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Updated: Dec 23, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
A COVID-19 Patient Who Underwent Endonasal Endoscopic Pituitary Adenoma Resection: A Case Report
Wende Zhu1, Xing Huang1, Hongyang Zhao1
1Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Background And Importance:
A pituitary adenoma patient who underwent surgery in our department was diagnosed with COVID-19 and 14 medical staff were confirmed infected later. This case has been cited several times but without accuracy or entirety, we feel obligated to report it and share our thoughts on the epidemic among medical staff and performing endonasal endoscopic surgery during COVID-19 pandemic.
Clinical Presentation:
The patient developed a fever 3 d post endonasal endoscopic surgery during which cerebrospinal leak occurred, and was confirmed with SARS-CoV-2 infection later. Several medical staff outside the operating room were diagnosed with COVID-19, while the ones who participated in the surgery were not.
Conclusion:
The deceptive nature of COVID-19 results from its most frequent onset symptom, fever, a cliché in neurosurgery, which makes it hard for surgeons to differentiate. The COVID-19 epidemic among medical staff in our department was deemed as postoperative rather than intraoperative transmission, and attributed to not applying sufficient personal airway protection. Proper personal protective equipment and social distancing between medical staff contributed to limiting epidemic since the initial outbreak. Emergency endonasal endoscopic surgeries are feasible since COVID-19 is still supposed to be containable when the surgeries are performed in negative pressure operating rooms with personal protective equipment and the patients are kept under quarantine postoperatively. However, we do not encourage elective surgeries during this pandemic, which might put patients in conditions vulnerable to COVID-19.
Insights
A pituitary adenoma patient contracted COVID-19 post-surgery, leading to staff infections. This highlights the need for strict personal protective equipment and quarantine protocols during the pandemic.
Area of Science:
- Neurosurgery
- Infectious Disease Epidemiology
Background:
- A case of pituitary adenoma surgery complicated by a postoperative COVID-19 diagnosis in the patient.
- Subsequent identification of COVID-19 infections among 14 medical staff members within the department.
Observation:
- The patient developed fever three days post-endonasal endoscopic surgery, later confirmed positive for SARS-CoV-2.
- Medical staff not involved in the surgery, but working in the department, were diagnosed with COVID-19.
- Surgical staff who participated in the procedure did not contract the virus.
Findings:
- COVID-19 transmission among staff was attributed to postoperative exposure and inadequate personal airway protection, not intraoperative spread.
- Fever, a common symptom in neurosurgery patients, can be misleading in differentiating COVID-19.
- Strict adherence to personal protective equipment and social distancing measures effectively limited the outbreak.
Implications:
- Emergency endonasal endoscopic surgeries can be safely performed during the COVID-19 pandemic under specific conditions.
- These conditions include negative pressure operating rooms, appropriate personal protective equipment, and postoperative patient quarantine.
- Elective surgeries are discouraged due to increased patient vulnerability to SARS-CoV-2 infection.
