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Quality of life and emotional burden after transnasal and transcranial anterior skull base surgery

  • Original Article - Brain Tumors
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Abstract

Objective

To analyze psychopathological outcome and health-related quality of life (QOL) for cohorts of patients undergoing transcranial or transnasal anterior skull base surgery.

Methods

A prospective study of patients undergoing elective surgery for various entities of the anterior skull base was performed. Evaluation for depression (ADS-K score) and anxiety (PTSS, STAI-S, STAI-T, and ASI-3 scores) was done before surgery, at 3 and 12 months after surgery. The correlation between preoperative psychological burden and postoperative quality of life as measured by the SF-36 and EuroQol questionnaires was analyzed. Incidence and influence of these psychiatric comorbidities on clinical outcome were examined and compared between transnasal and transcranial subgroups.

Results

We included 54 patients scheduled for surgery of a pituitary adenoma or meningioma of the anterior skull base between January 2013 and July 2017. Of these, a cohort of 40 (74.1%) completed follow-up interviews after 3 and 12 months. There were 60.0% female patients, median age was 57 years. 57.5% of patients had a meningioma and were operated transcranially, while 42.5% of patients received transnasal surgery for pituitary adenoma. The proportion of pathological anxiety scores significantly decreased from 75.0 to 45.0% (p = 0.002), without difference between transnasal and transcranial subgroups. After 3 months, mean EuroQol VAS score non-significantly increased by 0.07 (p = 0.236) across the entire cohort without significant difference between transcranial and transnasal subgroups (p = 0.478). The transnasal cohort tended to score higher in anxiety scores, whereas the transcranial cohort demonstrated higher depression scores without significant difference, respectively. The individually declared emotional burden significantly decreased from 6.7 to 4.0 on the ten-point Likert scale (p < 0.001) equally for both subgroups (transnasal, − 2.3; transcranial, − 3.0; p = 0.174). On last examination, about half of the patients in each subgroup (41.2% vs. 52.2%; p = 0.491) expressed a considerable recovery of preoperative bodily complaints such as headaches, dizziness, and unrest defined as a score of at least 8 on the Likert scaled item.

Conclusion

Both transnasal and transcranial approaches yield favorable postoperative QOL and psychopathological outcomes. The postoperative increase in QOL is partly influenced by preoperative expression of mental distress, which tends to resolve postoperatively.

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Abbreviations

ADS-K:

Center of epidemiology depression scale (Allgemeine Depressionsskala)

ASI-3:

Anxiety Sensitivity Index 3

EuroQol VAS:

EQ VAS

Fig.:

Figure

MCS:

Mental component score

PCS:

Physical component score

rANOVA:

Repeated measures analysis of variance

SF-36:

Short form 36

STAI-S:

State and trait anxiety inventory – state

STAI-T:

State and trait anxiety inventory – trait

QOL:

Quality of life

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Funding

The study was fully financed by the Department of Neurosurgery

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Authors and Affiliations

  1. Department of Neurosurgery, Technische Universität München, Munich, Germany

    Arthur Wagner, Verena Kammermeier, Ann-Kathrin Joerger, Nicole Lange, Bernhard Meyer & Ehab Shiban

  2. Department of Clinical Psychology, Private University of Applied Sciences, Göttingen, Germany

    Youssef Shiban

  3. Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany

    Florian Ringel

  4. Department of Neurosurgery, Universitätsklinikum Augsburg, Augsburg, Germany

    Ehab Shiban

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  1. Arthur Wagner
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Correspondence to Arthur Wagner.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study group acquired approval by the local ethics committee (Ethikkommission der Technischen Universität München, registration no. 409/13.

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Wagner, A., Shiban, Y., Kammermeier, V. et al. Quality of life and emotional burden after transnasal and transcranial anterior skull base surgery. Acta Neurochir 161, 2527–2537 (2019). https://doi.org/10.1007/s00701-019-04062-5

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