ABSTRACT
Background: Monobloc advancement with distraction is a holistic approach to treat the sequelae of syndromic craniosynostosis. These osteotomies create a communication between the nasal cavity and anterior cranial fossa that must be surgically obliterated to limit the infectious risks. In light of mandatory COVID-19 testing protocols amidst the pandemic, we aim to identify the specific challenges in management and present our strategy to overcome them. Case presentation: We report 2 cases of syndromic craniosynostosis treated with monobloc distraction during the COVID-19 pandemic and highlight safety concerns and our approach to managing these patients by avoiding nasopharyngeal swabs that may potentially penetrate the cranial base and place the patient as risk for iatrogenic injury. Discussion/conclusion: In patients undergoing surgical procedures that create a cranial base defect, caution must be exercised when attempting to test for COVID-19 which may be a source of potential iatrogenic injury. We propose a new algorithm for COVID-19 screening/surveillance following frontofacial advancement. Patients must be screened via alternative testing methods or treated as potential asymptomatic carriers of COVID-19 until postoperative imaging demonstrates complete ossification of the cranial base.
ABSTRACT
Corona virus disease 2019 (COVID-19) pandemic has become a globally challenging issue after its emergence in December 2019 from Wuhan, China. Despite its common presentation as respiratory distress, patients with COVID-19 have also shown neurological manifestation especially stroke. Therefore, the authors sought to determine the etiology, underlying risk factors, and outcomes among patients with COVID-19 presenting with stroke. We conducted a systematic review of the electronic database (PubMed, Google Scholar, Scopus, Medline, EMBASE, and Cochrane library) using different MeSH terms from November 2019 to June 2020. A total of 39 patients with stroke from 6 studies were included. The mean age of our included patients was 61.4 ± 14.2 years. Majority of the patients (n = 36, 92.3%) with COVID-19 had ischemic stroke, 5.1% (n = 2) had hemorrhagic stroke, and 2.6% (n = 1) had cerebral venous thrombosis at the time of initial clinical presentation. Almost all of the patients presented had underlying risk factors predisposing to stroke which included diabetes mellitus, hyperlipidemia, hypertension, and previous history of cerebrovascular disease. 51.2% (n = 20) of the included patients infected with COVID-19 with stroke died, while remaining patients were either discharged home or transferred to a rehabilitation unit. Exploring the neurological manifestation in terms of stroke among patients with COVID-19 is a step towards better understanding of the virus, preventing further spread, and treating the patients affected by this pandemic.