Patient selection
Our department, according to the actual COVID-19 protocol national guidelines, has suspended elective procedures and reviewed our criteria of prioritization [21]. Accordingly, we retain that a pituitary/skull base procedure can be considered non-deferrable upon the presence ofpituitary apoplexy associated with neurological defects;
tumors with massive suprasellar and/or supradiaphragmatic component with CSF circulation obstacle and/or hydrocephalus and/or intracranial hypertension signs;
At admission, patients are screened via interview and temperature is registered. Upon any suspicion of COVID-19, the infectivologist will be consulted in order to rule out the workflow; in any case, whether delaying surgery increases risks, precautions as for positive patients are required.
However, it should be minded that the certainty of COVID-19 negativity status is somehow difficult to assess: many COVID-19 cases are asymptomatic, and the reliability of screening tests is often limited and eventually low.
As general rule though, basic precautions, i.e., accurate and frequent hand washing, wearing a surgical mask and social distancing should be taken regardless of the patient Covid-19 status [10]; further peculiar precautions should be adopted in addition during critic procedures involving the respiratory mucosa, such as oro-tracheal aspiration, intubation, extubation, and/or when performing transnasal, transoral surgery, being essential to distinguish COVID-19-positive patients from the negative ones [6, 10, 11, 19].
Hence, in the last month, only three patients required urgent treatment, respectively, for the treatment of a pituitary apoplexy, a chondrosarcoma causing cavernous sinus syndrome and a pituitary macroadenoma determining chiasm compression. Once we cleared COVID-19 status (telephone interview and serological exam were run), we decided to adopt endoscopic endonasal approach in all these cases.