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World Neurosurg ; 144: e380-e388, 2020 12.
Article in English | MEDLINE | ID: covidwho-741539


BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge. Different models of reorganization have been described aiming to preserve resources and ensure optimal medical care. Limited clinical neurosurgical experience with patients with COVID-19 has been reported. We share organizational experience, attitudes, and preliminary data of patients treated at our institution. METHODS: Institutional guidelines and patient workflow are described and visualized. A cohort of all neurosurgical patients managed during the lockdown period is presented and analyzed, assessing suspected nosocomial infection risk factors. A comparative surgical subcohort from the previous year was used to investigate the impact on surgical activity. RESULTS: A total of 176 patients were admitted in 66 days, 20 of whom tested positive for COVID-19. Patients initially admitted to the neurosurgical ward were less likely to be suspected for a COVID-19 infection compared with patients admitted for critical emergencies, particularly with neurovascular and stroke-related diseases. The mortality of patients with COVID-19 was remarkably high (45%), and even higher in patients who underwent surgical intervention (77%). In addition to the expected decrease in surgical activity (-53%), a decrease in traumatic emergencies was noted. CONCLUSIONS: By applying infection prevention and resource-sparing logistics measures shared by the international medical community, we were able to maintain essential neurosurgical care in a pandemic with controlled nosocomial infection risk. Special consideration should be given to medical management and surgical indications in patients infected with severe acute respiratory syndrome coronavirus 2, because they seem to show a problematic hemostatic profile that might result in an unfavorable clinical and surgical outcome.

Academic Medical Centers , COVID-19/prevention & control , Central Nervous System Diseases/surgery , Cross Infection/prevention & control , Neurosurgery , Organizational Policy , Workflow , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Belgium/epidemiology , COVID-19/complications , COVID-19/epidemiology , COVID-19 Testing , Cerebrovascular Disorders/complications , Cerebrovascular Disorders/surgery , Child , Child, Preschool , Craniocerebral Trauma/surgery , Decompressive Craniectomy , Elective Surgical Procedures , Emergencies , Female , Humans , Hydrocephalus/surgery , Infant , Infant, Newborn , Infection Control , Intracranial Hemorrhages/surgery , Male , Mass Screening , Middle Aged , Neuroendoscopy , Neurosurgical Procedures/methods , Neurosurgical Procedures/statistics & numerical data , Personal Protective Equipment , Personnel Staffing and Scheduling , Retrospective Studies , Spinal Injuries/surgery , Telemedicine , Thrombectomy , Vascular Surgical Procedures , Young Adult
Crit Care ; 24(1): 495, 2020 08 12.
Article in English | MEDLINE | ID: covidwho-714111


BACKGROUND: Post-mortem studies can provide important information for understanding new diseases and small autopsy case series have already reported different findings in COVID-19 patients. METHODS: We evaluated whether some specific post-mortem features are observed in these patients and if these changes are related to the presence of the virus in different organs. Complete macroscopic and microscopic autopsies were performed on different organs in 17 COVID-19 non-survivors. Presence of SARS-CoV-2 was evaluated with immunohistochemistry (IHC) in lung samples and with real-time reverse-transcription polymerase chain reaction (RT-PCR) test in the lung and other organs. RESULTS: Pulmonary findings revealed early-stage diffuse alveolar damage (DAD) in 15 out of 17 patients and microthrombi in small lung arteries in 11 patients. Late-stage DAD, atypical pneumocytes, and/or acute pneumonia were also observed. Four lung infarcts, two acute myocardial infarctions, and one ischemic enteritis were observed. There was no evidence of myocarditis, hepatitis, or encephalitis. Kidney evaluation revealed the presence of hemosiderin in tubules or pigmented casts in most patients. Spongiosis and vascular congestion were the most frequently encountered brain lesions. No specific SARS-CoV-2 lesions were observed in any organ. IHC revealed positive cells with a heterogeneous distribution in the lungs of 11 of the 17 (65%) patients; RT-PCR yielded a wide distribution of SARS-CoV-2 in different tissues, with 8 patients showing viral presence in all tested organs (i.e., lung, heart, spleen, liver, colon, kidney, and brain). CONCLUSIONS: In conclusion, autopsies revealed a great heterogeneity of COVID-19-associated organ injury and the remarkable absence of any specific viral lesions, even when RT-PCR identified the presence of the virus in many organs.

Betacoronavirus/isolation & purification , Coronavirus Infections/virology , Pneumonia, Viral/virology , Aged , Autopsy , Brain/virology , COVID-19 , Colon/virology , Coronavirus Infections/therapy , Female , Heart/virology , Humans , Kidney/virology , Liver/virology , Lung/virology , Male , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2 , Spleen/virology
World Neurosurg ; 141: 157-161, 2020 09.
Article in English | MEDLINE | ID: covidwho-648118


BACKGROUND: When Belgium's coronavirus disease 2019 (COVID-19) outbreak began in March 2020, our neurosurgical department followed the protocol of most surgical departments in the world and postponed elective surgery. However, patients with tumor-like brain lesions requiring urgent surgery still received treatment as usual, in order to ensure ongoing neurooncologic care. From a series of 31 patients admitted for brain surgery, 3 were confirmed as infected by the novel severe acute respiratory syndrome coronavirus 2. CASE DESCRIPTION: We present the clinical outcomes of these 3 COVID-19 patients, who underwent an intracerebral biopsy in our department during April 2020. All suffered from a diffuse intraparenchymal hemorrhage postoperatively. Unfortunately, we were not able to identify a clear etiology of these postoperative complications. It could be hypothesized that an active COVID-19 infection status may be related to a higher bleeding risk. The remaining 28 neurooncologic non-COVID-19 patients underwent uneventful surgery during the same period. CONCLUSIONS: This case series reports the previously unreported and unexpected outcomes of COVID-19 patients suffering from acute hemorrhage after intracerebral biopsy procedures. Although no direct relation can yet be established, we recommend the neurosurgical community be cautious in such cases.

Biopsy/adverse effects , Coronavirus Infections/complications , Intracranial Hemorrhages/etiology , Intracranial Hemorrhages/therapy , Pneumonia, Viral/complications , Aged , Brain Neoplasms/surgery , COVID-19 , Epilepsy/surgery , Humans , Intracranial Hemorrhages/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Pandemics , Positron-Emission Tomography , Postoperative Complications/therapy , Treatment Outcome