CSF Rhinorrhea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 2: Impact of COVID-19.
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Authors
CRANIAL Consortium
Publication Date
2021-05Journal Title
World Neurosurg
ISSN
1878-8750
Publisher
Elsevier BV
Volume
149
Pages
e1090-e1097
Language
eng
Type
Article
This Version
VoR
Physical Medium
Print-Electronic
Metadata
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CRANIAL Consortium. (2021). CSF Rhinorrhea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 2: Impact of COVID-19.. World Neurosurg, 149 e1090-e1097. https://doi.org/10.1016/j.wneu.2020.12.169
Abstract
BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, concerns have been raised regarding the increased risk of perioperative mortality for patients with COVID-19, and the transmission risk to healthcare workers, especially during endonasal neurosurgical operations. The Pituitary Society has produced recommendations to guide management during this era. We sought to assess contemporary neurosurgical practice and the effects of COVID-19. METHODS: A multicenter prospective observational cohort study was conducted at 12 tertiary neurosurgical units (United Kingdom and Ireland). Data were collected from March 23 to July 31, 2020, inclusive. The data points collected included patient demographics, preoperative COVID-19 test results, operative modifications, and 30-day COVID-19 infection rates. RESULTS: A total of 124 patients were included. Of the 124 patients, 116 (94%) had undergone COVID-19 testing preoperatively (transsphenoidal approach, 97 of 105 [92%]; expanded endoscopic endonasal approach, 19 of 19 [100%]). One patient (1 of 116 [0.9%]) had tested positive for COVID-19 preoperatively, requiring a delay in surgery until the infection had been confirmed as resolved. Other than transient diabetes insipidus, no other complications were reported for this patient. All operating room staff had worn at least level 2 personal protective equipment. Adaptations to surgical techniques included minimizing drilling, draping modifications, and the use of a nasal iodine wash. At 30 days postoperatively, no evidence of COVID-19 infection (symptoms or positive formal testing results) were found in our cohort and no mortality had occurred. CONCLUSIONS: Preoperative screening protocols and operative modifications have facilitated endonasal neurosurgery during the COVID-19 pandemic, with the Pituitary Society guidelines followed for most of these operations. We found no evidence of COVID-19 infection in our cohort and no mortality, supporting the use of risk mitigation strategies to continue endonasal neurosurgery in subsequent pandemic waves.
Keywords
CRANIAL Consortium, Skull Base, Nasal Cavity, Humans, Cerebrospinal Fluid Rhinorrhea, Postoperative Complications, Endoscopy, Mass Screening, Neurosurgical Procedures, Cohort Studies, Prospective Studies, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, Child, Ireland, Female, Male, Young Adult, Preoperative Period, Personal Protective Equipment, United Kingdom, COVID-19, COVID-19 Testing
Identifiers
External DOI: https://doi.org/10.1016/j.wneu.2020.12.169
This record's URL: https://www.repository.cam.ac.uk/handle/1810/329688
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