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7276188 
Journal Article 
The risk of spread of infection during craniotomy/ craniostomy on patients with active COVID-19 infection: - myth or fact? 
Mch, AS; Mch, PS; Mch, RC; Sethi, S; Sahoo, SK; Karthigeyan, M; Gendle, C; Kumar, R; Gupta, S 
2020 
1 
World Neurosurgery
ISSN: 1878-8750
EISSN: 1878-8769 
147 
E272-E274 
English 
33326859 
WOS:000626743400032 
BACKGROUND AND OBJECTIVES: Craniotomies / craniostomies have been categorized as aerosol generating procedure and are presumed to spread COVID-19. However, the presence of SARS Cov -2 virus in the generated bone dust has never been proved. The objective is to evaluate the presence of virus in the bone dust (aerosol) generated during emergency neurosurgical procedures performed on active COVID-19 patients. This would determine the true risk of disease transmission during the surgery.

MATERIAL AND METHODS: Ten patients with active COVID-19 infection, admitted to our institute in one month required emergency craniotomy/ craniostomy. The Bone dust and mucosal scrapings form paranasal sinuses (if opened) collected during these procedures were tested for the virus using RT-PCR. The entire surgical team was observed for any symptoms related to COVID-19 for the next 14 days following surgery.

RESULTS: Nine patients had moderate viral load in their nasopharyngeal cavity detected on RT- PCR. None of the samples of bone dust from these 10 patients tested positive. Mucosal scrapping obtained in one patient where mastoid air cells were inadvertently opened tested negative as well. No health worker from the OR developed COVID related symptoms.

CONCLUSION: The bone dust generated during craniotomy/stomy of active patients does not contain the virus. The procedure, on an active patient is unlikely to spread the disease, leave aside COVID negative patients. However a study with larger cohort would be confirmatory. 
Aerosols; Bone dust; COVID-19; Craniotomy