Philippine Journal of Surgical Specialties Vol. 75, No. 1, January-June 2020, pp 30-32

AFNI Advisory on Performing Emergency Neurosurgical Procedures During the COVID-19 Pandemic

Author(s): The Academy of Filipino Neurosurgeons, Inc.

As a continuation of AFN Advisory No. 1, the following are additional recommendations for doing neurosurgical procedures during this time of the COVID-19 Pandemic.

While PPEs are in short supply, depending on the local situation of neurosurgical practice (i.e. number of practicing neurosurgeons, number of capable hospitals), neurosurgical operations are better limited to hospitals that can provide complete or near complete PPEs, as well as PAPRs and full-face respirators with P100 (HEPA) filters when needed by the particular case.

At this time of COVID-19 pandemic, surgery through the nasal cavity (endoscopic and non-endoscopic) should be done only for urgent or emergency cases. Endonasal surgery creates clouds of droplets and aerosols which may permeate the operating environment. Preoperative COVID-19 testing should be done on all patients who will undergo endoscopic trans-nasal surgery, whether symptomatic or not. If the test is negative and the patient is asymptomatic, use N95 mask and full PPE. If the test is positive, defer surgery as much as possible until the infection is cleared, verified by repeat testing1 (following DOH protocols).

When endonasal surgery cannot be postponed (urgent) in a COVID-19 positive patient, utilize a PAPR or full-face respirators with P100 (HEPA) filters for everyone in the operating room.1 If possible, perform two COVID-19 tests 24 hours apart while the patient is on quarantine, and perform the surgery only if the results of the 2 tests are negative.

In uncommon situation when one is dealing with pituitary apoplexy and surgery must be done as soon as possible, assume all patients are COVID-19 positive. Take a swab for COVID-19 testing as part of preoperative preparation. Consider the transcranial approach. If endonasal approach is utilized, the use of PAPR or full-face respirators with P100 (HEPA) filters is recommended for everyone in the operating room. In its absence, well-fitted N95 masks, eye protection (goggles/full-face shield), with full PPEs should be used.

Key words: Trans-nasal Surgery, Non-trans-nasal Endoscopic Procedures