Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
Neurol India. 2020 May-Jun;68(Supplement):S141-S145. doi: 10.4103/0028-3886.287683.
The COVID-19 pandemic is currently an evolving situation. Operating rooms (OR) are high-risk areas for the transmission of any respiratory infection with multiple personnel involved, in close proximity. Of concern to neurosurgeons, is the high-risk of aerosol generating procedures (AGPs) like transsphenoidal and endonasal surgery. Endonasal AGPs theoretically present a higher risk of viral exposure due to the longer duration of exposure and aggressive disruption of potentially virus-containing mucosa.
The current review discusses potential strategies to neuro-surgeons to avoid transmission of COVID 19 during endo-nasal and trans-sphenoidal surgeries.
We searched PubMed using the search terms "COVID-19", "SARS-CoV-2", "coronavirus" in combination with "neurosurgery", and identified 13 relevant articles. A pre-surgical risk assessment score is proposed based on the risk of transmission. A flow chart of patient selection and care has been formulated.
In all emergency patients, it is preferable to consider transcranial surgery or a sub-labial approach avoiding exposure to mucosa. Due to laboratory constraints routine swabs is not always available. Therefore, routine preoperative screening computed tomography (CT) chest is performed in all patients. Based on risk of transmission of infection to others, we propose a classification of patients for skull-based surgery into low, high and very high risk groups and suggest suitable personal protective equipment. Additionally, we discuss avoiding use of powered drills in or any AGP. However, cold procedures involving shavers and microdebriders generate lesser amounts of aerosol. Post-operatively, the length of stay could be reduced with a multidisciplinary approach.
目前，COVID-19 疫情形势正在不断变化。手术室（OR）是涉及多名密切接触人员的任何呼吸道传染病传播的高风险区域。令神经外科医生担忧的是，经鼻蝶窦和鼻内手术等气溶胶产生程序（AGP）的高风险。由于暴露时间更长且对潜在含有病毒的粘膜进行了积极的破坏，经鼻 AGP 理论上存在更高的病毒暴露风险。
本次综述讨论了神经外科医生在进行经鼻和经蝶窦手术时避免 COVID-19 传播的潜在策略。
我们使用搜索词“COVID-19”、“SARS-CoV-2”、“冠状病毒”与“神经外科”相结合，在 PubMed 上进行了搜索，共确定了 13 篇相关文章。根据传播风险提出了术前风险评估评分。制定了患者选择和护理的流程图。
在所有急诊患者中，最好考虑经颅手术或经唇下入路，避免暴露于粘膜。由于实验室限制，并非总能进行常规拭子检测。因此，我们对所有患者常规进行术前胸部 CT 检查。基于对他人感染传播的风险，我们将颅骨手术患者分为低、高和极高风险组，并建议使用适当的个人防护设备。此外，我们还讨论了避免在任何 AGP 中使用动力钻头。然而，涉及 shave 和 microdebrider 的冷程序产生的气溶胶较少。术后，可以通过多学科方法来缩短住院时间。
