Intraoperative Use and Validation of a Novel Negative Pressure, Face-Mounted Antechamber to Minimize Aerosolization of Particles during Endoscopic Skull Base Surgery

Background: The COVID-19 pandemic has revealed deficiencies in the adequacy of personal protective equipment (PPE) forhealth care workers. Endoscopic endonasal skull base surgery (ESBS) is thought to be among the highest risk aerosol-generating procedures (AGPs) for surgeons and operating room personnel. Objective: To validate the efficacy and clinical feasibility of a novel surgical device. Methods: A low-cost, modifiable, and easily producible negative pressure, face-mounted antechamber was developedutilizing 3D printing and silicone molding. Efficacy was evaluated using an optical particle sizer (OPS) to quantify aerosolsgenerated during both cadaver and intraoperative human use with high-speed drilling. Results: Particle counts in the cadaver showed that drilling led to a 2.49-fold increase in particles ≤5 μm ( p = 0.001), andthat the chamber was effective at reducing particles to levels not significantly different than baseline. In humans, drillingled to a 37-fold increase in in particles ≤5 μm ( p < 0.001), and the chamber was effective at reducing particles to a level notsignificantly different than baseline. Use of the antechamber in 6 complex cases did not interfere with the ability to performsurgery. Patients did not report any facial discomfort after surgery related to antechamber use. Conclusions: The use of a negative pressure facial antechamber can effectively reduce aerosolization from endoscopicdrilling without disturbing the flow of the operation. The antechamber, in conjunction with appropriate PPE, will be usefulduring the COVID-19 pandemic, as well as during flu season and any future viral outbreaks.