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Journal Club

Tumor/Skull Base

Surgical outcomes and longitudinal quality of life after endoscopic endonasal surgery for anterior skull base meningioma

Journal of Neurosurgery | 2022

Rapid review note

Journal Club is a rapid, AI-assisted appraisal layer. It highlights study design, effect estimates, and practice relevance, but it is still a briefing, not a replacement for the paper.

For education only. Not medical advice.

Paper snapshot

Rapid study overview

Open paper

DOI

10.3171/2021.11.JNS212090

PMID

N/A

PICO

Population

Fifty consecutively operated anterior skull base meningiomas managed with an endoscopic endonasal approach by 3 skull base teams in Melbourne.

Intervention

Endoscopic endonasal resection.

Comparator

No direct surgical control group; within-cohort analysis of predictors of outcome and quality of life.

Outcomes

Visual outcomes, extent of resection, sinonasal-specific quality of life, overall quality of life, and predictors of improvement.

Design

Type

Prospectively collected cohort study

Randomized

No

Multicenter

Yes

Blinded

N/A

Follow-up

Longitudinal QOL through 12 months

Primary endpoint

Longitudinal sinonasal and overall quality of life across the first postoperative year.

Secondary endpoints

  • Visual improvement
  • Extent of resection
  • Predictors of postoperative QOL improvement

Practice impact

What this means

This study is useful because it tells patients what recovery after endoscopic skull base meningioma surgery actually feels like. Quality of life dips early, recovers by roughly 6 weeks, and improves beyond baseline by 6 months, especially when vision improves. That is valuable counseling data, but it is not a head-to-head proof that endoscopy is the best route for every anterior skull base meningioma.

Bottom line

This paper is best used for counseling: after endoscopic resection of selected anterior skull base meningiomas, quality of life usually worsens for a few weeks, returns to baseline by about 6 weeks, and improves beyond baseline by 6 months, especially when vision improves.

Strength of evidence

low

Recommendation

do not change

Why it matters

  • The study provides useful prospective recovery data but no direct comparator.
  • Visual and QOL signals are encouraging, yet they come from a selected endoscopic cohort.
  • The paper is more practice-informing for counseling than practice-changing for route selection.

What would change my mind

  • A matched comparative study showing that endoscopic surgery produces better long-term QOL or visual outcomes than transcranial surgery in similar tumors.
  • Larger multicenter cohorts confirming the same recovery timeline and patient-reported gains.

Critical appraisal

How strong is the paper?

Methods critique

Risk of bias

This is a single-arm cohort without a transcranial comparison group, so it cannot prove that endoscopic surgery is superior to other approaches.

Confounding

Patients were selected for an endoscopic approach based on anatomy and resectability, and those same selection factors likely influenced visual and quality-of-life outcomes.

Missing data

Not every patient had reached all long-term milestones at analysis, which the authors note as a limitation for 6- and 12-month patient-reported outcomes.

Multiplicity

The paper tested multiple time points and several multivariable predictors across ASBQ and SNOT-22 outcomes, which increases the risk of chance findings in secondary associations.

Notes

  • The study is most valuable for counseling patients about the expected time course of recovery.
  • The authors acknowledge that ASBQ and SNOT-22 were not specifically validated for endoscopic meningioma cohorts.
  • Visual recovery appeared central to later QOL gains.

Stats check

NNT

N/A

Effect sizes

  • Visual improvement occurred in 73.1% of patients with preoperative field deficits.
  • Worse baseline ASBQ score and visual improvement predicted 6-month QOL gain (visual improvement beta 19.5, p=0.01; baseline ASBQ beta -0.49, p=0.01).
  • Tumor height was associated with failure of visual improvement (p=0.04).

Absolute effects

  • Median SNOT-22 worsened from 9 preoperatively to 40 on postoperative day 1, then returned near baseline by 6 weeks at 14.5.
  • Median ASBQ fell from 125 preoperatively to 108 at 3 weeks, returned near baseline by 6 weeks at 121, and improved to 144 by 6 months.
  • Overall QOL improved above baseline after 6 months and remained improved at 12 months.

Concerns

  • Without a transcranial control group, the paper cannot support a firm superiority claim for the endoscopic approach.
  • Patient-reported QOL metrics can be influenced by selection and expectation effects.
  • Later follow-up points are harder to interpret when not all patients had reached them at analysis.

External validity

Who it applies to

Patients with accessible midline anterior skull base meningiomas evaluated by experienced endoscopic skull base teams.

Who it does not

Patients with anatomy better suited to transcranial surgery, major lateral extension, or centers without mature endoscopic skull base workflows.

Generalizability notes

  • The data are strongest for patient counseling about recovery trajectory after endoscopic surgery.
  • Visual benefit and QOL recovery may not generalize to tumors outside the accessible midline endonasal corridor.
  • The 3-team Melbourne experience may outperform lower-volume programs.

Evidence trace

Source trace and metadata

Citations (4)

claim_id

methods_critique.risk_of_bias

locator

p. 1

claim_id

stats_check.effect_sizes

locator

p. 1

claim_id

stats_check.absolute_effects

locator

p. 6

claim_id

practice_impact.bottom_line

locator

p. 8

Metadata

Generated at

2026-03-08T16:15:00-05:00

Version

manual-pdf-repair-v1