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357

ICAR SINONASAL TUMORS

TABLE XXXII.2 (Continued)

Clinical endpoints ASBQ scores before,

Study

Year LOE Study design Study groups

Conclusion

1. Scores decreased from baseline to 1 month postoperatively, but increased again to baseline by 1 year 2. Lower postoperative scores were associated with older age, extended surgical approach, and receipt of postoperative RT 1. There was a 47% surgical complication rate, most commonly local infection 2. Other complications included frontal lobe contusion, dysphagia, speech disturbance, altered facial sensation, visual disturbance, and facial motor impairment 3. KPS on discharge was 90 in 13 patients, 80 in 6, and 70 or less in the remainder

Castelnuovo et al. 1664

2013 4

Retrospective case series

153 patients treated for skull base and SNM viaEEA

1 month after, and 1 year after surgical treatment

Mine et al. 185

2011 4

Retrospective case series

32 patients with SNM undergoing combined CFR

1. Surgical

complications

2. KPSon

discharge

Abbreviations: ASBQ, Anterior Skull Base Questionnaire; EQ-5D, EuroQOL 5 Dimension questionnaire; EEA, endoscopic endonasal approach; KPS, Karnof sky Performance Scale; NSS, Nasal Symptom Score; RT, radiation therapy; SNM, sinonasal malignancy; SNOT, Sino-Nasal Outcome Test; UPSIT, University of Pennsylvania Smell Identification Test.

rience visual complications, including diplopia, enoph thalmos, epiphora, dacryocystitis, and visual loss. 2088 De Almeida et al. found that those undergoing endoscopic tumor resection were more than five times as likely to report postoperative nasal symptoms. 2075 A literature review by the same group, however, found conflicting evi dence regarding the superiority of neurologic and visual outcomes with either approach, and Deckard et al. found no difference in sinonasal or general QOL between open and endoscopic groups. 2085,2124 Overall, the literature is limited by selection bias, with endoscopic approaches tending to encompass lower stage tumors, and low levels of evidence, as RCTs are not feasible. Examining morbidity of the endoscopic approach in more detail, Bhenswala et al. performed a meta-analysis of postoperative SNOT-22 scores, and found that scores ini tially worsened within the first month after surgery by 6.23 points, but subsequently improved to above baseline by 12 weeks (3.52 points) and 52 weeks (5.96). 2125 This trajec tory is confirmed by multiple other reports. 2090,2093,2126,2127 Pant et al. found a similar timeline of symptom dura tion as measured by the SNOT-22, and patients identified loss of smell/taste, nasal obstruction, postnasal drip, wak ing up at night, and lack of a good night sleep as the most important items affecting them. 2115 In contrast, Har row et al. and Cavel et al. both found that patients had persistent symptoms postoperatively. 2089,2128 Impaired

smell, appetite loss, recurrent nasal secretions, visual dis turbances, and interference with work and family life were identified by patients as most bothersome. 2128 Many patients who undergo endoscopic resection of their tumors received postoperative RT and chemotherapy as well, adding to their morbidity. Olfactory disturbance has received particular attention due to its anatomic association with surgical technique. Schreiber et al. examined a cohort of patients with ITAC and found, as expected, that unilateral surgery was asso ciated with greater olfactory preservation. 374 Tajudeen et al. reported similar findings with unilateral approach to ONB. 1361 A review of olfactory outcomes after EEA by Yin et al. found that hyposmia was commonly cited as a signifi cant patient complaint. 1512 The literature is varied on exact incidence, however, as the degree of smell loss is highly dependent on if tumors involve the olfactory groove and histology, with up to 100% anosmia seen in some studies on olfactory neuroblastoma. 2111,2129 The method of skull base reconstruction and NSF use has also received considerable attention in the literature. Pant et al. found better ASBQ scores in patients who did not receive NSF. 2115 In contrast, Harvey et al. found no dif ference in postoperative nasal symptom score and SNOT 22 scores between the cohort with and without NSF. 2130 Similarly, Hanson et al. found no significant difference in sense of smell in patients undergoing NSF versus those