Coronavirus Neurosurgical/Head and Neck Drape to Prevent Aerosolization of Coronavirus Disease 2019 (COVID-19): The Lenox Hill Hospital/Northwell Health Solution

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has infected more than 13 million people on a global scale and claimed more than half million deaths across 213 countries and territories. While the focus is currently on recovery from the pandemic, the disease has significantly changed the way we practice medicine and neurosurgery in New York City and the United States. Apart from the emergency cases, several health systems across the country have similarly started to perform elective surgeries. Although COVID-19 screening and testing guidelines have been proposed and adopted by many hospitals, these may not adequately protect the operating room personnel who are in proximity to the patient for prolonged periods. There are concerning reports of especially high transmission rates of COVID-19 in transmucosal head and neck procedures conducted by otolaryngologists and neurosurgeons, despite attempts at wearing what constitutes appropriate personal protective equipment.

Methods: Here, we describe a simple technique of additional draping that can be used for all cranial, endonasal, spinal, and neurointerventional cases to limit the transmission of coronavirus.

Results: The proposed technique offers a simple, commonly available, cost-effective alternative that avoids the use of additional retractor systems. Moreover, this technique can be used in all neurosurgical procedures.

Conclusions: With the rising concerns regarding airborne spread of the virus, we expect that these precautions will prove highly useful as we enter the recovery phase of this pandemic and hospitals attempt to prevent a return to widespread infection. In addition, its availability and cost effectiveness make this technique especially attractive to practical use in centers with limited resources.

Keywords: COVID-19; Coronavirus; Endoscopic endonasal; Neurosurgery.

Figure 1

(A) A large fluoroscope drape (91 × 112 cm; Premiere Guard Fluoroscope Drape, Houston, Texas, USA; http://www.premierguard.com) can be used to cover the eyes, nose, and mouth following intubation to limit dispersal of aerosolized virus. (B) The clear drape is secured low on the brow and hangs down over the eyes, nose, and mouth, allowing visualization of the face and endotracheal tube. (C) The drape can be modified to accommodate necessary cranial incisions. The surgical site is then prepped and draped sterilely in the usual fashion.

Figure 2

For endonasal endoscopic cases in which the risk of aerosolization of coronavirus disease 2019 (COVID-19) may be extremely high, the prevention drape should be modified with a small aperture (dotted line) to allow instruments to pass into and out of the nares.