Impact of COVID‐19 on pituitary surgery

Mitchell, Ruth A.; King, James; Goldschlager, Tony; Wang, Yi Yuen

doi:10.1111/ans.15959

Cited by 15 publications

(11 citation statements)

References 4 publications

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“…12 Strong indications were given to avoid transsphenoidal approaches for pituitary tumors due to the extremely high transmission risk and to favor open craniotomy for deteriorating visual deficits, as well as pituitary apoplexy causing rapid loss of vision. 13,14 Our experience concentrates on the Veneto region, which counts an overall population of 4.9 million and a territory of 18,345.35 km 2 (population density 267.59 inhabitants/km 2 ), resulting in the second most densely populated region in Italy. The National Health Service is independently programmed by the regional governments and is predominantly public in Veneto.…”

Section: Discussionmentioning

confidence: 99%

Neurosurgery in times of a pandemic: a survey of neurosurgical services during the COVID-19 outbreak in the Veneto region in Italy

Raneri

Rustemi

Zambon

et al. 2020

Neurosurgical Focus

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OBJECTIVEThe purpose of this study was to analyze the effect of the coronavirus disease 2019 (COVID-19) outbreak and of the subsequent lockdown on the neurosurgical services of the Veneto region in Italy compared to the previous 4 years.METHODSA survey was conducted in all 6 neurosurgical departments in the Veneto region to collect data about surgical, inpatient care and endovascular procedures during the month of March for each year from 2016 to 2020. Safety measures to avoid infection from SARS-CoV-2 and any COVID-19 cases reported among neurosurgical patients or staff members were considered.RESULTSThe mean number of neurosurgical admissions for the month of March over the 2016–2019 period was 663, whereas in March 2020 admissions decreased by 42%. Emergency admissions decreased by 23%. The average number of neurosurgical procedures was 697, and declined by 30% (range −10% to −51% in individual centers). Emergency procedures decreased in the same period by 23%. Subarachnoid hemorrhage and spontaneous intracerebral hemorrhage both decreased in Veneto—by 25% and 22%, respectively. Coiling for unruptured aneurysm, coiling for ruptured aneurysm, and surgery for ruptured aneurysm or arteriovenous malformation diminished by 49%, 27%, and 78%, respectively. Endovascular procedures for acute ischemic stroke (AIS) increased by 33% in 2020 (28 procedures in total). There was a slight decrease (8%) in brain tumor surgeries. Neurosurgical admissions decreased by 25% and 35% for head trauma and spinal trauma, respectively, while surgical procedures for head trauma diminished by 19% and procedures for spinal trauma declined by 26%. Admissions and surgical treatments for degenerative spine were halved. Eleven healthcare workers and 8 patients were infected in the acute phase of the pandemic.CONCLUSIONSThis multicenter study describes the effects of a COVID-19 outbreak on neurosurgical activities in a vast region in Italy. Remodulation of neurosurgical activities has resulted in a significant reduction of elective and emergency surgeries compared to previous years. Most likely this is a combined result of cancellation of elective and postponable surgeries, increase of conservative management, increase in social restrictions, and in patients’ fear of accessing hospitals. Curiously, only endovascular procedures for AIS have increased, possibly due to reduced physical activity or increased thrombosis in SARS-CoV-2. The confounding effect of thrombectomy increase over time cannot be excluded. No conclusion can be drawn on AIS incidence. Active monitoring with nasopharyngeal swabs, wearing face masks, and using separate pathways for infected patients reduce the risk of infection.

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Section: Discussionmentioning

confidence: 99%

Neurosurgery in times of a pandemic: a survey of neurosurgical services during the COVID-19 outbreak in the Veneto region in Italy

Raneri

Rustemi

Zambon

et al. 2020

Neurosurgical Focus

View full text Add to dashboard Cite

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“…If surgery cannot be delayed, appropriate recommendations for the management of patients with pituitary tumours should be followed [ 140 ]. The initial recommendation for preventive measures were affected by shortage of testing material for SARS-CoV-2 which was recommended only in case of suspected infection [ 134 ].…”

Section: Pituitary Surgery and Covid-19mentioning

confidence: 99%

COVID-19 and the pituitary

et al. 2021

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Background Despite COVID-19 being identified as severe respiratory viral infection, progressively many relevant endocrine manifestations have been reported greatly contributing to the severity of the clinical presentation. Systemic involvement in COVID-19 is due to the ubiquitous expression of angiotensin-converting enzyme 2 (ACE2) receptor, responsible for the entry in the cells of SARS-CoV-2, Several reports in humans and animal models showed a significant ACE2 mRNA expression in hypothalamus and pituitary cells. Moreover, higher mortality and poorer outcomes have been widely described in COVID-19 patients with obesity, diabetes and vertebral fractures, which are all highly prevalent in subjects with pituitary dysfunctions. Aim To review the main endocrine manifestations of COVID-19 with their possible implications for pituitary diseases, the possible direct and indirect involvement of the pituitary gland in COVID-19, the impact of COVID-19 on the management of established pituitary diseases which can be already at increased risk for worse outcomes and on neurosurgical activities as well as vaccination. Conclusions Our review underlines that there could be a specific involvement of the pituitary gland which fits into a progressively shaping endocrine phenotype of COVID-19. Moreover, the care for pituitary diseases need to continue despite the restrictions due to the emergency. Several pituitary diseases, such as hypopituitarism and Cushing disease, or due to frequent comorbidities such as diabetes may be a risk factor for severe COVID-19 in affected patients. There is the urgent need to collect in international multicentric efforts data on all these aspects of the pituitary involvement in the pandemic in order to issue evidence driven recommendations for the management of pituitary patients in the persistent COVID-19 emergency.

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“…Along with general concerns of ENT surgeons being particularly high risk for contracting COVID-19, a near complete arrest of pituitary and skull base procedures in many countries, including the UK, occurred [1]. This was supported by cautious guidance from various national bodies and societies [3,4]. However, patients have continued to present with large tumors causing brainstem and optic apparatus compression, at risk of permanent neurological injury without expedited surgery [2].…”

Section: Letter To the Editormentioning

confidence: 99%

A safe approach to surgery for pituitary and skull base lesions during the COVID-19 pandemic

et al. 2020

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Impact of COVID‐19 on pituitary surgery

Abstract: Ruth A. Mitchell has previously been the recipient of Foundation for Surgery scholarships.

Cited by 15 publications

References 4 publications

Neurosurgery in times of a pandemic: a survey of neurosurgical services during the COVID-19 outbreak in the Veneto region in Italy

Neurosurgery in times of a pandemic: a survey of neurosurgical services during the COVID-19 outbreak in the Veneto region in Italy

COVID-19 and the pituitary

A safe approach to surgery for pituitary and skull base lesions during the COVID-19 pandemic

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