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10.1016/j.wneu.2020.05.237

http://scihub22266oqcxt.onion/10.1016/j.wneu.2020.05.237
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suck abstract from ncbi


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pmid32479908      World+Neurosurg 2020 ; 140 (ä): 374-377
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  • Nasoseptal Flap Necrosis After Endoscopic Skull Base Surgery in the Setting of COVID-19 Pandemic #MMPMID32479908
  • Talmor G; Grube JG; Eloy JA; Liu JK; Hsueh WD
  • World Neurosurg 2020[Aug]; 140 (ä): 374-377 PMID32479908show ga
  • BACKGROUND: A novel viral strain known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created a worldwide pandemic known as coronavirus 2019 (COVID-19). Early reports from China have highlighted the risks associated with performing endoscopic endonasal skull base surgery in patients with SARS-CoV-2. We present a rare complication of nasoseptal flap (NSF) necrosis associated with COVID-19, further emphasizing the challenges of performing these procedures in this era. CASE DESCRIPTION: A 78-year-old man underwent an extended endoscopic endonasal transplanum resection of a pituitary macroadenoma for decompression of the optic chiasm. The resulting skull base defect was repaired using a pedicled NSF. The patient developed meningitis and cerebrospinal fluid (CSF) leak on postoperative day 13, requiring revision repair of the defect. Twelve days later, he developed persistent fever and rhinorrhea. The patient was reexplored endoscopically, and the NSF was noted to be necrotic and devitalized with evident CSF leakage. At that time, the patient tested positive for SARS-CoV-2. Postoperatively, he developed acute respiratory distress syndrome complicated by hypoxic respiratory failure and death. CONCLUSIONS: To our knowledge, this is the first reported case of NSF necrosis in a patient with COVID-19. We postulate that the thrombotic complications of COVID-19 may have contributed to vascular pedicle thrombosis and NSF necrosis. Although the pathophysiology of SARS-CoV-2 and its effect on the nasal tissues is still being elucidated, this case highlights some challenges of performing endoscopic skull base surgery in the era of COVID-19.
  • |*Coronavirus Infections[MESH]
  • |*Pandemics[MESH]
  • |*Pneumonia, Viral[MESH]
  • |Aged[MESH]
  • |Betacoronavirus/*pathogenicity[MESH]
  • |COVID-19[MESH]
  • |Cerebrospinal Fluid Leak/etiology[MESH]
  • |Humans[MESH]
  • |Male[MESH]
  • |Necrosis/etiology[MESH]
  • |Neurosurgical Procedures/*adverse effects[MESH]
  • |Postoperative Complications/virology[MESH]
  • |SARS-CoV-2[MESH]
  • |Skull Base/*surgery[MESH]


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