1
|
Farsakh A, Li S, Toomey F, Castle-Kirszbaum M, Kam J, Goldschlager T. Pituitary surgery and COVID. Pituitary 2024:10.1007/s11102-024-01423-x. [PMID: 38967764 DOI: 10.1007/s11102-024-01423-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Abstract
An effect of the COVID-19 pandemic was the disruption of healthcare systems, especially surgical services provided to the community. Pituitary surgery was especially impacted, given the majority of cases were deemed non-urgent with very few exceptions, and the high risk of viral transmission conferred by the endoscopic endonasal transsphenoidal approach. Patients suffering from pituitary lesions with resultant endocrinopathy or visual symptoms saw their treatment delayed or altered, which had implications on their outcomes and care. This disruption extended to surgical training and the usual functioning of academic units, necessitating changes to curricula and implementation of novel methods of progressing surgical education. This review will explore the effect of the COVID pandemic on pituitary surgery, the experiences of various surgeons as well as the adaptations implemented on the frontlines. The lessons learned from the experience of the pandemic may assist specialists in gleaning insights regarding the care of patients in the future.
Collapse
Affiliation(s)
- Ameen Farsakh
- Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, Australia.
| | - Sandra Li
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Fidel Toomey
- Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, Australia
| | - Mendel Castle-Kirszbaum
- Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jeremy Kam
- Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Medical Centre, Monash Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| |
Collapse
|
2
|
Gupta A, Goyal-Honavar A, Jonathan GE, Prabhu K, Varghese GM, Rupali P, Chacko AG. Adapting management strategies for sellar-suprasellar lesions during the COVID-19 pandemic: a pragmatic approach from the frontline. Br J Neurosurg 2024; 38:596-603. [PMID: 34148450 DOI: 10.1080/02688697.2021.1940852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/04/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE During the ongoing COVID-19 pandemic, endonasal surgeries for sellar-suprasellar lesions were discouraged due to the risk of transmission of the disease. We reviewed the changes in our management protocol for these lesions as our disease understanding and preparedness evolved. MATERIALS AND METHODS This was a retrospective observational study including patients with sellar-suprasellar and clival lesions presenting to us between March and October 2020. Management protocols were divided into three phases based on the prevalence of the disease and the number of mandatory preoperative COVID-19 tests being conducted. The surgical approach used was analyzed in relation to the preferred approach during pre-COVID times, and surgical outcomes and complications were noted. RESULTS A total of 31 cases were operated during this period. During Phase I (low prevalence; no preoperative COVID testing) endonasal surgeries were largely abandoned in favor of transcranial approaches. In Phase II (medium prevalence; one preoperative COVID test) we gradually resumed endonasal surgeries for 'emergent' and 'essential' cases, and subsequently in Phase III (high prevalence; two preoperative COVID tests), we had no hesitation in performing 'elective' endonasal surgeries with additional barriers for prevention of aerosol transmission. No patient developed COVID-19 infection postoperatively. Eight HCWs in our department acquired the disease during this period, none of whom were directly involved in the surgeries for the above cohort of patients. CONCLUSIONS With a strict preoperative COVID testing protocol, adherence to proper drilling techniques and using additional barriers to prevent droplet and aerosol spread, endonasal surgeries for sellar-suprasellar lesions are safe during this COVID-19 pandemic.
Collapse
Affiliation(s)
- Ankush Gupta
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
| | - Abhijit Goyal-Honavar
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
| | - Gandham Edmond Jonathan
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
| | - Krishna Prabhu
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
| | - George M Varghese
- Department of Infectious Diseases, Christian Medical College Hospital, Vellore, India
| | - Priscilla Rupali
- Department of Infectious Diseases and Hospital Infection Control Committee, Christian Medical College Hospital, Vellore, India
| | - Ari George Chacko
- Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College Hospital, Vellore, India
| |
Collapse
|
3
|
da Costa LFNP, Ferreira-Pinto PHC, Pontes JPM, Brito ACG, Martha BMR, da Silva WN, Rodrigues VHC, Tavares ABW, Simões EL, de Carvalho FG, Nigri F. Endoscopic endonasal transsphenoidal approach during COVID-19 pandemic in Brazil. Surg Neurol Int 2022; 13:504. [PMID: 36447871 PMCID: PMC9699875 DOI: 10.25259/sni_786_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
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.
Collapse
Affiliation(s)
| | | | - Julia Pereira Muniz Pontes
- Department of Surgical Specialties Neurosurgery Teaching and Assistance Unit, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | - Ana Beatriz Winter Tavares
- Department of Internal Medicine - Endocrine Service, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - Elington Lannes Simões
- Department of Neurosurgery, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Flavio Nigri
- Department of Neurosurgery, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
4
|
Vahabzadeh‐Hagh AM, Patel SH, Stramiello JA, Weissbrod PA. Patient-worn endoscopy mask to protect against viral transmission. Laryngoscope Investig Otolaryngol 2022; 7:190-196. [PMID: 35155797 PMCID: PMC8823177 DOI: 10.1002/lio2.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/25/2021] [Accepted: 11/26/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To design and evaluate patient-worn personal protective equipment (PPE) that allows providers to perform endoscopy while protecting against droplet and airborne disease transmission. STUDY DESIGN Single subject study. METHODS Mask efficacy was evaluated using a cough simulator that sprays dye visible under ultra-violet light. User-testing was performed on an airway trainer mannequin where each subject performed the endoscopy with and without the mask in random orders. Their time to completion and number of attempts before successful completion were recorded, and each subject was asked to fill out a NASA Task Load Index (TLX) form with respect to their experience. RESULTS The mask has a filtration efficiency of 97.31% and eliminated any expelled particles with the cough simulator. Without the mask, a simulated cough is visualized as it progresses away from the cough origin. Subjects who performed trans-nasal endoscopy spent 27.8 ± 8.0 s to visualize the vocal cords for the no mask condition and 28.7 ± 13.6 s for the mask condition (mean ± SD, p > .05). There was no statistically significant difference found in the mental demand, physical demand, temporal demand, performance, effort, and frustration of endoscopy under the no mask and mask conditions (all p > .05). CONCLUSION The designed PPE provides an effective barrier for viral droplet and airborne transmission while allowing the ability to perform endoscopy with ease. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
Collapse
Affiliation(s)
| | - Shiv H. Patel
- School of Medicine Simulation Training CenterUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Joshua A. Stramiello
- Department of OtolaryngologyUniversity of California‐San DiegoSan DiegoCaliforniaUSA
| | - Philip A. Weissbrod
- Department of OtolaryngologyUniversity of California‐San DiegoSan DiegoCaliforniaUSA
| |
Collapse
|
5
|
Abdala Vargas N, Ordóñez Rubiano EG, Rueda Esteban R, Bigio Roitman D, Sánchez Rentería S, Pinzón Navarro M. Desarrollo de una máscara de bajo costo para prevenir la propagación de aerosoles en endoscopia endonasal en la base del cráneo durante la pandemia del COVID-19. REPERTORIO DE MEDICINA Y CIRUGÍA 2021. [DOI: 10.31260/repertmedcir.01217372.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: desarrollar una máscara que sea reutilizable, esterilizable, fácil de usar y económica para reducir los riesgos de transmisión del COVID-19 durante los procedimientos endoscópicos endonasales. Métodos: modelo diseñado en Autodesk Fusion 360 y Meshmixer, construido con ácido poliláctico (PLA) utilizando una impresora 3D (PRUSA IK3 MK3s, Praga, República Checa) en el laboratorio de Anatomía de la Universidad de los Andes, Bogotá, Colombia. Se ajustaron tres orificios a la mascarilla, uno para el tubo endotraqueal, otro más grande en el medio para la instrumentación quirúrgica que permite la adaptación de una membrana translúcida estéril y el superior para adaptar la punta de la succión y generar un ambiente de presión negativa dentro de la máscara. Se utilizó un colchón de silicona y tres puntos para sujetar tiras y crear un ajuste a la cabeza durante largos períodos sin causar lesiones en la piel. Se realizaron diferentes pruebas, incluida la verificación con luz ultravioleta de la propagación de la fluoresceína después de la perforación ósea, la esterilización química y por calor de la máscara, y la succión de los aerosoles producidos al fumar un cigarrillo electrónico. Ambiente: laboratorio experimental. Resultados: las pruebas demostraron una reducción del efecto aerosol y de la dispersión de las gotas cuando se usa la máscara ventilada. Se consiguió una excelente maniobrabilidad y libertad. Sin embargo, fue limitado en términos de visualización durante la entrada nasal de los instrumentos al cráneo. Conclusiones: los resultados preliminares muestran que esta máscara ventilada permite una barrera quirúrgica para disminuir la transmisión del SARS-COV-2 durante los procedimientos endoscópicos endonasales.
Collapse
|
6
|
Williams SP, Leong SC. One year into the COVID-19 pandemic: What do we know so far from studies assessing risk and mitigation of droplet aerosolisation during endonasal surgery? A systematic review. Clin Otolaryngol 2021; 46:1368-1378. [PMID: 34473910 PMCID: PMC8653184 DOI: 10.1111/coa.13854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/26/2021] [Accepted: 08/22/2021] [Indexed: 01/14/2023]
Abstract
Objectives As we pass the anniversary of the declaration of a global pandemic by the World Health Organisation, it invites us to reflect upon the inescapable changes that coronavirus has wrought upon ENT and, in particular, rhinological practice. As it remains unclear when we will emerge from the shadow of COVID‐19, a critical analysis of the evidence base on both the assessment and mitigation of risk is vital for ENT departments worldwide. This article presents a systematic review of the literature examining articles which consider either the quantification of risk or strategies to mitigate risk specifically in the setting of rhinological surgery. Design Systematic literature review. Results The literature search yielded a total of 3406 returns with 24 articles meeting eligibility criteria. A narrative synthesis stratified results into two broad themes: (1) those which made an assessment as to the aerosolisation of droplets during sinus surgery, further sub‐divided into work which considered macroscopically visible droplets and that which considered smaller particles; (2) and those studies which examined the mitigation of this risk. Conclusion Studies considering the aerosolisation of both droplets and smaller particles suggest endonasal surgery carries significant risk. While results both highlight a range of innovative adjunctive strategies and support suction as an important intervention to reduce aerosolisation, appropriate use of personal protective equipment (PPE) should be considered mandatory for all healthcare professionals involved in rhinological surgery. Studies have demonstrated that close adherence to PPE use is effective in preventing COVID‐19 infection.
Collapse
Affiliation(s)
- Stephen P Williams
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Samuel C Leong
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
7
|
Aaronson DM, Poetker DM, Long CM, Zwagerman NT. COVID-19 Testing in the Era of Modern Neurosurgery: Mitigating Risk in Our Vulnerable Patient Populations. World Neurosurg 2021; 152:80-83. [PMID: 34133996 PMCID: PMC8197680 DOI: 10.1016/j.wneu.2021.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/02/2022]
Abstract
Background The respiratory illness identified as coronavirus disease 2019 (COVID-19) has resulted in a pandemic illness that has changed the face of healthcare. As the COVID-19 pandemic continues, patients have continued to require neurosurgical interventions, and the endoscopic endonasal approach for surgery has continued to be a mainstay treatment of pituitary tumors and anterior skull base lesions. Methods We sought to highlight the current lack of recommendations regarding testing protocols for neurosurgical patients. Results We implemented a novel testing protocol for our patient populations at increased risk and have proposed a model that can be used at other institutions to mitigate the risk of complications associated with some forms of COVID-19 testing. Conclusion Patients with anterior skull base defects may be at risk with current COVID-19 testing protocols, and may benefit from alternative specimen collection strategies.
Collapse
Affiliation(s)
- Daniel M Aaronson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | - David M Poetker
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christopher M Long
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nathan T Zwagerman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
8
|
Furstenau LB, Rabaioli B, Sott MK, Cossul D, Bender MS, Farina EMJDM, Filho FNB, Severo PP, Dohan MS, Bragazzi NL. A Bibliometric Network Analysis of Coronavirus during the First Eight Months of COVID-19 in 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:952. [PMID: 33499127 PMCID: PMC7908247 DOI: 10.3390/ijerph18030952] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic has affected all aspects of society. Researchers worldwide have been working to provide new solutions to and better understanding of this coronavirus. In this research, our goal was to perform a Bibliometric Network Analysis (BNA) to investigate the strategic themes, thematic evolution structure and trends of coronavirus during the first eight months of COVID-19 in the Web of Science (WoS) database in 2020. To do this, 14,802 articles were analyzed, with the support of the SciMAT software. This analysis highlights 24 themes, of which 11 of the more important ones were discussed in-depth. The thematic evolution structure shows how the themes are evolving over time, and the most developed and future trends of coronavirus with focus on COVID-19 were visually depicted. The results of the strategic diagram highlight 'CHLOROQUINE', 'ANXIETY', 'PREGNANCY' and 'ACUTE-RESPIRATORY-SYNDROME', among others, as the clusters with the highest number of associated citations. The thematic evolution. structure presented two thematic areas: "Damage prevention and containment of COVID-19" and "Comorbidities and diseases caused by COVID-19", which provides new perspectives and futures trends of the field. These results will form the basis for future research and guide decision-making in coronavirus focused on COVID-19 research and treatments.
Collapse
Affiliation(s)
- Leonardo B. Furstenau
- Graduate Program of Industrial Systems and Processes, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Bruna Rabaioli
- Department of Medicine, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Michele Kremer Sott
- Graduate Program of Industrial Systems and Processes, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Danielli Cossul
- Department of Psychology, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Mariluza Sott Bender
- Multiprofessional Residency Program in Urgency and Emergency, Santa Cruz Hospital, Santa Cruz do Sul 96810-072, Brazil;
| | - Eduardo Moreno Júdice De Mattos Farina
- Scientific Writing Office Department, Higher School of Sciences of Santa Casa de Misericórdia de Vitória, Vitória 29025-023, Brazil; (E.M.J.D.M.F.); (F.N.B.F.)
| | - Fabiano Novaes Barcellos Filho
- Scientific Writing Office Department, Higher School of Sciences of Santa Casa de Misericórdia de Vitória, Vitória 29025-023, Brazil; (E.M.J.D.M.F.); (F.N.B.F.)
| | - Priscilla Paola Severo
- Graduate Program in Law, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
| | - Michael S. Dohan
- Faculty of Business Administration, Lakehead University, Thunder Bay, ON P7B 5E1, Canada;
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
| |
Collapse
|