A safe approach to surgery for pituitary and skull base lesions during the COVID-19 pandemic

Kolias, Angelos G.; Tysome, James R.; Donnelly, Neil; Sharma, Rishi; Gkrania‐Klotsas, Effrossyni; Budohoski, Karol P.; Karcheva, S; Adapa, R.; Lawes, Indu; Gurnell, Mark; Hutchinson, Peter J.; Bance, Manohar; Axon, Patrick; Santarius, Thomas

doi:10.1007/s00701-020-04396-5

Cited by 24 publications

(24 citation statements)

References 8 publications

(10 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In cases for which the endonasal route represents the most favored corridor, prioritizing those cases that would benefit from that approach in the context of the pandemic remains challenging. 10 The place of elective and urgent cases remains one of the main controversies in this context, 11 and recent guidelines from the pituitary society highlighted the risk of transmission to healthcare workers during EES as one of the main challenges of pituitary surgery during the pandemic and also stressed the current paucity of data regarding EES. 12 Our study aims to describe common practices and provide a basis on which to construct recommendations for the management of EES in the setting of the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

Early practices in endonasal skull base surgery during the COVID-19 pandemic: a global survey

Champagne¹,

McDowell²,

Wang

et al. 2020

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVEDuring 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.METHODSThe authors conducted a web-based survey of skull base surgeons worldwide. Different practices by geographic region and COVID-19 prevalence were analyzed.RESULTSOne 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 more in 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.CONCLUSIONSThis 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.

show abstract

Section: Discussionmentioning

confidence: 99%

Early practices in endonasal skull base surgery during the COVID-19 pandemic: a global survey

Champagne¹,

McDowell²,

Wang

et al. 2020

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…Although some sources have advocated for the shift of extended endonasal approaches to intracranial corridors (e.g. pituitary pathology, CSF leak repair), we believe that in the considerable majority of cases, this may not be prudent [28,124]. When considering patient outcomes as well as risks to the healthcare teams, our expert panel consensus recommends that the trans-nasal route remain as the preferred surgical pathway for the majority of pathologies that have migrated to this route during the pre-COVID era.…”

Section: Post-operative Considerationsmentioning

confidence: 90%

“…A study from Wuhan looking at correlation between chest CT and RT-PCR found chest CT to be more sensitive in detecting COVID-19 [24][25][26]. Others have recommended employing two RT-PCR testing in sequence, several days apart [27][28][29]. Finally, some have advocated for two RT-PCR tests, followed by chest imaging [30].…”

Section: Optimal Pre-operative Testingmentioning

confidence: 99%

CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on rhinologic and skull base surgery during the COVID-19 pandemic

Chan

Banglawala

Chin

et al. 2020

Journal of Otolaryngology - Head & Neck Surgery

View full text Add to dashboard Cite

Healthcare services in many countries have been partially or completely disrupted by the Coronavirus (COVID-19) pandemic since its onset in the end of 2019. Amongst the most impacted are the elective medical and surgical services in order to conserve resources to care for COVID-19 patients. As the number of infected patients decrease across Canada, elective surgeries are being restarted in a staged manner. Since Otolaryngologists – Head & Neck Surgeons manage surgical diseases of the upper aerodigestive tract where the highest viral load reside, it is imperative that these surgeries resume in a safe manner. The aim of this document is to compile the current best evidence available and provide expert consensus on the safe restart of rhinologic and skull base surgeries while discussing the pre-operative, intra-operative, and post-operative care and tips. Risk assessment, patient selection, case triage, and pre-operative COVID-19 testing will be analyzed and discussed. These guidelines will also consider the optimal use of personal protective equipment for specific cases, general and specific operative room precautions, and practical tips of intra-operative maneuvers to optimize patient and provider safety. Given that the literature surrounding COVID-19 is rapidly evolving, these recommendations will serve to start our specialty back into elective rhinologic surgeries over the next months and they may change as we learn more about this disease.

show abstract

“…In most cases, TSS remains the safest, most effective, and most efficient approach to pituitary tumors. In a series of 9 consecutive patients without COVID-19 undergoing pituitary and skull base surgery during the pandemic, Kolias et al [8] reported that none of the patients or staff contracted COVID-19 following adoption of a standardized risk-mitigation strategy. In the rare instances where a patient with COVID-19 requires emergent surgery that cannot be deferred, alternative transcranial approaches may be considered (avoiding nasal mucosa).…”

Section: Recommendations For Pituitary Surgerymentioning

confidence: 99%

Pituitary society guidance: pituitary disease management and patient care recommendations during the COVID-19 pandemic—an international perspective

et al. 2020

Self Cite

View full text Add to dashboard Cite

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the viral strain that has caused the coronavirus disease 2019 (COVID-19) pandemic, has presented healthcare systems around the world with an unprecedented challenge. In locations with significant rates of viral transmission, social distancing measures and enforced 'lockdowns' are the new 'norm' as governments try to prevent healthcare services from being overwhelmed. However, with these measures have come important challenges for the delivery of existing services for other diseases and conditions. The clinical care of patients with pituitary disorders typically involves a multidisciplinary team, working in concert to deliver timely, often complex, disease investigation and management, including pituitary surgery. COVID-19 has brought about major disruption to such services, limiting access to care and opportunities for testing (both laboratory and radiological), and dramatically reducing the ability to safely undertake transsphenoidal surgery. In the absence of clinical trials to guide management of patients with pituitary disease during the COVID-19 pandemic, herein the Professional Education Committee of the Pituitary Society proposes guidance for continued safe management and care of this population.

show abstract

A safe approach to surgery for pituitary and skull base lesions during the COVID-19 pandemic

Cited by 24 publications

References 8 publications

Early practices in endonasal skull base surgery during the COVID-19 pandemic: a global survey

Early practices in endonasal skull base surgery during the COVID-19 pandemic: a global survey

CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on rhinologic and skull base surgery during the COVID-19 pandemic

Pituitary society guidance: pituitary disease management and patient care recommendations during the COVID-19 pandemic—an international perspective

Contact Info

Product

Resources

About