Neuropsychological outcome and quality of life following anterior craniofacial resection

Few studies address the quality of life or the neuropsychological outcome of patients following treatment of skull base neoplasms. Difficulties arise because of the inhomogeneities inherent in the diverse patient and tumor populations encountered. Paranasal sinus tumors without brain invasion were chosen as the simplest tumor-patient paradigm. Nearly all of the patients maintained a high Karnofsky Performance Status and were independent. Neuropsychological test performance was average overall on tests of attention, psychomotor speed, recognition, and word fluency. Mild impairments of motor scanning speed (frontal/parietal), fine motor coordination/dexterity of the left hand, moderate impairments of executive function (prefrontal), and fine motor coordination/dexterity of the right hand were identified. QOL self-evaluations are highly subjective. Consequently, several patients who were highly functional and without medical or physical disability reported low QOL-probably anxiety-based. It should be noted that poor QOL based on neurologic or head and neck symptomatology was very infrequent. Anterior craniofacial resection and other indicated adjunctive therapies for paranasal sinus tumors do not adversely affect independence. Neuropsychological assessments do identify impairments in this patient population following treatment. The impairments noted were generally mild and very amendable to intervention. While 30% of the patients in this study reported an overall poor quality of life, this did not seem to be related to the presence of neurologic or head and neck symptoms.