Reintroducing Endoscopic Skull Base Surgery During the COVID-19 Pandemic: A Single-Center Experience from the United States COVID-19 Epicenter

Background: The COVID-19 pandemic presented unique challenges for endoscopic skull base surgery (ESBS) given the elevated viral load in the nasopharynx and aerosolization of particles inherent to the endoscopic endonasal approach (EEA). Furthermore, reports and anecdotes shared within the skull base surgeon community suggesting potential elevated risk of COVID-19 transmission during ESBS led to an abundance of precaution and scrutiny regarding endonasal procedures during the pandemic. The Mount Sinai Hospital is a busy ESBS center located in New York City, the United States COVID-19 pandemic epicenter. We report a case series describing the early experience of resuming ESBS during the COVID-19 pandemic, including systems for case selection, surgical precautions and modifications, and patient outcomes. Methods: All consecutive ESBS cases and deferred surgical cases were identified prospectively within the first three-week period after resumption of urgent scheduled surgery. Data regarding indications, pre-surgical screening, operative results, and postoperative course were collected retrospectively. All data are presented using descriptive statistics. Results: With the study time frame, 14 patients underwent ESBS. Four patients had surgery deferred. The mean age was 57. The most common pathology was pituitary tumor, in 57% of patients. Visual symptoms precipitated the urgency in 36% of cases. All patients underwent COVID-19 screening with a minimum of one SARSCoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) nasal swab within 48 hours preceding surgery. All patients tested negative. There were no intraoperative complications. Median length of stay was two days. A total of 14% of patients experienced postoperative complications. Mean follow-up was 100.9 days. Conclusions: Due to its relatively low morbidity and potential short length of stay, ESBS is adaptable to unique pandemic challenges such as bed scarcity and exposure minimization. As endoscopic centers return to normal operations during the COVID-19 era, standard testing, case selection algorithms, and systematic surgical precautions and modifications can enable a safe resumption of ESBS