Discussion
COVID-19 requires meticulous precautions in order of limiting person-to-person spread, being respiratory droplets deposited on the mucous membranes of mouth, nose, and eyes of nearby people and by close personal contact, the main routes of diffusion [2, 8, 18].
Accordingly, medical and surgical maneuvers involving the respiratory mucosa were immediately considered high-risk procedures [11, 16, 24].
It should be remembered that an otorhinolaryngologist was the first doctor to die from COVID-19.
Patients with symptomatic COVID-19 should be treated for neurosurgical disease only when surgery is not deferrable, namely when delaying it, the patient is exposed to concrete risks quoad vitam et valetudinem. Patients harboring COVID-19 represent the main source of viral transmission and therefore must be treated in an adequate in hospital setting with personnel being provided of adequate personal protective equipment (PPE). Additionally, a quite vast number of patients be carrier of SARS-CoV-2 and can be responsible for infection transmission.
Considering the above, caseload reduced, and routine activities have been cancelled and/or postponed if possible, to limit the spread of SARS-CoV2.
Neurosurgical scientific societies identified the transnasal skull base surgery, transoral and transfacial corridors, as the most riskful for diffusion of COVID-19 and also recommended to spare the opening of paranasal cavities and mastoids during transcranial corridors [7, 19–21, 23]. To our knowledge, “maximally safe” protocols for performing neurosurgical procedures, while minimizing the risks of COVID-19 diffusion, include the use of adequate PPE, OR settings, and the advice of reducing aerosol/droplets generating maneuvers [15, 19, 21].
Our study reports the use of a face mask, namely a nose lid (Figs. 1 and 2), to be applied to the patient during endonasal procedures for skull base pathologies as a further possible COVID-19 mitigation strategy. Numerous models of face masks have been proposed and tested by individual users, researchers, doctors, and commercial entities with varying degrees of success in other disciplines [9, 14]. At the moment, in our field, there are no models of face masks to contain the spread of the virus.
In our case, the mask, i.e. the nose lid, it is cheap, promptly available and can be easily assembled with the use of a few tools that we all have available in the OR. The necessary materials include a non-latex glove and sterile protective film. This mask allows to both operating surgeon and his assistant to perform wider surgical maneuvers throughout the slits, without ripping it, while limiting the nostril airflow.