Pituitary adenoma surgeries in COVID-19 era: Early local experience from Egypt

Abstract

Background: The pandemic of COVID-19 has a great impact on all health-care services worldwide. Neurosurgical recommendations are to postpone the endoscopic endonasal pituitary surgeries during the pandemic. We would like to express our experience with urgent pituitary adenomas during the current COVID-19 pandemic. Methods: In our country, COVID-19 has started to become a paramount problem by March 2020. Nine cases of pituitary adenomas have presented with urgent manifestations. The endoscopic endonasal approach was performed in eight patients, while a craniotomy was selected for a recurrent pituitary adenoma. Pre- and postoperative thorough clinical evaluations with chest CT scans were performed. Other strict infection control measures have been applied. Results: In 8 weeks duration starting from the past days of February 2020, we have operated on four females and five males of pituitary adenomas. Visual deterioration was the main presenting symptom. The driving factor for surgery was saving vision in eight patients. Fortunately, the postoperative course was uneventful for all patients. No suspected COVID-19 infection has been reported in any patient or health-care team except one patient. In our city, PCR test was routinely not available. Conclusion: In the era of COVID-19, strict infection control precautions should be employed to limit the possibility of transmission of any possible infection to patient or any of the surgical team. We believe that the risk of getting such infection is not increased by the endonasal approach. Long-term follow-up and large numbers of prospective studies are recommended to delineate the impact of COVID-19 infection on pituitary surgeries.

Letter: COVID Conundrum: Postoperative COVID-19 Infections Following Endonasal Transsphenoidal Pituitary Surgery

“…Given the pituitary dysfunction after transsphenoidal surgery and potentially compromised stress response, the ramifications of a COVID-19 infection may thus be more serious in the post-transsphenoidal setting, and both patients and providers should be advised to pay heed to this additional risk. Although other small case reports have not found an increased risk following endonasal transsphenoidal surgery, 3 we suggest patients be strongly advised to restrict their activities to minimize their exposure risk after discharge. Hospital policies should consider these patients high risk for COVID-19 infection even in the setting of the negative preoperative COVID-19 test.…”

Endoscopic endonasal transsphenoidal approach during COVID-19 pandemic in Brazil

“…Different surgical strategies were implemented in COVID-19negative patients. Arnaout et al (Egypt) [2] prevented the dissemination of vapor or surgical debris using an extra suction tube inside the nostril. Barbosa et al (Brazil) [3] sealed the patient's head and trunk with a surgical microscope bag, leaving a small hole to insert the endoscopic instruments.…”

“…Most patients underwent urgent pituitary surgery due to chiasm compression, severe hormonal dysfunction, pituitary apoplexy, or refractory headache. [ 7 ] The centers used the clinical history and the following strategies to investigate COVID-19 in the preoperative period: (a) RTPCR alone,[ 3 , 17 , 20 ] (b) blood test (IgM/IgG) and RT-PCR,[ 14 , 24 ] (c) only chest CT,[ 2 , 22 ] and (d) RT-PCR and chest. [ 1 ] To reduce contamination in the OR, most groups used one surgical mask plus N95, face shields, eye protection, surgical gown, double surgical glove, and limited staff members presence.…”

“…Arnaout et al . (Egypt)[ 2 ] prevented the dissemination of vapor or surgical debris using an extra suction tube inside the nostril. Barbosa et al .…”

The pituitary gland in the COVID-19 pandemic: A narrative review of the literature

“…Other authors shared the same experience about the feasibility and the safety of maintaining this clinical service throughout the pandemic (primarily based on the presence of solid clinical indications for urgent surgery). [66][67][68] On the other hand, Penner et al [69] operated successfully on functional pituitary adenomas (without visual compromise) during the pandemic. They adopted a good preoperative screening program (requiring two negative PCR tests preoperatively) and the use of adequate personal protective equipment during patient contact.…”