“Quality of life after endoscopic endonasal repair of spontaneous csf rhinorrhea: a dual-instrument analysis using SNOT-22 and the anterior skull base questionnaire”
Year: 2026
Type: article
Abstract: Background Spontaneous cerebrospinal fluid (CSF) rhinorrhea is an uncommon but potentially life-threatening condition, increasingly recognized as a downstream consequence of idiopathic intracranial hypertension (IIH), chronic skull base pressure erosion, and obesity. Although endoscopic endonasal repair achieves high primary success rates exceeding 93%, the impact of surgical repair on patient-reported quality of life (QoL) across its full multidimensional burden - rhinological, sleep-related, psychosocial, and functional - has not been characterized with validated instruments beyond 12 months in the published literature. Objectives To assess the magnitude, pattern, and durability of QoL improvement following endoscopic endonasal multilayer repair of spontaneous CSF rhinorrhea using two independently validated instruments - the 22-item Sino-Nasal Outcome Test (SNOT-22) and the Anterior Skull Base Questionnaire (ASBQ) - across four timepoints over 24 months. Methods Ambispective (combined retrospective and prospective) observational cohort study of 85 consecutive adults (≥ 18 years) who underwent endoscopic endonasal multilayer repair for spontaneous CSF rhinorrhea at two major tertiary referral centers in Khyber Pakhtunkhwa, Pakistan, between 15 February 2022 and 14 February 2024, with follow-up completed by 15 February 2026. Reconstruction was algorithm-driven by defect size: fascia lata/fat graft for 3–6 mm defects ( n = 28, 32.9%), middle turbinate flap (MTF) for 7–10 mm ( n = 30, 35.3%), and nasoseptal flap (NSF) for 1–2 cm ( n = 27, 31.8%). Preoperative baseline SNOT-22 and ASBQ scores were reconstructed retrospectively at item level from contemporaneous clinic documentation and structured patient recall; all postoperative scores were collected concurrently by face-to-face, clinician-administered structured interview at the scheduled 3-month, 1-year, and 2-year follow-up visits. Paired comparisons were made using the paired t-test and Wilcoxon signed-rank test. Statistical significance was set at p < 0.05. Results Mean age was 39 ± 14.3 years; 68.2% were female. The mean preoperative SNOT-22 total score was 64.5 ± 12.5, falling to 27.0 ± 8.5 at 3 months, 20.0 ± 6.5 at 1 year, and 17.5 ± 5.5 at 2 years - a reduction of 47.0 points (72.9%), exceeding the established minimal clinically important difference (MCID) of 8.9 by more than fivefold ( p < 0.001). All four SNOT-22 domains improved significantly ( p < 0.001), with the rhinologic domain showing the largest absolute gain (↓18.0 points). ASBQ total score improved from 3.0 ± 0.6 preoperatively to 4.3 ± 0.4 at 2 years (↑1.3, p < 0.001). The nasal symptoms domain showed the greatest ASBQ improvement (↑2.3); the financial status domain improved least (↑0.4). The primary surgical success rate was 97.6% at 3 months; overall success after revision surgery was 100%. Conclusions Endoscopic endonasal multilayer repair of spontaneous CSF rhinorrhea produces large, clinically significant, and durable improvements in both sinonasal-specific and skull base–specific QoL, sustained across 24 months. The rhinologic and sleep domains recover most rapidly, while olfactory and financial domains improve more slowly. These findings support routine QoL assessment as part of postoperative follow-up and underscore the multidimensional burden relief achievable in this population. To our knowledge, this is the first study restricted to spontaneous CSF rhinorrhea to apply both the SNOT-22 and the ASBQ in the same cohort with 24-month follow-up.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7225814303