The nose lid for the endoscopic endonasal procedures during COVID-19 era: technical note
- 11 August 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Acta Neurochirurgica
- Vol. 162 (10), 2335-2339
- https://doi.org/10.1007/s00701-020-04518-z
Abstract
Background COVID-19 pandemic has disrupted the global health systems worldwide. According to the tremendous rate of interhuman transmission via aerosols and respiratory droplets, severe measures have been required to contain contagion spread. Accordingly, medical and surgical maneuvers involving the respiratory mucosa and, among them, transnasal transsphenoidal surgery have been charged of maximum risk of spread and contagion, above all for healthcare professionals. Method Our department, according to the actual COVID-19 protocol national guidelines, has suspended elective procedures and, in the last month, only three patients underwent to endoscopic endonasal procedures, due to urgent conditions (a pituitary apoplexy, a chondrosarcoma causing cavernous sinus syndrome, and a pituitary macroadenoma determining chiasm compression). We describe peculiar surgical technique modifications and the use of an endonasal face mask, i.e., the nose lid, to be applied to the patient during transnasal procedures for skull base pathologies as a further possible COVID-19 mitigation strategy. Results The nose lid is cheap, promptly available, and can be easily assembled with the use of few tools available in the OR; this mask allows to both operating surgeon and his assistant to perform wider surgical maneuvers throughout the slits, without ripping it, while limiting the nostril airflow. Conclusions Transnasal surgery, transgressing respiratory mucosa, can definitely increase the risk of virus transmission: we find that adopting further precautions, above all limiting high-speed drill can help preventing or at least reducing aerosol/droplets. The creation of a non-rigid face mask, i.e., the nose lid, allows the comfortable introduction of instruments through one or both nostrils and, at the same time, minimizes the release of droplets from the patient’s nasal cavity.Keywords
This publication has 25 references indexed in Scilit:
- SARS-CoV-2 Transmission in Patients With Cancer at a Tertiary Care Hospital in Wuhan, ChinaJAMA Oncology, 2020
- Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 PandemicJAMA Otolaryngology–Head & Neck Surgery, 2020
- Letter: The Risk of COVID-19 Infection During Neurosurgical Procedures: A Review of Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2) Modes of Transmission and Proposed Neurosurgery-Specific Measures for MitigationNeurosurgery, 2020
- Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1The New England Journal of Medicine, 2020
- Letter: Precautions for Endoscopic Transnasal Skull Base Surgery During the COVID-19 PandemicNeurosurgery, 2020
- Endonasal instrumentation and aerosolization risk in the era of COVID‐19: simulation, literature review, and proposed mitigation strategiesInternational Forum of Allergy & Rhinology, 2020
- COVID‐19 and the Otolaryngologist: Preliminary Evidence‐Based ReviewThe Laryngoscope, 2020
- How will country-based mitigation measures influence the course of the COVID-19 epidemic?The Lancet, 2020
- [Epidemiology, Treatment, and Epidemic Prevention and Control of the Coronavirus Disease 2019: a Review].2020
- Endoscopic Endonasal Surgery for Pituitary AdenomasWorld Neurosurgery, 2014