December 2020 Medical Corner
Avoiding COVID Transmission During Surgery
This month the PNA Medical Corner features a study co-authored by two PNA members: Drs. Georgios Zenonos and Paul Gardner. The study looks at the best ways to avoid transmission of COVID-19 during endonasal skull base surgery. They recommend doing more intense preoperative screening in symptomatic and asymptomatic patients. They advise use of reverse transcriptase-polymerase chain reaction (RT-PCR) for any patient with symptoms. And they recommend increased use of airborne Personal Protective Equipment.
doi: 10.3171/2020. 9.FOCUS20569. 9.FOCUS20569.
Early practices in endonasal skull base surgery during the COVID-19 pandemic: a global survey
Pierre-Olivier Champagne 1, Michael M McDowell 1, Eric W Wang 1 2, Carl H Snyderman 1 2, Georgios A Zenonos 1, Paul A Gardner 1 2
• PMID: 33260127 DOI: 10.3171/2020.9.FOCUS20569
Objective: During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, endoscopic endonasal surgery (EES) is feared to be a high-risk procedure for the transmission of coronavirus disease 2019 (COVID-19). Nonetheless, data are lacking regarding the management of EES during the pandemic. The object of this study was to understand current worldwide practices pertaining to EES for skull base/pituitary tumors during the SARS-CoV-2 pandemic and provide a basis for the formulation of guidelines.
Methods: The authors conducted a web-based survey of skull base surgeons worldwide. Different practices by geographic region and COVID-19 prevalence were analyzed.
Results: One hundred thirty-five unique responses were collected. Regarding the use of personal protective equipment (PPE), North America reported using more powered air-purifying respirators (PAPRs), and Asia and Europe reported using more standard precautions. North America and Europe resorted more to reverse transcriptase-polymerase chain reaction (RT-PCR) for screening asymptomatic patients. High-prevalence countries showed a higher use of PAPRs. The medium-prevalence group reported lower RT-PCR testing for symptomatic cases, and the high-prevalence group used it significantly asymptomatic cases. Nineteen respondents reported transmission of COVID-19 to healthcare personnel during EES, with a higher rate of transmission among countries classified as having a medium prevalence of COVID-19. These specific respondents (medium prevalence) also reported a lower use of airborne PPE. In the cases of healthcare transmission, the patient was reportedly asymptomatic 32% of the time.
Conclusions: This survey gives an overview of EES practices during the SARS-CoV-2 pandemic. Intensified preoperative screening, even in asymptomatic patients, RT-PCR for all symptomatic cases, and an increased use of airborne PPE is associated with decreased reports of COVID-19 transmission during EES.
Keywords: COVID-19; endoscopic endonasal surgery; pituitary; skull base; survey.