CSF Rhinorrhea After Endonasal Intervention to the Skull Base (CRANIAL) — Part 2: Impact of COVID-19

, Soham Bandyopadhyay, Danyal Z. Khan, Hani J. Marcus (Lead / Corresponding author), Benjamin E. Schroeder, Vikesh Patel, Alice O'Donnell, Shahzada Ahmed, Andrew F. Alalade, Ahmad M.S. Ali, Callum Allison, Sinan Al-Barazi, Rafid Al-Mahfoudh, Meriem Amarouche, Anuj Bahl, David Bennett, Raj Bhalla, Pragnesh Bhatt, Alexandros Boukas, Ivan CabriloAnnabel Chadwick, Yasir A. Chowdhury, David Choi, Simon A. Cudlip, Neil Donnelly, Neil L. Dorward, Graham Dow, Daniel M. Fountain, Joan Grieve, Anastasios Giamouriadis, Catherine Gilkes, Kanna Gnanalingham, Jane Halliday, Brendan Hanna, Caroline Hayhurst, Jonathan Hempenstall, Duncan Henderson, Kismet Hossain-Ibrahim, Theodore Hirst, Mark Hughes, Mohsen Javadpour, Alistair Jenkins, Mahmoud Kamel, Richard J. Mannion, Angelos G. Kolias, Habibullah Khan, Mohammad Saud Khan, Peter Lacy, Shumail Mahmood, Daniel Murray, Paresh P. Naik, Ramesh Nair, Claire Nicholson, Alex Paluzzi, Omar Pathmanaban, Dimitris Paraskevopoulos, Jonathan Pollock, Nick Phillips, Rory J. Piper, Bhaskar Ram, Iain Robertson, Elena Roman, Peter Ross, Thomas Santarius, Parag Sayal, Jonathan Shapey, Rishi Sharma, Simon Shaw, Alireza Shoakazemi, Syed Shumon, Saurabh Sinha, Georgios Solomou, Wai Cheong Soon, Simon Stapleton, Patrick Statham, Benjamin Stew, Nick Thomas, Georgios Tsermoulas, James R. Tysome, Adithya Varma, Philip Weir, Adam Williams, Mohamed Youssef

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)
79 Downloads (Pure)


Background: During the coronavirus disease 2019 (COVID-19) pandemic, concerns have been raised regarding the increased risk of perioperative mortality for patients with COVID-19, and the transmission risk to healthcare workers, especially during endonasal neurosurgical operations. The Pituitary Society has produced recommendations to guide management during this era. We sought to assess contemporary neurosurgical practice and the effects of COVID-19.

Methods: A multicenter prospective observational cohort study was conducted at 12 tertiary neurosurgical units (United Kingdom and Ireland). Data were collected from March 23 to July 31, 2020, inclusive. The data points collected included patient demographics, preoperative COVID-19 test results, operative modifications, and 30-day COVID-19 infection rates.

Results: A total of 124 patients were included. Of the 124 patients, 116 (94%) had undergone COVID-19 testing preoperatively (transsphenoidal approach, 97 of 105 [92%]; expanded endoscopic endonasal approach, 19 of 19 [100%]). One patient (1 of 116 [0.9%]) had tested positive for COVID-19 preoperatively, requiring a delay in surgery until the infection had been confirmed as resolved. Other than transient diabetes insipidus, no other complications were reported for this patient. All operating room staff had worn at least level 2 personal protective equipment. Adaptations to surgical techniques included minimizing drilling, draping modifications, and the use of a nasal iodine wash. At 30 days postoperatively, no evidence of COVID-19 infection (symptoms or positive formal testing results) were found in our cohort and no mortality had occurred.

Conclusions: Preoperative screening protocols and operative modifications have facilitated endonasal neurosurgery during the COVID-19 pandemic, with the Pituitary Society guidelines followed for most of these operations. We found no evidence of COVID-19 infection in our cohort and no mortality, supporting the use of risk mitigation strategies to continue endonasal neurosurgery in subsequent pandemic waves.

Original languageEnglish
Pages (from-to)e1090-e1097
Number of pages8
JournalWorld Neurosurgery
Early online date11 Jan 2021
Publication statusPublished - May 2021


  • Cerebrospinal fluid leak
  • Cerebrospinal fluid rhinorrhea
  • CSF
  • EEA
  • Endoscopic endonasal
  • Skull base surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


Dive into the research topics of 'CSF Rhinorrhea After Endonasal Intervention to the Skull Base (CRANIAL) — Part 2: Impact of COVID-19'. Together they form a unique fingerprint.

Cite this