Amarouche Meriem, Rashid Samin, Eraifej John, Borg Anouk, Halliday Jane, Warner Orlando J, Cudlip Simon A
Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
Oxford Functional Neurosurgery Group, Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom.
J Neurol Surg B Skull Base. 2021 May 27;83(Suppl 2):e419-e429. doi: 10.1055/s-0041-1730352. eCollection 2022 Jun.
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. 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 -test, Mann-Whitney U test, and Pearson Chi-square test, significance set at <0.05. 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, = 0.0002) pre-pandemic. Median duration of surgery was 70 minutes (IQR: 28) during the pandemic and 79 minutes (IQR: 33.75, = 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. 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.
新冠疫情给垂体瘤患者的外科治疗带来了重大干扰。疫情早期发布的指南建议避免经鼻入路，以降低将新冠病毒传播给参与这些手术的医护人员的风险。 这项观察性单中心研究比较了疫情开始后垂体瘤内镜经蝶窦入路（TSA）与疫情前时期的结果。比较了麻醉时间、手术时间和并发症发生率。回顾了新感染新冠病毒的情况以及向患者和工作人员的传播率。使用独立样本t检验、曼-惠特尼U检验和Pearson卡方检验分析数据，显著性设定为P<0.05。 在12个月期间，分别有50例和69例患者在疫情期间和疫情前接受了垂体瘤内镜TSA手术。所有患者术前新冠病毒检测均为阴性。疫情期间麻醉的中位持续时间为35分钟（四分位间距[IQR]：22），疫情前为25分钟（IQR：8，P = 0.0002）。疫情期间手术的中位持续时间为70分钟（IQR：28），疫情前为79分钟（IQR：33.75，P = 0.126）。术中脑脊液漏和并发症发生率之间无统计学显著差异。没有工作人员新冠病毒检测呈阳性。3例患者出院后新冠病毒检测呈阳性，但感染是社区获得性的。 与已发表的指南不同，充分的术前检测、多学科方法以及实施标准化方案和新冠疫苗接种使得在疫情期间垂体疾病患者能够安全地进行内镜经蝶窦手术。
