Sinus and anterior skull base surgery during the COVID-19 pandemic: systematic review, synthesis and YO-IFOS position

European Archives of Oto-Rhino-Laryngology https://doi.org/10.1007/s00405-020-06236-9 REVIEW ARTICLE Sinus and anterior skull base surgery during the COVID‑19 pandemic: systematic review, synthesis and YO‑IFOS position Thomas Radulesco1,2,3 · Jerome R. Lechien1,4,5 · Leigh J. Sowerby1,6 · Sven Saussez1,4 · Carlos Chiesa‑Estomba1,7 · Zoukaa Sargi1,8 · Philippe Lavigne1,9 · Christian Calvo‑Henriquez1,10 · Chwee Ming Lim1,11 · Napadon Tangjaturonrasme1,12 · Patravoot Vatanasapt1,13 · Puya Dehgani‑Mobaraki1,14,15 · Nicolas Fakhry1,2 · Tareck Ayad1,9 · Justin Michel1,2,3 Received: 24 April 2020 / Accepted: 20 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020, corrected publication 2020 Abstract Purpose The COVID-19 pandemic has caused significant confusion about healthcare providers’ and patients’ pandemicspecific risks related to surgery. The aim of this systematic review is to summarize recommendations for sinus and anterior skull base surgery during the COVID-19 pandemic. Methods PubMed/MEDLINE, Google Scholar, Scopus and Embase were searched by two independent otolaryngologists from the Young Otolaryngologists of IFOS (YO-IFOS) for studies dealing with sinus and skull base surgery during COVID19 pandemic. The review also included unpublished guidelines edited by Otolaryngology-Head and Neck Surgery or Neurosurgery societies. Perioperative factors were investigated including surgical indications, preoperative testing of patients, practical management in operating rooms, technical aspects of surgery and postoperative management. The literature review was performed according to PRISMA guidelines. The criteria for considering studies or guidelines for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework. Results 15 International publications met inclusion criteria. Five references were guidelines from national societies. All guidelines recommended postponing elective surgeries. An algorithm is proposed that classifies endonasal surgical procedures into three groups based on the risk of postponing surgery. Patients’ COVID-19 status should be preoperatively assessed. Highest level of personal protective equipment (PPE) is recommended, and the use of high-speed powered devices should be avoided. Face-to-face postoperative visits must be limited. Conclusions Sinus and skull base surgeries are high-risk procedures due to potential aerosolization of SARS-CoV-2 virus. Protection of health care workers by decreasing exposure and optimizing the use of PPE is essential with sinus and anterior skull base surgery. Keywords Coronavirus infections · Nose diseases · Operative procedures · Health planning guidelines Introduction Since its emergence in December 2019 in Wuhan, China, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has rapidly spread worldwide [1]. The pandemic has significantly impacted the management of all patients, in all medical fields, regardless of COVID-19 status. In many countries, the number of elective surgeries has been substantially reduced to redeploy healthcare workers and to preserve * Thomas Radulesco thomas.radulesco@ap‑hm.fr Extended author information available on the last page of the article personal protective equipment (PPE), medication supply and hospital equipment for the care of COVID-19 patients [2]. A critical issue concerns the risk of infection for health care providers [3]. In Wuhan, 40 of the 138 first patients hospitalized were health care providers, and the same issue was reported in Italy [4,5]. It has been shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by high viral loads in upper airways [6]. As such, Otolaryngologist—Head and Neck surgeons and surrounding staff are especially vulnerable to viral transmission during clinical encounters, in-office procedures and surgery [7,8]. Among the common ENT surgeries, tracheostomy, endolaryngeal procedures and sinus and skull base surgeries 13 Vol.:(0123456789) European Archives of Oto-Rhino-Laryngology are still considered as high-risk procedures [7]. There are currently only a few published recommendations specifically addressing sinus and anterior skull base surgery. Most elective surgeries are being postponed, but practitioners need recommendations to continue to manage urgent cases [9]. Moreover, the planning for the resumption of surgical activity after the first peak of the pandemic in the next months must be anticipated and planned at this time. The aim of this systematic review was to summarize national recommendations or publications related to sinus and anterior skull base surgery during the COVID-19 pandemic, focusing on surgical indications, preoperative testing of patients, practical management in operating rooms, technical aspects of surgery and postoperative management. Methods The study was conducted by the COVID-19 Task Force of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (YO-IFOS), Fig. 1  PRISMA diagram 13 which includes European, Asian, North and South American, Oceanian and Middle-East and African otolaryngologists. The literature review was performed according to PRISMA guidelines [10] (Fig. 1). Two independent authors conducted the PubMed/MEDLINE, Google Scholar, Scopus, Embase and MedRxiv search for identifying papers published between January 2020 and April 2020. Titles and abstracts were reviewed to screen out non-relevant articles and the working group reviewed the full text of remaining articles/guidelines. The following keywords were used for the search strategy: “COVID-19” OR “SARS CoV-2” AND “ENT” OR “sinus surgery” OR “transnasal” OR “nasal” OR “endoscopic” OR “neurosurgery” OR “skull base” OR “guidelines” OR “consensus”. This review also included unpublished guidelines and recommendations edited by different otolaryngological or neurosurgical societies and institutions across the world, by contacting societies directly. The criteria for considering studies or guidelines for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework [11, 12]. European Archives of Oto-Rhino-Laryngology Intervention Rhinologie, AFR) proposed an algorithm classifying surgical procedures into three groups:—A: requiring immediate treatment—B: requiring treatment within a maximum of 4 weeks and—C: non-urgent procedures. The updated algorithm was validated by YO-IFOS working group (Table 2). In France, only group A procedures could be performed during the pandemic. Group B procedures would then be prioritized once group A procedures were performed. All publications and/or guidelines related to sinus or anterior skull base surgery and COVID-19 were included in this review. Preoperative assessment of patients’ COVID‑19 status (RT‑PCR, chest computed tomography, examination) Comparison and outcome Radulesco et al. [14] recommended (...truncated)