoradiation, and chemotherapy alone were received by 21 (29.6%), 12 (16.9%), and 2 (2.8%) patients, respectively. The mean follow-up was 14.5 months at the time QOL data were collected. Patients with malignant tumors were found to have significantly worse scores on the ASBQ (p ⫽ 0.0061), SNOT-20 (p ⫽ 0.0097), and

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Statistical analysis was performed to identify predictive factors affecting QOL using Student’s t-test. Correlation between QOL questionnaires and objective LKE was calculated using Pearson correlation coefficient, being interpreted as “strong” between r ⫽ 0.5 and r ⫽ 1.0, “moderate” between r ⫽ 0.3 and r ⫽ 0.5, “weak” between r ⫽ 0.1 and r ⫽ 0.3, and no correlation between r ⫽ 0 and r ⫽ 0.1. A significance level of ⱕ0.05 was used for all statistical tests. All calculations were performed using Stata Version 9 statistical software (StataCorp LP, College Station, TX).

LKE (p ⫽ 0.006) compared with patients with benign neoplasms. Furthermore, 20 patients staged as T3 or T4 according to TNM staging criteria were scored significantly worse than 8 patients with T1 or T2 tumors on the ASBQ (p ⫽ 0.0410), SNOT-20 (p ⫽ 0.0088), and LKE (p ⫽ 0.0031). Patients receiving postoperative CRT showed significantly worse scores than those who received surgical resection alone on the ASBQ (p ⫽ 0.0025), SNOT-20 (p ⫽ 0.0009), and the LKE (p ⫽ 0.0003). There was no statistical difference by gender, for patients above and below 60 years of age, and for patients receiving preoperative CRT. Patients undergoing MIER compared with open/endoscopic-assisted resection did not have statistically different QOL measures. The EQ-5D (parts 1 and 2) did not show statistical differences between any of the groups measured (Table 2). Each QOL instrument was also compared with each other and to the LKE. There was a strong correlation between the ASBQ and the EQ-5D and SNOT-20 (r ⬍ ⫺0.5) and there were moderate correlations between the SNOT-20 and EQ-5D (r ⬎ 0.3) and between SNOT-20 and LKE (r ⬎ 0.3). However, the LKE had weak correlations with ASBQ (r ⬎ ⫺0.3) and EQ-5D (r ⬍ 0.3; Table 3).

DISCUSSION The advances in endoscopic techniques, refinement of surgical instrumentation, and advent of surgical navigation has facilitated evolution of MIER. Direct comparative analysis of MIER with open craniofacial resection has also shown comparable surgical parameters, complications, and long-term patient survival for benign and malignant sinonasal and skull base neoplasms.19–22 However, the exact impact of these advanced endoscopic techniques on the patient’s QOL remains to be elucidated. This is essential because the underlying skull base pathology and the associated interventions, such as extensive open or endoscopic surgery, radiation, and/or chemotherapy, have the potential for significant morbidity. Furthermore, any surgery at the skull base interface traverses the paranasal sinus region, and, thus, can irreversibly influence the intrinsic sinonasal physiology, including nasal airflow, mucociliary clearance, and olfaction. Thus, precise assessment of QOL metrics is imperative to understanding patient physical, emotional, and social well-being of these patients. Careful understanding of different aspects of QOL will help surgeons to improve preoperative assessment, to identify impediments to long-term care, and to proactively apply interventions to patients at risk for adverse outcomes.4 With this in mind, the present study aimed to evaluate QOL measures in patients undergoing MIER for sinonasal and skull base tumors using several validated QOL metrics. The SNOT-20 score is

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Table 2 Comparative analysis of QOL scores for key patient variables Category Gender Men (40) Women (31) p Value Age (yr) ⬍60 (39) ⬎60 (32) p Value Benign vs malignant Benign (39) Malignant (32) p Value Preoperative CRT None (60) Preoperative CRT (11) p Value Stage of malignancy T1 or T2 (8) T3 or T4 (20) p Value Open surgery Endoscopic alone (56) Endoscopic assisted (15) p Value Postoperative CRT None (48) Postoperative CRT (23) p Value

ASBQ

SNOT-20

124.25 124.6774 0.9431

12.45 15.96774 0.3319

121.56 127.40 0.322

EQ-5D

EQ-VAS

Lund Kennedy Score

7.25 7 0.6667

78.35897 82.22581 0.3008

3.289474 3.259259 0.9647

16.83 11.06 0.094

7.28 7.00 0.627

78.71 81.43 0.474

131.5485 115.7813 0.0061*

9.923077 18.9375 0.0097*

6.820513 7.53125 0.2126

80.33333 79.74194 0.8768

125.9833 116 0.2090

13.65 15.81818 0.6234

6.95 8.181818 0.1952

80.05085 80.18182 0.9780

128.3922 114.35 0.0410*

10.96078 21.7 0.0088*

6.803922 8 0.0795

127.8036 111.8667 0.0792

12.66071 18.93333 0.2028

6.785714 8.466667 0.0841

130.3333 112.1304 0.0025*

9.770833 22.78261 0.0009*

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6.75 7.956522 0.0532

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O C 79.86275 80.63158 0.8676

3.65 2.87 0.216

2.235294 4.419355 0.0006* 3.092593 4.181818 0.2592

2.511111 5 0.0031*

81.09091 76.33333 0.4231

3.226415 3.5 0.7846

80.72917 78.63636 0.6100

2.302326 5.181818 0.0003*

*Statistically significant (p ⬍ 0.05). CRT ⫽ chemoradiation; ASBQ ⫽ Anterior Skull Base Quality-of-Life Questionnaire; EQ-5D ⫽ European Quality-of-Life–5 Dimensions questionnaire (part 1); EQ-VAS ⫽ European Quality-of-Life questionnaire visual analog scale (part 2); LKE ⫽ Lund–Kennedy endoscopic score; SNOT-20 ⫽ 20-item Sino-Nasal Outcome Test.

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Table 3 Correlation between the various QOL metric tools

ASBQ EQ-5D SNOT-20 LKE

ASBQ

EQ-5D

1 ⫺0.7111** ⫺0.6029** ⫺0.2936

1 0.3982* 0.1725

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SNOT-20

LKE

1 0.3881*

1

*Moderate correlation (r ⬎ 0.30); **Strong correlation (r ⬎ 0.50). ASBQ ⫽ Anterior Skull Base Quality-of-Life Questionnaire; EQ-5D ⫽ European Quality-of-Life–5 Dimensions questionnaire; LKE ⫽ Lund-Kennedy endoscopic score; SNOT-20 ⫽ 20-item Sino-Nasal Outcome Test.

perhaps the most familiar tool available for rhinologists and is useful for comparison across studies to evaluate sinonasal QOL outcomes in patients. Nonetheless, it is a disease-specific instrument for rhinosinusitis and may not accurately reflect specific concerns encountered by patients with sinonasal and skull base neoplasms. For this reason, the ASBQ was used as a disease-specific instrument. Furthermore, EQ-5D was used as a general health-related assessment tool to gain perspective of overall patient well-being. LKE was also incorporated to gather objective data on the endoscopic appearance of the postoperative sinonasal cavity. Several important observations stem from the present study. The vast majority of the patients were treated with endoscopic resection alone, with nearly equal representation of benign and malignant pathologies in this patient group. ASBQ, SNOT-20, and LKE scores

were significantly worse for patients with malignant tumors relative to benign tumors. Furthermore, patients with advanced stage T3 and T4 disease had worse scores by SNOT-20, ASBQ, and LKE compared with T1 and T2 tumors. The addition of postoperative radiation and/or chemotherapy also statistically impacted SNOT-20, ASBQ, and LKE scores. The use of adjunct open approaches did not statistically change QOL scores, although ASBQ trended toward significance. The EQ-5D did not significantly differ between the benign and malignant groups in the study. The findings from the present analysis corroborate previous QOL work assessing surgical management of sinonasal and skull base neoplasms. Gil et al. evaluated QOL using ASBQ in 40 patients undergoing the subcranial approach for extirpation of skull base tumors.13 Malignant histology was noted to be the most influential factor in reducing the overall ASBQ score. Radiotherapy, old age, comorbidity, and wide resection also significantly worsened QOL scores in specific domains. Interestingly, the present study mirrors the aforementioned findings in a similar patient cohort managed by the endoscopic approach, with higher-stage malignant tumors and postoperative CRT adversely affecting QOL scores. This would suggest that intrinsic variables related to the presenting skull base pathology (i.e., malignant histology and stage) and associated treatment may be a better predictor of QOL, irrespective of the surgical technique used to extirpate the tumor. In a follow-up study, Abergel et al. compared QOL after transnasal endoscopic and subcranial skull base resection for 78 benign and malignant tumors.6 Univariate and multivariate analyses showed that patients undergoing endoscopic surgery reported significantly better scores in physical function and impact on emotional domains, with

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clinically significant differences. In contrast, all patients in the current analysis underwent surgery using endoscopy as the primary treatment modality, with only 15 patients requiring adjunct open approaches. Statistically significant differences were not observed in endoscopic versus endoscopic-assisted/open cases. At the very least, the data suggest that patients undergoing endoscopic resection have similar outcomes to open procedures. It is possible that the inclusion of a larger number of adjunct open cases may have resulted in statistical significance, favoring the purely endoscopic approach in improving postoperative QOL. McCoul et al. prospectively assessed SNOT-22 and ASBQ scores in 85 patients undergoing endoscopic management of pituitary and nonpituitary pathology.9 Overall scores on the ASBQ did not differ significantly between preoperative and postoperative visits at 3 and 6 weeks. ASBQ scores improved at 3 months, which were maintained at 6 months postoperatively. The mean ASBQ scores of 3.78 and 3.31 for benign and malignant neoplasms in the present study compare favorably with the ASBQ score of 3.9 reported by McCoul et al. at 6 months, especially because the majority of the tumors in their series were benign. Similarly, Abergel et al. reported ASBQ scores ranging from 2.78 to 3.10 in the six domains for patients undergoing the endoscopic approach.6 Given that both benign and malignant tumors were included in their cohort, the lower score is not unexpected, given that cases with malignant histology likely had lower ASBQ scores. SNOT-20, a surrogate marker of sinonasal morbidity in patients with rhinosinusitis, has been applied to measure rhinologic outcomes assessing QOL after skull base surgery in several studies.8–10,23 Balaker et al. evaluated differences in SNOT-20 scores between three postsurgical time intervals versus baseline in 69 patients undergoing endoscopic anterior skull base surgery.23 Patients experienced statistical worsening of symptoms in the first 3 months, especially in the nasal domain. These symptoms returned to baseline within 6–9 months, except for postnasal discharge. Similarly, Pant et al. assessed SNOT-20 scores in 51 patients undergoing endonasal skull base surgery.8 Although a transient increase in scores was noted at 1–3 months, this statistically improved at 6–12 months. In the present analysis, the SNOT-20 scores at the last follow-up were 0.50 and 0.95 for patients with benign and malignant tumors, respectively. This is in congruence with 0.81 reported by McCoul et al. at 1 year.9 This also underscores the adverse impact of the malignant pathology of symptom scores, given the almost twofold difference between benign and malignant neoplasms. LKE scores were used to better ascertain the status of the postoperative tumor cavity in this patient group. LKE scores of 2.24 and 4.42 were calculated for the malignant and benign groups, respectively. The statistically higher scores for malignant tumors again highlight the greater rhinologic morbidity for this group. The exact reasons for this difference are not definitively known but could be related to potentially wider resection for malignant cases and use of adjunct CRT. This, in turn, may result in ongoing physiological dysfunction, with purulent drainage, crusting, and scarring resulting in higher SNOT-20 scores. This also emphasizes the need for aggressive postoperative management in this patient group, with serial debridement, frequent saline irrigations, and culture-directed antibiotics for sinonasal exacerbations. A important aim of the present study was to perform a comparison between the various QOL measures and between the QOL measures and the LKE. A strong correlation was found between the ASBQ and the SNOT-20 instruments. This supports the recent work by McCoul et al. who showed that the two scores correlated at r ⬍ ⫺0.50 at all time points.9 This is not surprising because both instruments measure QOL based on psychometric and rhinologic symptoms. The ASBQ also strongly correlated to the EQ-5D. However, given that EQ-5D did not differentiate between any of the assessed variables in this study, it is likely to be too nonspecific to use as a QOL metric after skull base surgery. The LKE as a whole correlated weakly with the other QOL

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instruments, with the exception of moderate correlation to the SNOT20. This has previously been noted during correlation between endoscopic scores and the Rhinosinusitis Disability Index in patients with chronic rhinosinusitis.11 In this study, although improvements in postoperative endoscopic scores were significantly correlated to improvement in subscale scores on the RSDI, the correlations were relatively weak and only explained a portion of the improvement in QOL. Given the lack of a single ideal metric to measure symptom and endoscopic morbidity, the use of multiple instruments in evaluating QOL in skull base patients could provide complementary information to guide patient care. Important limitations of the study must be considered. Similar to previous QOL studies in skull base surgery, a large sample size is difficult to attain. The rarity of these tumors often precludes histologyspecific investigations, and even with pooling all tumors into a single sample, study populations remain relatively small. In addition, the data collected in this study were derived from a single data point in the postoperative period. Additional data points obtained preoperatively and at set intervals in the postoperative period could facilitate a more robust data analysis and are currently an ongoing effort to gather additional prospective QOL data. Finally, multi-institutional reporting could be used to improve the study sample size, confirm study results, and identify additional clinically significant differences to identify patients at risk for low QOL in the posttreatment period.

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The present study assessed QOL metrics in 71 patients undergoing endoscopic skull base surgery for benign and malignant tumors. Comparative analysis showed worsened postoperative QOL in patients with malignant tumors, especially with advanced T stage and undergoing postoperative CRT. Given the quantifiable QOL changes noted in this patient group, the concurrent use of multiple instruments may better predict outcomes after endoscopic tumor surgery and guide patient counseling in the pre- and postoperative period.

REFERENCES 1.

2.

3.

4. 5.

6.

7.

8. 9.

10.

11.

Patel SG, Singh B, Polluri A, et al. Craniofacial surgery for malignant skull base tumors: Report of an international collaborative study. Cancer 98:1179–1187, 2003. Luong A, Citardi MJ, and Batra PS. Management of sinonasal malignant neoplasms: Defining the role of endoscopy. Am J Rhinol Allergy 24:150–155, 2010. Nicolai P, Battaglia P, Bignami M, et al. Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: A 10-year experience. Am J Rhinol 22:308–316, 2008. Gil Z, and Fliss DM. Quality of life in patients with skull base tumors: Current status and future challenges. Skull Base 20:11–18, 2010. Abergel A, Fliss DM, Margalit N, and Gil Z. A prospective evaluation of short-term health-related quality of life in patients undergoing anterior skull base surgery. Skull Base 20:27–33, 2010. Abergel A, Cavel O, Margalit N, et al. Comparison of quality of life after transnasal endoscopic vs open skull base tumor resection. Arch Otolaryngol Head Neck Surg 138:142–147, 2012. Ransom ER, Doghramji L, Palmer JN, and Chiu AG. Global and disease-specific health-related quality of life after complete endoscopic resection of anterior skull base neoplasms. Am J Rhinol Allergy 26:76–79, 2012. Pant H, Bhatki AM, Snyderman CH, et al. Quality of life following endonasal skull base surgery. Skull Base 20:35–40, 2010. McCoul ED, Anand VK, Bedrosian JC, and Schwartz TH. Endoscopic skull base surgery and its impact on sinonasal-related quality of life. Int Forum Allergy Rhinol 2:174–181, 2012. McCoul ED, Anand VK, and Schwartz TH. Improvements in sitespecific quality of life 6 months after endoscopic anterior skull base surgery: A prospective study. J Neurosurg 117:498–506, 2012. Mace JC, Michael YL, Carlson NE, et al. Correlations between endoscopy score and quality of life changes after sinus surgery. Arch Otolaryngol Head Neck Surg 136:340–346, 2010.

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12.

13.

14. 15. 16.

17.

Piccirillo JF, Merritt MG Jr, and Richards ML. Psychometric and clinometric validity of the 20-Item Sino-Nasal Outcome Test (SNOT20). Otolaryngol Head Neck Surg 126:41–47, 2002. Gil Z, Abergel A, Spektor S, et al. Quality of life following surgery for anterior skull base tumors. Arch Otolaryngol Head Neck Surg 129: 1303–1309, 2003. Gil Z, Abergel A, Spektor S, et al. Development of a cancer-specific anterior skull base quality-of-life questionnaire. J Neurosurg 100:813–819, 2004. The EuroQol Group. EuroQol—A new facility for the measurement of health-related quality of life. Health Policy 16:199–208, 1990. Brazier J, Jones N, and Kind P. Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire. Qual Life Res 2:169–180, 1993. Hurst NP, Kind P, Ruta D, et al. Measuring health-related quality of life in rheumatoid arthritis: Validity, responsiveness and reliability of EuroQol (EQ-5D). Br J Rheumatol 36:551–559, 1997.

18.

19.

20.

21. 22. 23.

Lund VJ, and Kennedy DW. Quantification for staging sinusitis. The Staging and Therapy Group. Ann Otol Rhinol Laryngol Suppl 167: 17–21, 1995. Batra PS. Minimally invasive endoscopic resection of sinonasal and anterior skull base malignant neoplasms. Expert Rev Med Devices 7:781–791, 2010. Eloy JA, Vivero RJ, Hoang K, et al. Comparison of transnasal endoscopic and open craniofacial resection for malignant tumors of the anterior skull base. Laryngoscope 119:834–840, 2009. Harvey RJ, and Dalgorf DM. Chapter 10: Sinonasal malignancies. Am J Rhinol Allergy 27:S35–S38, 2013. Hennessey PT, and Reh DD. Chapter 9: Benign sinonasal neoplasms. Am J Rhinol Allergy 27:S31–S34, 2013. Balaker AE, Bergsneider M, Martin NA, et al. Evolution of sinonasal symptoms following endoscopic anterior skull base surgery. Skull Base 20:245–251, 2010. e

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Comparative analysis of quality-of-life metrics after endoscopic surgery for sinonasal neoplasms.

The objective of this study was to evaluate the postoperative quality of life (QOL) after endoscopic resection of sinus and skull base neoplasms using...
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