Microscope Tent for Skull Base Surgery during COVID-19 Pandemic

The SARS-CoV-2 virus and resulting COVID-19 pandemic have significantly impacted surgical procedures of the skull base. In particular, aerosol-generating procedures (AGP) confer a greater risk of surgeons contracting the disease1. AGPs include the use of electrocautery, open suctioning, and drilling. Temporal bone drilling aerosolizes bone, blood, and mucosa. The lining of the eustachian tube, middle ear, and mastoid air cells has been shown to harbor multiple respiratory viruses. Incidents of combined neurootology and neurosurgical procedures resulting in infections of surgeons and trainees have been reported. Intraoperative exposures may occur even when patients test negative for COVID-19 preoperatively, despite proper personal protective equipment (PPE). We describe the use of a protective tent to reduce the number of aerosolized particles within the operating room. Using a standard c-arm drape ([Fig. 1]), a sterile tent can be created between the operating field and microscope. The drape is cut in the middle between the two arms. One side has a circumferential rubber band that goes around the patient and irrigation bag, where it is then secured with clamps. Suction tubing and drill wires are passed beneath this with additional tenting support from a Leyla's retractor on the contralateral side ([Fig. 2]). Surgeons may attach suctions to the integrated smoke evacuator of the Neptune 3 Waste Management System. The surgeon accesses the operative site by two small slits that accommodate the forearms, while still allowing access to the microscope handles ([Fig. 3]). The surgical technician can pass instruments by going beneath the drape, through small slits, or by the creation of a flap that is closed and secured when the surgeon is actively working. During temporal bone drilling it has been clear that the generation of smoke, fluids, and other particles is substantial ([Fig. 4]). With consistent use, we have found that both the surgeon and assistants quickly accommodate to the new set-up. In addition to proper PPE (eye protection and N95 surgical mask), a protective tent that limits the spread of particles during AGPs in skull base surgery may help decrease transmission of COVID-19 to health care workers.

Fig. 1 C-arm drape diagram. This is cut down the middle (narrow).

Fig. 2 C-arm drape positioned between patient and microscope.

Fig. 3 Surgeon access through small slits, stretched around forearm.

Fig. 4 Dust and smoke particles are aerosolized during drilling, visible within the light beam of the microscope.

Publication History

Article published online:
12 February 2021