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J Neurol Surg B Skull Base 2022; 83(S 02): e419-e429
DOI: 10.1055/s-0041-1730352
Original Article

Safety of Endoscopic Transsphenoidal Pituitary Surgery during the COVID-19 Pandemic and Comparison to the Pre-Pandemic Era

Meriem Amarouche
1   Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
,
Samin Rashid
1   Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
,
John Eraifej
1   Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
2   Oxford Functional Neurosurgery Group, Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
,
Anouk Borg
1   Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
,
Jane Halliday
1   Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
,
Orlando J. Warner
3   Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
,
Simon A. Cudlip
1   Department of Neurological Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Abstract

Objective The COVID-19 pandemic has caused significant disruption to the surgical care of patients with pituitary tumors. Guidance issued early during the pandemic suggested avoiding transnasal approaches to minimize risks of transmitting COVID-19 to health care professionals involved in these procedures.

Methods This observational, single-center study compares results of endoscopic transsphenoidal approach (TSA) for pituitary tumors since the start of the pandemic to a pre-pandemic period. Anesthetic time, surgical time, and complication rates were compared. Newly acquired COVID-19 infections and transmission rates to patients and staff were reviewed. Data were analyzed by using the independent t-test, Mann–Whitney U test, and Pearson Chi-square test, significance set at p <0.05.

Results Over a 12-month period, a total of 50 and 69 patients underwent endoscopic TSA for pituitary tumor during and before the pandemic, respectively. All patients tested negative for COVID-19 preoperatively. Median duration of anesthesia was 35 minutes (interquartile range [IQR]: 22) during the pandemic and 25 minutes (IQR: 8, p = 0.0002) pre-pandemic. Median duration of surgery was 70 minutes (IQR: 28) during the pandemic and 79 minutes (IQR: 33.75, p = 0.126) pre-pandemic. There were no statistically significant differences between intraoperative CSF leaks and complication rates. No staff members tested positive for COVID-19. Three patients tested positive for COVID-19 postdischarge, but the infections were community acquired.

Conclusion In contrast to published guidelines, adequate preoperative testing, a multidisciplinary approach and the implementation of standardized protocols and vaccination against COVID-19 allow for endoscopic transsphenoidal surgery to be performed safely in patients with pituitary pathology during the pandemic.

Keywords

pituitary surgery - transsphenoidal - nonfunctioning pituitary adenoma - functioning pituitary adenoma - Rathke's cleft cyst - COVID-19 pandemic

Note

An abstract of an earlier version of this work was presented at two national conferences, the Glasgow Pituitary Clinicopathological Conference in September 2020 and the British Neuroendoscopy Society Meeting in November 2020. It has also been accepted for a poster presentation at the North American Skull Base Society Meeting in February 2021.


All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.


Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


Informed consent was obtained from all individual participants included prospectively in the study. Part of the data was collected retrospectively and for this type of study formal consent is not required.




Publication History

Received: 28 December 2020

Accepted: 04 April 2021

Article published online:
27 May 2021

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