Abstract
Objective The continually evolving coronavirus disease 2019 (COVID-19) pandemic has created
a dire need for rapid reorganization of health care delivery within surgical services.
Ensuing initial reports of high infection rates following endoscopic sinus and skull
base surgery, various expert and societal guidelines have emerged. We hereby provide
a scoping review of the available literature on endoscopic sinus and skull base surgery,
exploring both the risk of aerosolization and expert recommendations on surgical management
during the pandemic.
Methods A literature search of the PubMed database was performed up until May 9th, 2020.
Additionally, websites and published statements from otolaryngology associations were
searched for recommendations. This scoping review followed the guidelines provided
by the Preferred Reporting Items for Systematic Reviews and Meta Analyses Extension
for Scoping Reviews.
Results A total of 29 peer-reviewed publications and statements from expert recommendations
or professional associations were included. Current expert guidance relies mainly
on scarce, anecdotal evidence, and two cadaveric studies, which have demonstrated
potential aerosolization during transnasal surgery. General consensus exists for delaying
surgery when possible, ascertaining COVID-19 status preoperatively and donning of
adequate personal protective equipment by all operating room staff (including at minimum
an N95 mask). Cold, nonpowered surgical instruments are deemed the safest, while thermal
instruments (electrocautery and laser) and high-speed drills should be minimized.
Conflicting recommendations emerge for use of microdebriders.
Conclusion Endoscopic sinus and skull base surgery impart a potential risk of aerosolization.
Hence, surgical indications, protective measures for health care workers, and surgical
instrumentation must be adapted accordingly in the COVID-19 context.
Keywords
pituitary surgery - skull base surgery - aerosolization - endoscopic sinus surgery
- COVID-19
