• Samuel N Helman, Roberto M Soriano, Martin L Tomov, Vahid Serpooshan, Joshua M Levy, Gustavo Pradilla, and C Arturo Solares.
• Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia.
• Oper Neurosurg (Hagerstown). 2020 Sep 1; 19 (3): 271-280.

BackgroundCOVID-19 poses a risk to the endoscopic skull base surgeon. Significant efforts to improving safety have been employed, including the use of personal protective equipment, preoperative COVID-19 testing, and recently the use of a modified surgical mask barrier.ObjectiveTo reduce the risks of pathogen transmission during endoscopic skull base surgery.MethodsThis study was exempt from Institutional Review Board approval. Our study utilizes a 3-dimensional (3D)-printed mask with an anterior aperture fitted with a surgical glove with ports designed to allow for surgical instrumentation and side ports to accommodate suction ventilation and an endotracheal tube. As an alternative, a modified laparoscopic surgery trocar served as a port for instruments, and, on the contralateral side, rubber tubing was used over the endoscrub endosheath to create an airtight seal. Surgical freedom and aerosolization were tested in both modalities.ResultsThe ventilated mask allowed for excellent surgical maneuverability and freedom. The trocar system was effective for posterior surgical procedures, allowing access to critical paramedian structures, and afforded a superior surgical seal, but was limited in terms of visualization and maneuverability during anterior approaches. Aerosolization was reduced using both the mask and nasal trocar.ConclusionThe ventilated upper airway endoscopic procedure mask allows for a sealed surgical barrier during endoscopic skull base surgery and may play a critical role in advancing skull base surgery in the COVID-19 era. The nasal trocar may be a useful alternative in instances where 3D printing is not available. Additional studies are needed to validate these preliminary findings.Copyright © 2020 by the Congress of Neurological Surgeons.

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