The nose lid for the endoscopic endonasal procedures during COVID-19 era: technical note
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TECHNICAL NOTE - NEUROSURGICAL TECHNIQUE EVALUATION
The nose lid for the endoscopic endonasal procedures during COVID-19 era: technical note Domenico Solari 1
&
Ilaria Bove 1 & Felice Esposito 1 & Paolo Cappabianca 1 & Luigi M. Cavallo 1
Received: 16 June 2020 / Accepted: 30 July 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background COVID-19 pandemic has disrupted the global health systems worldwide. According to the tremendous rate of interhuman transmission via aerosols and respiratory droplets, severe measures have been required to contain contagion spread. Accordingly, medical and surgical maneuvers involving the respiratory mucosa and, among them, transnasal transsphenoidal surgery have been charged of maximum risk of spread and contagion, above all for healthcare professionals. Method Our department, according to the actual COVID-19 protocol national guidelines, has suspended elective procedures and, in the last month, only three patients underwent to endoscopic endonasal procedures, due to urgent conditions (a pituitary apoplexy, a chondrosarcoma causing cavernous sinus syndrome, and a pituitary macroadenoma determining chiasm compression). We describe peculiar surgical technique modifications and the use of an endonasal face mask, i.e., the nose lid, to be applied to the patient during transnasal procedures for skull base pathologies as a further possible COVID-19 mitigation strategy. Results The nose lid is cheap, promptly available, and can be easily assembled with the use of few tools available in the OR; this mask allows to both operating surgeon and his assistant to perform wider surgical maneuvers throughout the slits, without ripping it, while limiting the nostril airflow. Conclusions Transnasal surgery, transgressing respiratory mucosa, can definitely increase the risk of virus transmission: we find that adopting further precautions, above all limiting high-speed drill can help preventing or at least reducing aerosol/droplets. The creation of a non-rigid face mask, i.e., the nose lid, allows the comfortable introduction of instruments through one or both nostrils and, at the same time, minimizes the release of droplets from the patient’s nasal cavity. Keywords Nose lid . COVID-19 . Transnasal surgery . Pituitary surgery . Endoscopic endonasal skull base surgery
Introduction COVID-19 resulting from the new coronavirus strain (SARSCoV-2) represents an unprecedented challenge for the global health system. Since its appearance in Wuhan, China, in December 2019, it has rapidly spread worldwide up to be classified as a pandemic by the World Health Organization (WHO) on March 12, 2020 [3].
This article is part of the Topical Collection on Neurosurgical technique evaluation * Domenico Solari [email protected] 1
Division of Neurosurgery, Università degli Studi di Napoli “Federico II”, Via Pansini 5, 80131 Naples, Italy
The interhuman transmission is the result of droplets’ projection toward another host or via human contact (e.g., handshaking) or through an ine
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