Transnasal endoscopic skull base surgery in the COVID-19 era: Recommendations for increasing the safety of the method.
Transnasal endoscopic skull base surgery in the COVID-19 era: Recommendations for increasing the safety of the method.
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DOI：
10.1016/j.advms.2021.03.001
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发表时间：
2021-03
影响因子：
2.7
通讯作者：
Carrau RL
中科院分区：
文献类型：
--
作者：
Lyson T;Kisluk J;Alifier M;Politynska-Lewko B;Sieskiewicz A;Kochanowicz J;Reszec J;Niklinski J;Rogowski M;Konopinska J;Mariak Z;Carrau RL
近年来，经鼻内窥镜颅底手术（eSBS）已被采用，在很大程度上取代了外部方法所需的扩展程序。虽然有时被认为是“微创”，但eSBS仍然需要在鼻/鼻旁窦内进行广泛的操作。此外，应考虑到敏感脑结构暴露于望远镜发出的光和热，以综合评价该方法的安全性。虽然专门针对eSBS安全性的研究数量仍然很少，但最近随着SARS-CoV-2大流行，这个问题已经扩大，这也对手术人员的安全产生了影响。必须强调的是，eSBS可能直接使外科医生暴露于潜在的大量病毒污染气溶胶。因此，必须考虑到患者和外科医生的焦虑。因此，安全要求必须遵循最高标准。本文总结了目前对SARS-CoV-2生物学和人类免疫学在宿主-病毒关系方面的特点的认识，同时考虑到有关SARS-CoV-2对神经系统令人担忧的亲和力的最新信息。根据这些信息，提供工作流建议供考虑。这不仅在大流行期间有用，而且在我们与病毒共存的不可预测的时间轴期间也有用。建议包括手术室的技术改造、个人防护设备、SARS-CoV-2感染的检测标准、干扰素预防性预处理、抗IL-6治疗以及最后但并非最不重要的患者心理支持。
Transnasal endoscopic skull base surgery (eSBS) has been adopted in recent years, in great part to replace the extended procedures required by external approaches. Though sometimes perceived as “minimally invasive”, eSBS still necessitates extensive manipulations within the nose/paranasal sinuses. Furthermore, exposure of susceptible cerebral structures to light and heat emanated by the telescope should be considered to comprehensively evaluate the safety of the method. While the number of studies specifically targeting eSBS safety still remains scarce, the problem has recently expanded with the SARS-CoV-2 pandemic, which also has implications for the safety of the surgical personnel. It must be stressed that eSBS may directly expose the surgeon to potentially high volumes of virus-contaminated aerosol. Thus, the anxiety of both the patient and the surgeon must be taken into account. Consequently, safety requirements must follow the highest standards. This paper summarizes current knowledge on SARS-CoV-2 biology and the peculiarities of human immunology in respect of the host-virus relationship, taking into account the latest information concerning the SARS-CoV-2 worrisome affinity for the nervous system. Based on this information, a workflow proposal is offered for consideration. This could be useful not only for the duration of the pandemic, but also during the unpredictable timeline involving our coexistence with the virus. Recommendations include technical modifications to the operating theatre, personal protective equipment, standards of testing for SARS-CoV-2 infection, prophylactic pretreatment with interferon, anti-IL6 treatment and, last but not least, psychological support for the patient.
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DOI：
10.1038/nrmicro.2016.81
发表时间：
2016-08
期刊：
Nature reviews. Microbiology
影响因子：
--
作者：
de Wit E;van Doremalen N;Falzarano D;Munster VJ
通讯作者：
Munster VJ
影响因子：
3.1
作者：
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影响因子：
7.6
作者：
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通讯作者：
LAZARUS, RS
影响因子：
5.4
作者：
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通讯作者：
Poehlmann, Stefan
影响因子：
2.6
作者：
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