Suction mask device: a simple, inexpensive, and effective method of reducing spread of aerosolized particles during endoscopic endonasal surgery in the era of COVID-19

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  • 1 Departments of Neurosurgery and
  • 2 Head and Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio;
  • 3 Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi; and
  • 4 Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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OBJECTIVE

Aerosol-generating procedures, including endoscopic endonasal surgery (EES), are a major risk for physicians during the COVID-19 pandemic. Techniques for reducing aerosolization and risk of transmission of COVID-19 during these procedures would be valuable to the neurosurgical community. The authors aimed to simulate the generation of small-particle aerosols during EES and craniectomy in order to develop methods to reduce the spread of aerosolized particles, and to test the effectiveness of these methods.

METHODS

This study was performed at the Anatomical Laboratory for Visuospatial Innovations in Otolaryngology and Neurosurgery at The Ohio State University. The following two scenarios were used to measure three different particle sizes (0.3, 2.5, and 10 µm) generated: 1) drilling frontotemporal bone, simulating a craniectomy; and 2) drilling sphenoid bone, simulating an endonasal approach. A suction mask device was created with the aim of reducing particle release. The presence of particles was measured without suction, with a single Frazier tip suction in the field, and with the suction mask device in addition to the Frazier suction tip. Particles were measured 12 cm from the craniectomy or endonasal drilling region.

RESULTS

In the absence of any aerosol-reducing devices, the number of particles measured during craniectomy was significantly higher than that generated by endonasal drilling. This was true regardless of the particle size measured (0.3 µm, p < 0.001; 2.5 µm, p < 0.001; and 10 µm, p < 0.001). The suction mask device reduced the release of particles of all sizes measured in the craniectomy simulation (0.3 µm, p < 0.001; 2.5 µm, p < 0.001; and 10 µm, p < 0.001) and particles of 0.3 µm and 2.5 µm in the single Frazier suction simulation (0.3 µm, p = 0.031; and 2.5 µm, p = 0.026). The suction mask device further reduced the release of particles of all sizes during EES simulation (0.3 µm, p < 0.001; and 2.5 µm, p < 0.001) and particles of 0.3 µm and 2.5 µm in the single Frazier suction simulation (0.3 µm, p = 0.033; and 2.5 µm, p = 0.048). Large particles (10 µm) were not detected during EES.

CONCLUSIONS

The suction mask device is a simple and effective means of reducing aerosol release during EES, and it could potentially be used during mastoidectomies. This could be a valuable tool to reduce the risk of procedure-associated viral transmission during the COVID-19 pandemic.

ABBREVIATIONS EES = endoscopic endonasal surgery.

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Contributor Notes

Correspondence Daniel M. Prevedello: Wexner Medical Center, The Ohio State University, Columbus, OH. daniel.prevedello@osumc.edu.

T.H. and M.A.Z. contributed equally to this work.

INCLUDE WHEN CITING Published online April 23, 2021; DOI: 10.3171/2020.10.JNS203196.

Disclosures Dr. Prevedello: consultant for Stryker, Medtronic Corp., Codman, and Integra; honoraria from Storz and Leica Microsystems; clinical or research support for the study described from Storz and Integra; royalties from ACE Medical, KLS-Martin, and Mizuho; and ownership in eLum, Soliton, and Three Rivers.

  • 1

    O'Sullivan ED. PPE guidance for covid-19: be honest about resource shortages. BMJ. 2020;369:m1507.

  • 2

    Patel ZM, Fernandez-Miranda J, Hwang PH, . Letter. Precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurgery. 2020;87(1):E66E67.

    • Search Google Scholar
    • Export Citation
  • 3

    Workman AD, Welling DB, Carter BS, . Endonasal instrumentation and aerosolization risk in the era of COVID-19: simulation, literature review, and proposed mitigation strategies. Int Forum Allergy Rhinol. 2020;10(7):798805.

    • Search Google Scholar
    • Export Citation
  • 4

    Bhat TA, Kalathil SG, Bogner PN, . An animal model of inhaled vitamin E acetate and EVALI-like lung injury. N Engl J Med. 2020;382(12):11751177.

    • Search Google Scholar
    • Export Citation
  • 5

    Peretto G, Sala S, Caforio ALP. Acute myocardial injury, MINOCA, or myocarditis? Improving characterization of coronavirus-associated myocardial involvement. Eur Heart J. 2020;41(22):21242125.

    • Search Google Scholar
    • Export Citation
  • 6

    Taylor D, Lindsay AC, Halcox JP. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382:15641567.

    • Search Google Scholar
    • Export Citation
  • 7

    Workman AD, Jafari A, Welling DB, . Airborne aerosol generation during endonasal procedures in the era of COVID-19: risks and recommendations. Otolaryngol Head Neck Surg. 2020;163(3):465470.

    • Search Google Scholar
    • Export Citation
  • 8

    Kashima HK, Kessis T, Mounts P, Shah K. Polymerase chain reaction identification of human papillomavirus DNA in CO2 laser plume from recurrent respiratory papillomatosis. Otolaryngol Head Neck Surg. 1991;104(2):191195.

    • Search Google Scholar
    • Export Citation
  • 9

    Kwak HD, Kim SH, Seo YS, Song KJ. Detecting hepatitis B virus in surgical smoke emitted during laparoscopic surgery. Occup Environ Med. 2016;73(12):857863.

    • Search Google Scholar
    • Export Citation
  • 10

    David AP, Jiam NT, Reither JM, . Endoscopic skull base and transoral surgery during COVID-19 pandemic: minimizing droplet spread with negative-pressure otolaryngology viral isolation drape. Head Neck. 2020;42(7):15771582.

    • Search Google Scholar
    • Export Citation
  • 11

    Helman SN, Soriano RM, Tomov ML, . Ventilated upper airway endoscopic endonasal procedure mask: surgical safety in the COVID-19 era. Oper Neurosurg (Hagerstown). 2020;19(3):271280.

    • Search Google Scholar
    • Export Citation
  • 12

    Khoury T, Lavergne P, Chitguppi C, . Aerosolized particle reduction: a novel cadaveric model and a negative airway pressure respirator (NAPR) system to protect health care workers from COVID-19. Otolaryngol Head Neck Surg. 2020;163(1):151155.

    • Search Google Scholar
    • Export Citation
  • 13

    Maharaj SH. The nasal tent: an adjuvant for performing endoscopic endonasal surgery in the Covid era and beyond. Eur Arch Otorhinolaryngol. 2020;277(10):29292931.

    • Search Google Scholar
    • Export Citation
  • 14

    Gao Z, Xu Y, Sun C, . A systematic review of asymptomatic infections with COVID-19. J Microbiol Immunol Infect. 2021;54(1):1216.

  • 15

    Zhu N, Zhang D, Wang W, . A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727733.

  • 16

    Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods Mol Biol. 2015;1282:123.

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