Endoscopic endonasal transsphenoidal approach during COVID-19 pandemic in Brazil

Louise Ferreira Nascimento Pestana da Costa; Pedro Henrique Costa Ferreira-Pinto; Julia Pereira Muniz Pontes; Ana Carolina Gonçalves Brito; Bernardo Martins Rodrigues Martha; Wellerson Novaes da Silva; Victor Hugo Corrêa Rodrigues; Ana Beatriz Winter Tavares; Elington Lannes Simões; Felipe Gonçalves de Carvalho; Flavio Nigri

doi:10.25259/SNI_786_2022

Endoscopic endonasal transsphenoidal approach during COVID-19 pandemic in Brazil

Surg Neurol Int. 2022 Nov 4:13:504. doi: 10.25259/SNI_786_2022. eCollection 2022.

Affiliations

¹ Department of Neurosurgery, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
² Department of Neurosurgery, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil.
³ Department of Surgical Specialties Neurosurgery Teaching and Assistance Unit, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
⁴ Department of Anatomical Pathology, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil.
⁵ Department of Internal Medicine - Endocrine Service, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil.

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.

Keywords: COVID-19; Pandemic; Pituitary; Transsphenoidal.