Adapting management strategies for sellar-suprasellar lesions during the COVID-19 pandemic: a pragmatic approach from the frontline

Gupta, Ankush; Goyal-Honavar, Abhijit; Jonathan, Gandham E; Prabhu, Krishna; Varghese, George M.; Rupali, Priscilla; Chacko, Ari G

doi:10.1080/02688697.2021.1940852

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…[9][10][11] We reported our experience with resuming endoscopic endonasal surgery for sellar-suprasellar tumors where we emphasized adherence to a stringent protocol, preoperative SARS-CoV 2 testing, the use of PPE and attention to operative techniques. 12 As aerosol-carried particles of the virus may remain viable up to 2 hours, 13 we recommended additional physical barriers on the nose during endonasal surgeries to further reduce aerosol propagation. In this series of 16 endonasal endoscopic surgeries, we report the effectiveness of a low-cost NPM placed over the patient's face in preventing droplet and aerosol generation.…”

Section: Discussionmentioning

confidence: 99%

A Negative-Pressure Face-Mounted System Reduces Aerosol Spread during Endonasal Endoscopic Surgery

Gandham

Goyal-Honavar

Johnson

et al. 2022

J Neurol Surg B Skull Base

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Purpose: As there is a potential risk of Covid-19 transmission during endonasal surgery we studied methods to reduce droplet and aerosol generation during these procedures. Methods: Droplet spread was assessed using ultraviolet light and a camera that detected fluorescence in the operative field and surgeon’s personal protective equipment. Density of aerosols sized <10µ was measured using a photometric particle counter. We designed a face-mounted negative-pressure mask placed on the patients face during endoscopic endonasal surgery. Sixteen patients were recruited between October 2020 to March 2021 and randomly assigned to the mask and no-mask groups. We compared droplet spread and aerosols generated in both groups, with copious irrigation and continuous suction during drilling forming the mainstay of surgical technique in all cases. Results: Droplet contamination due to direct spillage of fluorescein from the syringe was noted in two patients. Aerosol density rose during sphenoid drilling in both groups, with no significant difference when continuous suction and irrigation were employed (1.27 times vs. 1.07 times the baseline, p=0.248). Aerosol density rose significantly when suction and irrigation were interrupted in the no-mask group (44.9 times vs. 1.2 times, p=0.028), which was not seen when the mask was used. Conclusions: Aerosol generation increases during drilling in endonasal procedures and is a concern during this pandemic. The use of a rigid suction close to the drill along with copious irrigation is effective in reducing aerosol spread. The use of a negative pressure mask provides additional safety when inadvertent blockage of suction and inadequate irrigation occur.

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Section: Discussionmentioning

confidence: 99%

A Negative-Pressure Face-Mounted System Reduces Aerosol Spread during Endonasal Endoscopic Surgery

Gandham

Goyal-Honavar

Johnson

et al. 2022

J Neurol Surg B Skull Base

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“…Unless emergent intervention was indicated, they were operated a minimum of 21 days from the date of their positive test. In cases operated by the endonasal route, we employed a specially developed negative-pressure face-mounted system and additional personal protective equipment (PPE) [8] .…”

Section: Methodsmentioning

confidence: 99%

A prospective evaluation of postoperative fever in adult neurosurgery patients in the COVID-19 era

Goyal-Honavar¹,

Gupta²,

Manesh³

et al. 2022

Journal of Clinical Neuroscience

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“…[5] In cases operated endonasally, we employed a negative-pressure face-mounted system, and additional personal protective equipment (PPE). [9] Data collection and protocol for evaluation of postoperative fever All clinical parameters such as daily maximum temperature, number of spikes of fever, and use of surgical adjuncts were collected prospectively during the daily ward and intensive care unit (ICU) rounds. Details of surgery were recorded from surgical and anaesthetic records on the day of surgery.…”

Section: Preoperative Covid-19 Testing Protocolmentioning

confidence: 99%

Distinct patterns of postoperative fever in paediatric neurosurgery patients

Goyal-Honavar,

Markose,

Gupta

et al. 2023

Preprint

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Purpose: Postoperative fever is a common problem following neurosurgery but data on the causes among paediatric patients is sparse. In this report, we determined the incidence, causes and outcomes of postoperative fever in paediatric neurosurgical patients (<18 years), and contrasted the findings with an adult cohort published recently from our unit. Methods: We recruited 61 patients operated for non-traumatic neurosurgical indications over 12 months. A standard protocol was followed for the evaluation and management of postoperative fever, collecting data regarding operative details, daily maximal temperature, clinical features, and use of surgical drains, urinary catheters, and other adjuncts. Elevated body temperature of >99.9°F or 37.7°C for >48 hours or associated with clinical deterioration or localising features was considered as “fever”; elevated temperature not meeting these criteria were classified as transient elevation in temperature (TET). Results: Twenty-five patients (34.2%) had postoperative fever, more frequent than in adult patients. TET occurred in 12 patients (16.4%). The most common causes of fever were aseptic meningitis (36%), followed by urinary tract infections (16%), pyogenic meningitis, COVID-19 and wound infections. Postoperative fever was associated with significantly longer duration of hospital admission and was the commonest cause of readmission. Conclusion: In contrast to adults, early temperature elevations in paediatric patients may portend infectious and serious non-infectious causes of fever, including delayed presentation with aseptic meningitis, a novel association among paediatric patients. Investigation guided by clinical assessment and conservative antibiotic policy in keeping with the institutional microbiological profile provide the most appropriate strategy in managing paediatric postoperative fever.

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Adapting management strategies for sellar-suprasellar lesions during the COVID-19 pandemic: a pragmatic approach from the frontline

Cited by 5 publications

References 25 publications

A Negative-Pressure Face-Mounted System Reduces Aerosol Spread during Endonasal Endoscopic Surgery

A Negative-Pressure Face-Mounted System Reduces Aerosol Spread during Endonasal Endoscopic Surgery

A prospective evaluation of postoperative fever in adult neurosurgery patients in the COVID-19 era

Distinct patterns of postoperative fever in paediatric neurosurgery patients

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