Nasoseptal Flap Necrosis After Endoscopic Skull Base Surgery in the Setting of COVID-19 Pandemic.
Aged
Betacoronavirus
/ pathogenicity
COVID-19
Cerebrospinal Fluid Leak
/ etiology
Coronavirus Infections
Humans
Male
Necrosis
/ etiology
Neurosurgical Procedures
/ adverse effects
Pandemics
Pneumonia, Viral
Postoperative Complications
/ virology
SARS-CoV-2
Skull Base
/ surgery
Surgical Flaps
/ surgery
COVID-19
Cerebrospinal fluid leak
Endoscopic skull base surgery
Nasoseptal flap necrosis
Pituitary adenoma
SARS-CoV-2
Transsphenoidal
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
16
05
2020
accepted:
25
05
2020
pubmed:
2
6
2020
medline:
28
8
2020
entrez:
2
6
2020
Statut:
ppublish
Résumé
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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32479908
pii: S1878-8750(20)31208-0
doi: 10.1016/j.wneu.2020.05.237
pmc: PMC7256530
pii:
doi:
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
374-377Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Références
MMWR Morb Mortal Wkly Rep. 2020 Feb 07;69(5):140-146
pubmed: 32027631
Laryngoscope. 2015 Jan;125(1):80-5
pubmed: 25111727
Stroke. 2020 Jul;51(7):e124-e127
pubmed: 32396456
World Neurosurg. 2014 Jan;81(1):136-43
pubmed: 23022644
J Neurosurg. 2018 May;128(5):1463-1472
pubmed: 28731395
J Virol. 2005 Dec;79(23):14614-21
pubmed: 16282461
Thromb Haemost. 2020 Jun;120(6):949-956
pubmed: 32349133
Trop Med Int Health. 2020 Mar;25(3):278-280
pubmed: 32052514
Neurosurg Focus. 2012 Jun;32(6):E7
pubmed: 22655696
J Am Coll Cardiol. 2020 Jun 16;75(23):2950-2973
pubmed: 32311448
Ann Vasc Surg. 2020 Jul;66:8-10
pubmed: 32360432
Emerg Microbes Infect. 2020 Dec;9(1):747-756
pubmed: 32196430
Science. 2020 Mar 13;367(6483):1260-1263
pubmed: 32075877
Neurosurgery. 2008 Jul;63(1 Suppl 1):ONS44-52; discussion ONS52-3
pubmed: 18728603
Eur J Case Rep Intern Med. 2020 Apr 29;7(5):001691
pubmed: 32399457
Neurosurg Focus. 2014;37(4):E4
pubmed: 25270144
J Pathol. 2004 Jun;203(2):631-7
pubmed: 15141377
Rhinology. 2020 Jun 1;58(3):299-301
pubmed: 32240279
EClinicalMedicine. 2020 Apr 05;21:100331
pubmed: 32292899
Am J Rhinol Allergy. 2017 Sep 1;31(5):334-337
pubmed: 28859712
J Neurol Surg B Skull Base. 2018 Oct;79(Suppl 4):S291-S299
pubmed: 30210981
Clin Chem Lab Med. 2020 Jun 25;58(7):1116-1120
pubmed: 32172226
Am J Rhinol Allergy. 2009 Sep-Oct;23(5):518-21
pubmed: 19807986