Rhinologic Procedures in the Era of COVID-19: Health-care Provider Protection Protocol.

INTRODUCTION: SARS-CoV-2 has been identified as the pathogen causing the outbreak of Coronavirus Disease 2019 (COVID-19) that started in Wuhan, China, in December 2019. SARS-CoV-2 has human-to-human transmission ability and universally contagious to all populations. The main transmission patterns are respiratory droplets transmission and contact transmission. The purpose of this study is to propose a protocol that may be used as a guide to reduce the incidence of COVID-19 infections among otolaryngology care teams. METHODS: A prospective cohort study was conducted to show the efficacy of our protocol to prevent transmission to health-care providers from March 11, 2020 through April 14, 2020. The protocol consisted of a series of protective measures that we applied to all health-care providers, then testing of our providers for COVID-19 using reverse transcription polymerase chain reaction along with immunoglobulin M (IgM) and immunoglobulin G (IgG) testing at the end of the study period to ensure effectiveness. RESULTS: Our protocol resulted in zero transmissions to our health-care providers during the duration of the initial study. We were involved in greater than 150 sinonasal, skull base, open airway, and endoscopy procedures during this study. At the conclusion of the initial 5 weeks, we had no health-care providers test positive for SARS-CoV-2. CONCLUSION: According to our proposed protocol, we were able to provide care for all patients in clinic, hospital, emergent, intensive, and surgical settings with no transmission of SARS-CoV-2 by symptomatology and post evaluation testing.

Leptomeningeal metastasis of primary central nervous system (CNS) neoplasms.

Leptomeningeal dissemination of primary CNS tumors varies widely by histologic subtype. In certain tumors including medulloblastoma, ependymoma, germ cell tumors, and primary CNS lymphoma, seeding of the cerebrospinal fluid space is a critical factor in determining stage, prognosis and appropriate therapy. Other tumor types, such as glioma, may have radiographic evidence of leptomeningeal metastases without clear impact on prognosis or therapy.

Hemodynamic evaluation of basilar and vertebral artery angioplasty.

OBJECTIVE: The postangioplasty evaluation of a stenotic vessel is often conducted by studying serial angiograms to determine the anatomic reduction in stenosis. In flow-limiting stenosis, the hemodynamic change that accompanies these anatomic changes is of great importance in evaluating the success of the angioplasty. The purpose of this article is to demonstrate the usefulness of phase contrast magnetic resonance angiography (PCMRA) in evaluating the hemodynamic changes that occur after angioplasty of the basilar and vertebral arteries. METHODS: Between January 1998 and February 2000, PCMRA was performed for the hemodynamic evaluation of 130 patients who presented at our institution. Twenty-six patients were evaluated for vertebrobasilar insufficiency, and flow rates of their vertebral and basilar arteries were determined. In five patients, angioplasty was done on the basilar or vertebral arteries, and PCMRA was performed to determine flow rates before and after the procedure. RESULTS: Of the five patients undergoing angioplasty, the average percentage of stenosis was 81%. The average increase in basilar artery flow rate was 46 ml/min (P < 0.05) after angioplasty. Two of these patients are described. One patient demonstrated the comparison of flow rates in the vertebral and basilar arteries after angioplasty. The second patient showed follow-up flow rates measured after angioplasty and up to 4 months later to predict restenosis. CONCLUSION: The use of flow rate data before and after angioplasty is helpful not only to evaluate the treatment immediately after the procedure but also to evaluate the effectiveness of the treatment during a long period. PCMRA provides a noninvasive method for measuring arterial flow rates with far-reaching implications in neurosurgery.