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Endonasal Surgery and COVID-19 Protections for Surgeons

In This Video

  • Skull-base procedures present a high potential for a high viral load. Physicians at Massachusetts General Hospital have modified personal protective equipment (PPE) and the way procedures are conducted
  • Collaboration with colleagues at Mass Eye and Ear resulted in the creation of protective hoods around COVID-19 patient to protect neurosurgeons
  • Surgery done through a microscope or endoscope may lead to adaptation of exoscopic techniques, which will allow surgeons to continue to wear PPE during skull base cases

William T. Curry, MD, co-director of Mass General Neuroscience and director of neurosurgical oncology in the Department of Neurosurgery at Massachusetts General Hospital and the Mass General Cancer Center, discusses a collaboration with colleagues at Massachusetts Eye and Ear to create protective equipment to shield neurosurgeons during skull-base procedures. This work will help create thorough personal protective equipment and may adapt some of the instrumentation to reduce aerosolization of particles carrying the coronavirus.


In my subspecialty, which is neuro-oncology, these cases, while not always emergent, have urgency to them, so we were able to proceed for the most part as we would have. For some of our cases, and particularly the skull-base procedures, where we go through the nose, where there is the potential for a high viral load, we actually modified both the way we protect ourselves and the way we conducted the procedures.

We were able to be innovative and in collaboration with colleagues at Mass Eye and Ear, create protective hoods around the patient through which we operate. And we also published a number of papers looking at the aerosolization of nasal particles that occurs during these skull base procedures. Starting from some of the observations that occurred during the early COVID period, we will at least think very differently about the risk to surgeons and everybody in the operating room during these procedures, and so, therefore, we will have more thorough PPE [personal protective equipment] and we may even adapt some of the instrumentation to reduce aerosolization of particles.

On another level, you know, much of the surgery that we do is done through a microscope or sometimes using an endoscope. This may lead to a more rapid adaptation of what is called exoscopic techniques, where the light source in a camera sits above the patient or the surgical field, rather than in between the surgeon and the field. And that will allow us to continue to wear very protective PPE during these skull base cases.

Learn about the Stephen E. and Catherine Pappas Center for Neuro-Oncology

Refer a patient to the Department of Neurosurgery


High-speed drilling appears to be the single greatest risk factor for potentially infectious aerosolization of new coronavirus during endonasal surgery, even when activated for only several seconds.


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