Endoscopic endonasal transsphenoidal approach during COVID-19 pandemic in Brazil

Abstract

Background: Endoscopic endonasal transsphenoidal approach (EETA) is a well-established technique for sellar tumor resection. However, this route causes aerosol dispersion from the nasal cavity. In the context of the coronavirus (COVID-19) pandemic, new measures were taken aiming at the safety and protection of patients and health-care professionals. Herein, we present a Brazilian experience with EETA during COVID-19 pandemic.

Methods: This study was based on the review of medical records and observation in the operating room of the patients undergoing endoscopic surgery in the period from May 2020 to July 2022. All patients were tested by real-time polymerase chain reaction (RT-PCR) COVID-19 before and after surgery. Since September 2021, it has been mandatory to present vaccination cards for adults (over 18 years old).

Results: This case series included 28 patients and 35 surgical procedures using the EETA, who presented of nonfunctioning macroadenomas (19 cases - 67.8%), GH-secreting tumor (three cases - 10.8%), ACTH-secreting tumor (three cases - 10.8%), meningiomas (two cases - 7.1%), and Rathke's cleft cyst (one case - 3.5%). There were eight cases of diabetes insipidus (28.5%), five cases of cerebrospinal fluid leak (17.8%), and one case of meningitis (3.5%). Three patients died due to meningitis (one case), carotid occlusion (one case), and COVID-19 complications (one case).

Conclusion: A simple protocol was established to perform EETA during the COVID-19 pandemic. The pituitary surgeries were maintained to treat critical cases. To date, the protocol should be continually updated to improve the procedure's safety.

Keywords: COVID-19; Pandemic; Pituitary; Transsphenoidal.

Figure 1:

(a) Overview of patient preparation. During the perioperative period, the patient was covered by the nasal and surgical drapes. (b) Nasal drape was used to reduce the nostril. (c) All team members used N95 and surgical cloak. (d) The instruments were inserted through the reduced nostril.

Figure 2:

(a) Coronal sellar MRI - red arrow shows a left microadenoma. (b) Postoperative cranial computed tomography exhibiting a large intracranial hemorrhage – right frontal lobe. There are multiple other frontoparietal hemorrhagic foci and signs of subfalcine herniation.