Surgical outcomes and longitudinal quality of life after endoscopic endonasal resection of craniopharyngioma.
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BACKGROUND: Craniopharyngiomas present a complex challenge for the neurosurgeon. The imperative is finding the balance between optimizing the extent of resection, decompressing critical structures and limiting the morbidity to the patient. The endoscopic endonasal approach is increasingly utilised for the management of craniopharyngioma, offering improved access to the suprasellar region while minimizing morbidity to the optic apparatus and neurovascular structures. Data regarding post operative quality of life outcomes remains limited in the literature. This mutli-centered prospective study evaluated surgical morbidity and patient reported outcomes measures following endoscopic endonasal resection within the Australian context. METHOD: Patients undergoing endoscopic endonasal resection for craniopharyngioma at three tertiary skull base units in Melbourne, Australia were prospectively enrolled between 2016 and 2024. Pre-operative and serial post operative assessments included gross total resection, visual outcomes, endocrine outcomes and quality of life measures. Quality of life measures were reported using the Sinonasal Outcome Test (SNOT-22) and Anterior Skull Base Questionnaire (ASBQ-35). Patients' questionnaires were collected at baseline and sequentially in the first 12 months post operatively. RESULTS: A total of 32 patients underwent endoscopic endonasal resection of craniopharyngioma over the study period. Sino-nasal specific quality of life initially worsened following surgery. As expected, day 1 SNOT-22 scores were significantly worse compared to baseline (mean difference -23.8 (95%CI: -41.4 to -6.17, p = 0.004). Based on the minimum clinically important difference (MCID) of 8.9, SNOT-22 scores remained worse at day 1, 3 and 7 before falling below MCID at week 3. This trend continued out to 6 and 12 months post-operatively with further reduction in mean difference to near zero at 12 months post-operatively (mean difference -0.1 (95%CI: -20.6 to 20.3). In the nasal subdomain, there was a significant increase in symptoms at Day 1 (p = 0.034) and 3 (p = 0.001) while no significant difference was found beginning at day 7 (p = 0.099). Overall quality of life, as measured by the ASBQ-35, was worse at 6 weeks post-operatively compared to baseline (107.0 ± 20.5 v 119.3 ± 18.5; mean change 12.1 (95%CI: 0.5-23.7, p = 0.042). This had returned to normal by 3 months and was maintained at 12 months post-operatively. CONCLUSION: The endoscopic endonasal is a safe technique with good tumour control and acceptable visual and endocrine outcomes. Post-operative quality of life based on SNOT-22 and ASBQ appears to expediently return to baseline for patients with no evidence of long-term QOL detriment. It is the preferred technique in appropriately selected cases amongst our surgeons.