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Quality of Life After Combined Endonasal Endoscopic Odontoidectomy and Posterior Suboccipital Decompression and Fusion.

TitleQuality of Life After Combined Endonasal Endoscopic Odontoidectomy and Posterior Suboccipital Decompression and Fusion.
Publication TypeJournal Article
Year of Publication2018
AuthorsOttenhausen M, Alalade AF, Rumalla K, Nair P, Baaj A, Härtl R, Kacker A, Greenfield JP, Anand VK, Schwartz TH
JournalWorld Neurosurg
Volume116
Paginatione571-e576
Date Published2018 Aug
ISSN1878-8769
KeywordsAdolescent, Adult, Child, Combined Modality Therapy, Decompression, Surgical, Female, Follow-Up Studies, Humans, Male, Middle Aged, Nasal Cavity, Neuroendoscopy, Neurosurgical Procedures, Occipital Bone, Odontoid Process, Quality of Life, Spinal Fusion, Surveys and Questionnaires, Young Adult
Abstract

BACKGROUND: Basilar invagination can result from systemic diseases that can weaken structural integrity of the craniocervical junction. Definitive treatment often requires ventral decompression and posterior decompression and fusion. Endonasal odontoidectomy is a relatively new minimal access procedure; quality of life (QOL) after this procedure has not been reported.

METHODS: We reviewed a consecutive database of endonasal odontoidectomy cases and identified patients having posterior decompression and fusion. Two QOL questionnaires were administered postoperatively: Sino-Nasal Outcome Test and 36-Item Short Form Survey. Comparisons with other endonasal or Chiari procedures were performed.

RESULTS: The study comprised 14 patients; 79% had Chiari malformation in addition to basilar invagination. Mean follow-up was 17.2 months. Symptomatic improvement occurred in 78.6% after surgery. Average postoperative Sino-Nasal Outcome Test scores were 39.2 ± 17.93, with worst scores in areas related to fatigue and sleep patterns but not nasal function. 36-Item Short Form Survey scores were lower in areas of physical function and general health but better for emotional health and pain. Compared with patients undergoing Chiari malformation surgery without endonasal odontoid resection or fusion, patients undergoing odontoidectomy had higher QOL in areas of role emotional, emotional well-being, and pain but worse QOL in general health and role physical.

CONCLUSIONS: Patients undergoing posterior decompression and fusion with endonasal odontoidectomy do well after surgery with respect to nasal function and emotional health. Patients who also have severe basilar invagination associated with systemic diseases demonstrate reduced QOL after surgery in areas of physical function and sleep leading to fatigue, irritability, and concentration difficulty, likely related to their systemic disease.

DOI10.1016/j.wneu.2018.05.041
Alternate JournalWorld Neurosurg
PubMed ID29775769