Postoperative Pain Outcomes in Patients with Fibrous Dysplasia Involving the Skull Base: Systematic Review and Meta-analysis

Introduction: While patients with skull base fibrous dysplasia (SBFD) commonly undergo surgery for refractory neurological symptoms or deformity, postoperative improvement of pain in this group of patients remains questionable. This study aims to review the available evidence on pain outcomes in patients undergoing skull base surgery for SBFD.

Methods: A comprehensive literature search was conducted for studies investigating postoperative outcomes in patients with SBFD. Random-effects model meta-analysis of pooled data was performed, with improvement in pain, neurological symptoms, and the need for revisions being our primary endpoints.

Results: Thirteen studies yielding 48 patients were analyzed. Mean age at surgery was 22.9 years, and the mean follow-up duration was 44.5 months. Polyostotic disease comprised the majority of cases (68.1%, 95% CI: 47.4 - 86.5%). Thirty-seven patients underwent surgery for a primary complaint of refractory pain (93.8%, 95% CI: 75.4 - 100%). Preoperatively, neurological symptoms were present in 21 patients (42%, 95% CI: 19.2 - 66.1%), and included: Visual field defects (VFD) in 44.2% of patients; Diplopia in 23.3% of patients; Decreased visual acuity in 18.6% of patients; Hearing impairment in 9.3% of patients; Anosmia in 4.6% of patients. Postoperatively, improvement in pain was noted in 28 patients (83%, 95% CI: 52.9 - 100%). Neurological symptoms improved in 14/21 patients (79%, 95% CI: 38.2 - 100%). Revisions were required in 3 patients (0.02%, 95% CI: 0.01 - 15.5%), and none of the revisions were performed due to pain.

Conclusion : This review highlights the safety and efficiency of skull base surgery in alleviating fibrous dysplasia-related pain. Our findings may assist surgeons and patients in tailoring decision-making with respect to chronic pain in patients with SBFD.