The novel coronavirus commonly referred to as COVID-19 became a global pandemic in
the March of 2020 and created unprecedented challenges for health care systems worldwide.
Early case reports demonstrated a high risk of aerosolization and infection of operating
room staff during endoscopic endonasal approaches, highlighting the need for safe
management strategies in patients with COVID-19 with acute pathology. During periods
of epidemiologic infectious surges, elective cases have often been suspended. However,
patients presenting with urgent pathology, such as pituitary apoplexy or acute visual
compromise from sellar or parasellar lesions still require treatment regardless of
infectious status. Here, we present a case of an asymptomatic COVID-19 patient with
progressive vision loss that underwent successful microscopic resection of pituitary
adenoma, without evidence of spread to the operating room staff. We hypothesize that
during microscopic approaches to the sella, there is relatively less forceful irrigation,
and as a result, potentially less aerosolization. This may decrease the risk of viral
spread to the surgeons and the operating room staff. Additionally, we report that
fluorescent in situ hybridization studies of tumor tissue for SARS-CoV-2 may not reliably
be able to detect viral infections. In conclusion, for asymptomatic patients at high
risk for COVID, microscopic transsphenoidal approaches may provide a safer alternative.
These patients should undergo preoperative testing, and repeat testing should be considered
if possible for negative results. Proper PPE should however still be utilized to maximize
safety of the operating room staff.
