PMC:7417198 / 6972-9639 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7417198","sourcedb":"PMC","sourceid":"7417198","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7417198","text":"Technical consideration\nConsidering all the above, we retained useful to adopt peculiar surgical technique modifications, in order to further limit the spread of droplets and aerosols [3, 11, 24]\nBefore starting, cottonoid pledgets soaked with diluted iodopovidone are placed and left in place for at least 5 min to rinse off mucosa from any contamination [5];\nAfter usual nasal pyramid sterile draping, an endonasal surgery facial mask, namely a nose lid, is assembled: a sterile non-latex glove layer is used to cover nostril and fixed with adhesive protection film over the nasal bridge; initially, two and then three narrow slit cut are placed over the nares to let instruments enter the nostrils (Figs. 1, 2, and 3).\nFig. 1 Pictures showing the layer of sterile non-latex glove with a two and b three slit cuts, being used as nose lid. Without any instrument that pierces it, the cuts are minimal\nFig. 2 Picture showing the intraoperative setting. The nose lid is fixed with adhesive protection film over the nasal bridge and instruments can slide through the slit cuts the lid adheres to their outer diameter. a The endoscope is inserted through one nostril, i.e., the right. b Three-four hands technique: the endoscope is held by assistant at the most superior aspect of the left nostril and the surgeon holds the instruments inside the right nostril and the suction tube beneath the endoscope\nFig. 3 Picture showing the details of intraoperative setting demonstrating that air flow through the nose can be limited by the use of the nose lid. a The microdrill is inserted through the left nostril and the nose lid adheres to its outer diameter. b The endoscope and suction tube are inserted through one nostril, i.e., the right, in two different slit cuts. c The endoscope is inserted through the right nostril while the microdrill in the left one, each of them in the relative slit cut\nThe slit cuts permit to limit the empty space of the nares allowing the entrance and exit only of the surgical instruments. The procedure then has been run as usual throughout into 3 steps: the nasal, the sphenoid, and the sellar phases.\nA corridor between middle turbinates and the nasal septum is created and thereafter the nasal septum is detached from the sphenoid rostrum with blunt instruments. Cautery is limited as much as possible. The anterior wall of the sphenoid sinus is widely opened with osteotomes and rongeurs preferably and opening of the sellar floor is performed using chisel and hammer; microdrill with continuous irrigation, to reduce as much as possible the spreading of aerosol and bone dust, is used only to refine skull base opening upon the 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