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      Ventilated Upper Airway Endoscopic Endonasal Procedure Mask: Surgical Safety in the COVID-19 Era

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          Abstract

          BACKGROUND

          COVID-19 poses a risk to the endoscopic skull base surgeon. Significant efforts to improving safety have been employed, including the use of personal protective equipment, preoperative COVID-19 testing, and recently the use of a modified surgical mask barrier.

          OBJECTIVE

          To reduce the risks of pathogen transmission during endoscopic skull base surgery.

          METHODS

          This study was exempt from Institutional Review Board approval. Our study utilizes a 3-dimensional (3D)-printed mask with an anterior aperture fitted with a surgical glove with ports designed to allow for surgical instrumentation and side ports to accommodate suction ventilation and an endotracheal tube. As an alternative, a modified laparoscopic surgery trocar served as a port for instruments, and, on the contralateral side, rubber tubing was used over the endoscrub endosheath to create an airtight seal. Surgical freedom and aerosolization were tested in both modalities.

          RESULTS

          The ventilated mask allowed for excellent surgical maneuverability and freedom. The trocar system was effective for posterior surgical procedures, allowing access to critical paramedian structures, and afforded a superior surgical seal, but was limited in terms of visualization and maneuverability during anterior approaches. Aerosolization was reduced using both the mask and nasal trocar.

          CONCLUSION

          The ventilated upper airway endoscopic procedure mask allows for a sealed surgical barrier during endoscopic skull base surgery and may play a critical role in advancing skull base surgery in the COVID-19 era. The nasal trocar may be a useful alternative in instances where 3D printing is not available. Additional studies are needed to validate these preliminary findings.

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          Most cited references 7

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          Endonasal instrumentation and aerosolization risk in the era of COVID-19: simulation, literature review, and proposed mitigation strategies.

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            An inexpensive blue filter for fluorescein-assisted repair of cerebrospinal fluid rhinorrhea

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              Letter: precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic

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                Author and article information

                Journal
                Oper Neurosurg (Hagerstown)
                Oper Neurosurg (Hagerstown)
                ons
                Operative Neurosurgery
                Oxford University Press
                2332-4252
                2332-4260
                30 May 2020
                Affiliations
                [1 ] Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine , Atlanta, Georgia
                [2 ] Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology , Atlanta, Georgia
                [3 ] Department of Pediatrics, Emory University School of Medicine , Atlanta, Georgia
                [4 ] Children's Healthcare of Atlanta , Atlanta, Georgia
                [5 ] Department of Neurosurgery, Emory University School of Medicine , Atlanta, Georgia
                Author notes
                Correspondence: Samuel N. Helman, MD, Emory University, Department of Otolaryngology-Head and Neck Surgery, 550 Peachtree Street NE, Suite 1135, Atlanta, GA 30308, USA. Email: shelman@ 123456emory.edu
                Article
                opaa168
                10.1093/ons/opaa168
                7534784
                32472685
                Copyright © 2020 by the Congress of Neurological Surgeons

                This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                Page count
                Pages: 10
                Product
                Categories
                Instrumentation and Technique
                AcademicSubjects/MED00930
                Neuros/3
                Custom metadata
                PAP

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