Reintroducing Endoscopic Skull Base Surgery During the COVID-19 Pandemic: A Single-Center Experience from the United States COVID-19 Epicenter

Georgios A Maragkos,Satish Govindaraj,Raj K Shrivastava,Joshua B Bederson,Todd Spock,Alfred Marc Iloreta,Patrick Colley,Peter F Morgenstern,Anthony Del Signore,Remi Kessler,Ian T Mcneill,Costas G Hadjipanayis

doi:10.29024/jsim.94

Georgios A Maragkos, Satish Govindaraj + Show 10 more

Open Access

https://doi.org/10.29024/jsim.94

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Abstract

Background: The COVID-19 pandemic presented unique challenges for endoscopic skull base surgery (ESBS) given the elevated viral load in the nasopharynx and aerosolization of particles inherent to the endoscopic endonasal approach (EEA). Furthermore, reports and anecdotes shared within the skull base surgeon community suggesting potential elevated risk of COVID-19 transmission during ESBS led to an abundance of precaution and scrutiny regarding endonasal procedures during the pandemic. The Mount Sinai Hospital is a busy ESBS center located in New York City, the United States COVID-19 pandemic epicenter. We report a case series describing the early experience of resuming ESBS during the COVID-19 pandemic, including systems for case selection, surgical precautions and modifications, and patient outcomes. Methods: All consecutive ESBS cases and deferred surgical cases were identified prospectively within the first three-week period after resumption of urgent scheduled surgery. Data regarding indications, pre-surgical screening, operative results, and postoperative course were collected retrospectively. All data are presented using descriptive statistics. Results: With the study time frame, 14 patients underwent ESBS. Four patients had surgery deferred. The mean age was 57. The most common pathology was pituitary tumor, in 57% of patients. Visual symptoms precipitated the urgency in 36% of cases. All patients underwent COVID-19 screening with a minimum of one SARSCoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) nasal swab within 48 hours preceding surgery. All patients tested negative. There were no intraoperative complications. Median length of stay was two days. A total of 14% of patients experienced postoperative complications. Mean follow-up was 100.9 days. Conclusions: Due to its relatively low morbidity and potential short length of stay, ESBS is adaptable to unique pandemic challenges such as bed scarcity and exposure minimization. As endoscopic centers return to normal operations during the COVID-19 era, standard testing, case selection algorithms, and systematic surgical precautions and modifications can enable a safe resumption of ESBS.

Highlights

Endoscopic skull base surgery (ESBS) during the coronavirus disease 19 (COVID-19) pandemic has garnered much attention in the realm of physician and patient safety in light of reports of disease transmission from Wuhan, China
Due to its relatively low morbidity and potential short length of stay, endoscopic skull base surgery (ESBS) is adaptable to unique pandemic challenges such as bed scarcity and exposure minimization
As endoscopic centers return to normal operations during the COVID-19 era, standard testing, case selection algorithms, and systematic surgical precautions and modifications can enable a safe resumption of ESBS

Summary

Introduction

Endoscopic skull base surgery (ESBS) during the coronavirus disease 19 (COVID-19) pandemic has garnered much attention in the realm of physician and patient safety in light of reports of disease transmission from Wuhan, China. Once formally reported, spread of infection from this case was deemed to be due to postoperative, instead of intraoperative, transmission from a lack of personal airway protection [15] At this juncture in the pandemic, it is known that COVID-19 is caused by a strain recognized as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with the primary nidus of infection being the nasal cavity. This poses a special risk in neurosurgical procedures involving the skull base that require a transnasal approach and has necessitated a fundamental change in practice to protect operative neurosurgeons. We report a case series describing the early experience of resuming ESBS during the COVID-19 pandemic, including systems for case selection, surgical precautions and modifications, and patient outcomes

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