Abel P. David, MD1; Nicole T. Jiam, MD1; Joshua M. Reither, CST2,3; Jose G. Gurrola II, MD1,2; Manish Aghi, MD PhD2,4; Ivan H. El-Sayed, MD1,2

1Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco (San Francisco, CA)
2Center for Minimally Invasive Skull Base Surgery, University of California, San Francisco (San Francisco, CA)
3University of California, San Francisco Medical Center (San Francisco, CA)
4Department of Neurological Surgery, University of California, San Francisco (San Francisco, CA)
Corresponding Author:
Ivan H. El-Sayed, MD
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
2233 Post Street, UCSF Box 349, San Francisco, California 94115
Phone: 415-353-2757
E-mail: Ivan.El-Sayed@ucsf.edu
Disclosure of Funding: None
Short Running Head: Preventing Droplet Spread During Skull Base Surgery
Keywords: COVID-19; aerosolization; skull base; endoscopic surgery; negative-pressure
 
Abstract
Background:  The COVID-19 pandemic has raised concern of transmission of infectious organisms through aerosols formation in endonasal and transoral surgery.
Methods: Retrospective review. We introduce the Negative-Pressure Otolaryngology Viral Isolation Drape (NOVID) system to reduce the risk of aerosol. NOVID consists of a plastic drape suspended above the patient’s head and surgical field with a smoke evacuator suction placed inside the chamber.
Results:  Four patients underwent endonasal (4) and endo-oral surgery (1). Fluorescein was applied to the surgical field. Black light examination of fluorescein treated operative fields revealed minimal contamination distant to the surgical field. In two prolonged cases with high-speed drilling, droplets were identified under the barrier and on the tip of the smoke evacuator. Instruments and cottonoids appeared to be a greater contributor to field contamination.
Conclusions: Negative-pressure aspiration of air under a chamber barrier which appears to successfully keep aerosol and droplet contamination to a minimum.