World Neurosurg. 2021 May;149:e1090-e1097. doi: 10.1016/j.wneu.2020.12.169. Epub 2021 Jan 11.
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.
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.
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.
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.
在 2019 年冠状病毒病（COVID-19）大流行期间，人们对 COVID-19 患者围手术期死亡率增加以及对医护人员的传播风险（尤其是在鼻内神经外科手术期间）表示担忧。垂体学会已经提出了指导这一时期管理的建议。我们试图评估当代神经外科实践和 COVID-19 的影响。
在 12 个三级神经外科中心（英国和爱尔兰）进行了一项多中心前瞻性观察队列研究。数据收集时间为 2020 年 3 月 23 日至 7 月 31 日。收集的数据点包括患者人口统计学、术前 COVID-19 检测结果、手术修改和 30 天 COVID-19 感染率。
共纳入 124 例患者。在 124 例患者中，116 例（94%）在术前接受了 COVID-19 检测（经蝶窦入路 97 例[92%]；扩大经鼻内镜入路 19 例[100%]）。1 例（116 例中的 1 例[0.9%]）术前 COVID-19 检测阳性，需要延迟手术，直至感染被确认为已解决。除短暂性尿崩症外，该患者无其他并发症。所有手术室工作人员均至少佩戴了 2 级个人防护设备。手术技术的调整包括尽量减少钻孔、修改覆盖物和使用鼻腔碘洗液。在术后 30 天，我们的队列中未发现 COVID-19 感染的证据（症状或阳性正式检测结果），也未发生死亡。
术前筛查方案和手术修改促进了 COVID-19 大流行期间的鼻内神经外科手术，大多数手术都遵循了垂体学会的指南。我们在队列中未发现 COVID-19 感染，也未发生死亡，这支持使用风险缓解策略在随后的大流行浪潮中继续进行鼻内神经外科手术。
