Trepanation revisited in COVID-19 era: A perspective on craniotomy during current pandemic, surgical technique, and complications avoidance.

ABSTRACT

Background: Craniotomy creates maximum aerosols threatening the health care workers (HCWs) of operation room. The technique of trepanation and measures to avoid complications has never been described in the literature. The time taken for craniotomy by different instruments has also never been compared. Methods: The study included only COVID-positive patients who underwent surgery. Craniotomy was performed using trephine, pneumatic/power drill (PD), and Hudson brace-Gigli saw (HB-GS). Trepanation as done in 32 patients. The generation of aerosols and time taken for craniotomy by these instruments was observed. The droplet spread over a waterproof graph paper of 10 × 10 sq. cm was calculated in 13 cases of all the three craniotomy methods. The technique of trepanation and maneuvers to overcome complications was discussed. Results: There was a gross difference in aerosol production and soiling of the surgical drapes, floor, surgeon's glove, gowns, face shield, goggles, etc. The average number of droplet aerosol in trepanation group was 4.76, 23.6 in drill and 21.3 in Gigli saw method. The average time taken for trepanation, PD, and HB-GS craniotomy was 4.8, 22.8, and 24.4 min, respectively. One mortality secondary to COVID was noted. All the HCWs assisting trepanation were negative for COVID-19 during postoperative follow-up of 7 days. However, 13 members of the surgical team which assisted in electric drill and HB-GS methods were COVID-positive. Conclusion: Trepanation should be the preferred method of craniotomy during COVID-19 pandemic as it is associated with the least aerosolization and is the most time efficient.