Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May 27;83(Suppl 2):e419-e429.
doi: 10.1055/s-0041-1730352. eCollection 2022 Jun.

Safety of Endoscopic Transsphenoidal Pituitary Surgery during the COVID-19 Pandemic and Comparison to the Pre-Pandemic Era

Meriem Amarouche  1 , Samin Rashid  1 , John Eraifej  1   2 , Anouk Borg  1 , Jane Halliday  1 , Orlando J Warner  3 , Simon A Cudlip  1
Affiliations

Safety of Endoscopic Transsphenoidal Pituitary Surgery during the COVID-19 Pandemic and Comparison to the Pre-Pandemic Era

Meriem Amarouche et al. J Neurol Surg B Skull Base. .

Abstract

Objective The COVID-19 pandemic has caused significant disruption to the surgical care of patients with pituitary tumors. Guidance issued early during the pandemic suggested avoiding transnasal approaches to minimize risks of transmitting COVID-19 to health care professionals involved in these procedures. Methods This observational, single-center study compares results of endoscopic transsphenoidal approach (TSA) for pituitary tumors since the start of the pandemic to a pre-pandemic period. Anesthetic time, surgical time, and complication rates were compared. Newly acquired COVID-19 infections and transmission rates to patients and staff were reviewed. Data were analyzed by using the independent t -test, Mann-Whitney U test, and Pearson Chi-square test, significance set at p <0.05. Results Over a 12-month period, a total of 50 and 69 patients underwent endoscopic TSA for pituitary tumor during and before the pandemic, respectively. All patients tested negative for COVID-19 preoperatively. Median duration of anesthesia was 35 minutes (interquartile range [IQR]: 22) during the pandemic and 25 minutes (IQR: 8, p = 0.0002) pre-pandemic. Median duration of surgery was 70 minutes (IQR: 28) during the pandemic and 79 minutes (IQR: 33.75, p = 0.126) pre-pandemic. There were no statistically significant differences between intraoperative CSF leaks and complication rates. No staff members tested positive for COVID-19. Three patients tested positive for COVID-19 postdischarge, but the infections were community acquired. Conclusion In contrast to published guidelines, adequate preoperative testing, a multidisciplinary approach and the implementation of standardized protocols and vaccination against COVID-19 allow for endoscopic transsphenoidal surgery to be performed safely in patients with pituitary pathology during the pandemic.

Keywords: COVID-19 pandemic; Rathke's cleft cyst; functioning pituitary adenoma; nonfunctioning pituitary adenoma; pituitary surgery; transsphenoidal.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Number of neurosurgical operations undertaken at the John Radcliffe Hospital between March 2, 2019 and March 1, 2020.
Fig. 2
Fig. 2
Number of neurosurgical operations undertaken at the John Radcliffe Hospital between March 2, 2020 and March 1, 2021.
Fig. 3
Fig. 3
Number of endoscopic transsphenoidal approach cases performed per month in the pandemic and pre-pandemic patient cohorts.
Fig. 4
Fig. 4
Level I personal protective equipment guidance.
Fig. 5
Fig. 5
Level II personal protective equipment guidance.
Fig. 6
Fig. 6
Clear sheet over the patient with small openings for the instruments and endoscope.
Fig. 7
Fig. 7
Nasal latex slits through ioban drape.
See this image and copyright information in PMC

References

    1. Fleseriu M, Buchfelder M, Cetas J S et al.Pituitary society guidance: pituitary disease management and patient care recommendations during the COVID-19 pandemic-an international perspective. Pituitary. 2020;23(04):327–337. - PMC - PubMed
    1. Patel Z M, Fernandez-Miranda J, Hwang P H et al.Letter: precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurgery. 2020;87(01):E66–E67. - PMC - PubMed
    1. SBNS SBNS COVID-19 bulletins / guidance documentsAccessed 2020 at:https://www.sbns.org.uk/index.php/about-us/news/
    1. Lu D, Wang H, Yu R, Yang H, Zhao Y. Integrated infection control strategy to minimize nosocomial infection of coronavirus disease 2019 among ENT healthcare workers. J Hosp Infect. 2020;104(04):454–455. - PMC - PubMed
    1. Tran K, Cimon K, Severn M, Pessoa-Silva C L, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7(04):e35797. - PMC - PubMed