Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 994  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 »   Next article
 »   Previous article
 »   Table of Contents

 Resource Links
 »   Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
 »   Citation Manager
 »   Access Statistics
 »   Reader Comments
 »   Email Alert *
 »   Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded55    
    Comments [Add]    

Recommend this journal


Year : 2020  |  Volume : 68  |  Issue : 7  |  Page : 141--145

Impact of SARS-Cov2 on Endoscopic Trans-Nasal Skull Base Surgeries

1 Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
2 Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India

Correspondence Address:
Dr. Manas Panigrahi
Department of Neurosurgery, Krishna Institute of Medical Sciences, 1-8-31/1, Ministers Road, Secunderabad, Telangana
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.287683

Rights and Permissions

Background: The COVID-19 pandemic is currently an evolving situation. Operating rooms (OR) are high-risk areas for the transmission of any respiratory infection with multiple personnel involved, in close proximity. Of concern to neurosurgeons, is the high-risk of aerosol generating procedures (AGPs) like transsphenoidal and endonasal surgery. Endonasal AGPs theoretically present a higher risk of viral exposure due to the longer duration of exposure and aggressive disruption of potentially virus-containing mucosa. Objective: The current review discusses potential strategies to neuro-surgeons to avoid transmission of COVID 19 during endo-nasal and trans-sphenoidal surgeries. Materials and Methods: We searched PubMed using the search terms “COVID-19”, “SARS-CoV-2”, “coronavirus” in combination with “neurosurgery”, and identified 13 relevant articles. A pre-surgical risk assessment score is proposed based on the risk of transmission. A flow chart of patient selection and care has been formulated. Conclusion: In all emergency patients, it is preferable to consider transcranial surgery or a sub-labial approach avoiding exposure to mucosa. Due to laboratory constraints routine swabs is not always available. Therefore, routine preoperative screening computed tomography (CT) chest is performed in all patients. Based on risk of transmission of infection to others, we propose a classification of patients for skull-based surgery into low, high and very high risk groups and suggest suitable personal protective equipment. Additionally, we discuss avoiding use of powered drills in or any AGP. However, cold procedures involving shavers and microdebriders generate lesser amounts of aerosol. Post-operatively, the length of stay could be reduced with a multidisciplinary approach.


Print this article     Email this article

Online since 20th March '04
Published by Wolters Kluwer - Medknow