Comparison of Sinonasal Quality of Life between Patients undergoing Microscopic and Endoscopic Transsphenoidal Surgery for Pituitary Lesions: A Prospective Cohort Study

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 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 two surgical techniques.

Method: The study design was a nonblinded, prospective, and cohort study. Adult patients with sellar pathology and planned transsphenoidal surgery were screened at four pituitary centers in the United States 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 Short-Form (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 patients were enrolled in the study. Overall, 218 were analyzed (111 microsurgery patients and 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 and 13% in the endoscopic surgery group, p = 0.15). Endoscopic technique patients were more likely to have postoperative nasal debridements (p < 0.001). ASK Nasal-12 and SF-8 scores worsened substantially for both the groups at 2 weeks after surgery, but then returned to baseline at 3 months. At 3 months after surgery, endoscopic patients reported statistically better sinonasal QOL compared with microscopic patients (p = 0.02), but there were no significant differences in any of the other postoperative time points.

Conclusion: This is the first multicenter study to examine the impact of 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.