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

Abstract

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.

The worldwide impact of COVID-19 on cancer care: A meta-analysis of surveys published after the first wave of the pandemic

“…PPE were routinely used by workers in 80% [c.i. 61%-94%, I 2 99%, number of studies: 16 ( 18 , 26 , 31 , 33 – 35 , 37 – 39 , 44 , 52 , 53 , 59 , 61 , 63 , 65 )] of cases. No moderator was alone able to explain the true heterogeneity.…”

Pituitary Disorders and COVID-19, Reimagining Care: The Pandemic A Year and Counting

“…Testing for COVID-19 at 48-72 h prior to any surgery is advised (45,46), especially for pituitary surgery where risks are higher for patients, but also for staff (43,47). Intensified preoperative screening, even in asymptomatic patients, reverse transcription polymerase chain reaction (rRT-PCR) for all symptomatic cases, and an increased use of airborne PPE was reported in a large international survey to associated with decreased reports of COVID-19 transmission during transsphenoidal surgery (TSS) (45). Interestingly in the survey, patients were reportedly asymptomatic 32% of the time in cases of healthcare transmission (45).…”

The pituitary gland in the COVID-19 pandemic: A narrative review of the literature

“…Pituitary adenomas and skull base procedures were generally viewed as elective procedures and often postponed or cancelled altogether. [62] Furthermore, Mazzatenta et al [63] compared their non COVID19-related workload in the neurosurgery department for 2020 to the 2 previous years. As expected, the surgical procedures in 2020 constituted only 26%-28% of the previous 2 years.…”

“…[72] Among the issues related to this challenge is the typical scenario of asymptomatic COVID-19 cases where the risk of transmission might be exacerbated by the lack of vigilance and the not adapting to the strict contact measures otherwise enforced in known COVID-19-infected cases. Champagne et al [62] explored the neurosurgical practices in different geographical zones stratified according to the prevalence of COVID-19. The group reported a higher rate of viral transmission to healthcare providers in medium prevalence zones than high prevalence zones.…”

“…Routine screening appears to alleviate the risk of COVID transmission even in high prevalence areas compared to other areas where such measures were not deployed routinely. [62,70] Furthermore, Iorio-Morin et al [70] stressed adoping a set of general contact precautions in every case, including the use of appropriate PPE, negative pressure operating rooms, limiting traffic through OR, and limiting the number of healthcare providers dealing with infected cases, as well as dedicating a designated anesthetic team to handle such cases.…”