Microscopic Transsphenoidal Approach for Macroadenoma in an Asymptomatic COVID-19 Patient: A Case Report

The novel coronavirus commonly referred to as COVID-19 became a global pandemic in the March of 2020 and created unprecedented challenges for health care systems worldwide. Early case reports demonstrated a high risk of aerosolization and infection of operating room staff during endoscopic endonasal approaches, highlighting the need for safe management strategies in patients with COVID-19 with acute pathology. During periods of epidemiologic infectious surges, elective cases have often been suspended. However, patients presenting with urgent pathology, such as pituitary apoplexy or acute visual compromise from sellar or parasellar lesions still require treatment regardless of infectious status. Here, we present a case of an asymptomatic COVID-19 patient with progressive vision loss that underwent successful microscopic resection of pituitary adenoma, without evidence of spread to the operating room staff. We hypothesize that during microscopic approaches to the sella, there is relatively less forceful irrigation, and as a result, potentially less aerosolization. This may decrease the risk of viral spread to the surgeons and the operating room staff. Additionally, we report that fluorescent in situ hybridization studies of tumor tissue for SARS-CoV-2 may not reliably be able to detect viral infections. In conclusion, for asymptomatic patients at high risk for COVID, microscopic transsphenoidal approaches may provide a safer alternative. These patients should undergo preoperative testing, and repeat testing should be considered if possible for negative results. Proper PPE should however still be utilized to maximize safety of the operating room staff.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021