Endoscopic endonasal skull base surgery during the COVID-19 pandemic: A developing country perspective

Abstract

Background: Although primarily a respiratory disorder, the coronavirus pandemic has paralyzed almost all aspects of health-care delivery. Emergency procedures are likely continuing in most countries, however, some of them raises certain concerns to the surgeons such as the endoscopic endonasal skull base surgeries. The aim of this study is to present the current situation from a developing country perspective in dealing with such cases at the time of the COVID-19 pandemic. Methods: A cross-sectional analytical survey was distributed among neurosurgeons who performed emergency surgeries during the COVID-19 pandemic in Cairo, Egypt, between May 8, 2020, and June 7, 2020. The survey entailed patients’ information (demographics, preoperative screening, and postoperative COVID-19 symptoms), surgical team information (demographics and postoperative COVID-19 symptoms), and operative information (personal protective equipment [PPE] utilization and basal craniectomy). Results: Our survey was completed on June 7, 2020 (16 completed, 100% response rate). The patients were screened for COVID-19 preoperatively through complete blood cell (CBC) (100%), computed tomography (CT) chest (68.8%), chest examination (50%), C-reactive protein (CRP) (50%), and serological testing (6.3%). Only 18.8% of the surgical team utilized N95 mask and goggles, 12.5% utilized face shield, and none used PAPRs. Regarding the basal craniectomy, 81.3% used Kerrison Rongeur and chisel, 25% used a high-speed drill, and 6.3% used a mucosal shaver. None of the patients developed any COVID-19 symptoms during the first 3 weeks postsurgery and one of the surgeons developed high fever with negative nasopharyngeal swabs. Conclusion: In developing countries with limited resources, preoperative screening using chest examination, CBC, and CT chest might be sufficient to replace Reverse transcription polymerase chain reaction. Developing countries require adequate support with screening tests, PPE, and critical care equipment such as ventilators.

Impact of COVID-19 on Neurosurgery in Brazil's Health System: The Reality of a Developing Country Affected by the Pandemic

“…However, the mean cost of these procedures showed an increase ( P = 0.0172) due to limited resources, a lack of specialized neurosurgeons, need for a multidisciplinary team, and challenges maintaining demand for a procedure with a difficult surgical approach. 29 , 30 The cost of craniotomies also varies with patient factors such as age and comorbidities, as well as hospital factors such as teaching hospital status, hospital volume, and geographic region. 31 We believe that we could extend these factors to other neurosurgical procedures, and they likely contributed to an increased mean cost per procedure in our cohort.…”

Rate of Postoperative COVID-19 Infection After Endonasal Transsphenoidal Surgery and Evaluation of Factors Affecting COVID-19 Transmission

“…No viral transmission to the patients and surgical team has been reported in nine cases from Cambridge, United Kingdom. [5] Soliman et al [6] reported no disease transmission in 16 patients, although one surgeon exhibited the symptoms despite a negative PCR test for COVID-19. Finally, in a series of three patients published in the early periods of the pandemic, Penner et al [7] reported no disease transmission in any patient or the members of the surgical team.…”