The Korean Society for Neuro-Oncology (KSNO) Guideline for the Management of Brain Tumor Patients During the Crisis Period: A Consensus Survey About Specific Clinical Scenarios (Version 2023.1).

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, there was a shortage of medical resources and the need for proper treatment guidelines for brain tumor patients became more pressing. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has undertaken efforts to develop a guideline that is tailored to the domestic situation and that can be used in similar crisis situations in the future. As part II of the guideline, this consensus survey is to suggest management options in specific clinical scenarios during the crisis period. METHODS: The KSNO Guideline Working Group consisted of 22 multidisciplinary experts on neuro-oncology in Korea. In order to confirm a consensus reached by the experts, opinions on 5 specific clinical scenarios about the management of brain tumor patients during the crisis period were devised and asked. To build-up the consensus process, Delphi method was employed. RESULTS: The summary of the final consensus from each scenario are as follows. For patients with newly diagnosed astrocytoma with isocitrate dehydrogenase (IDH)-mutant and oligodendroglioma with IDH-mutant/1p19q codeleted, observation was preferred for patients with low-risk, World Health Organization (WHO) grade 2, and Karnofsky Performance Scale (KPS) ≥60, while adjuvant radiotherapy alone was preferred for patients with high-risk, WHO grade 2, and KPS ≥60. For newly diagnosed patients with glioblastoma, the most preferred adjuvant treatment strategy after surgery was radiotherapy plus temozolomide except for patients aged ≥70 years with KPS of 60 and unmethylated MGMT promoters. In patients with symptomatic brain metastasis, the preferred treatment differed according to the number of brain metastasis and performance status. For patients with newly diagnosed atypical meningioma, adjuvant radiation was deferred in patients with older age, poor performance status, complete resection, or low mitotic count. CONCLUSION: It is imperative that proper medical care for brain tumor patients be sustained and provided, even during the crisis period. The findings of this consensus survey will be a useful reference in determining appropriate treatment options for brain tumor patients in the specific clinical scenarios covered by the survey during the future crisis.

Postoperative surveillance in cranial and spinal tumor neurosurgery: when is this warranted?

OBJECTIVE: The outbreak of COVID-19 and the sudden increase in the number of patients requiring mechanical ventilation significantly affected the management of neurooncological patients. Hospitals were forced to reallocate already scarce human resources to maximize intensive care unit (ICU) capacities, resulting in a significant postponement of elective procedures for patients with brain and spinal tumors, who traditionally require elective postoperative surveillance on ICU or intermediate care wards. This study aimed to characterize those patients in whom postoperative monitoring is required by analyzing early postoperative complications and associated risk factors. METHODS: All patients included in the analysis experienced benign or malignant cerebral or intradural tumors and underwent surgery between September 2017 and May 2019 at University Hospital Münster, Germany. Patient data were generated from a semiautomatic, prospectively designed database. The occurrence of adverse events within 24 hours and 30 days postoperatively-including unplanned reoperation, postoperative hemorrhage, CSF leakage, and pulmonary embolism-was chosen as the primary outcome measure. Furthermore, reasons and risk factors that led to a prolonged stay on the ICU were investigated. By performing multivariable logistic regression modeling, a risk score for early postoperative adverse events was calculated by assigning points based on beta coefficients. RESULTS: Eight hundred eleven patients were included in the study. Eleven patients (1.4%) had an early adverse event within 24 hours, which was either an unplanned reoperation (0.9%, n = 7) or a pulmonary embolism (0.5%, n = 4) within 24 hours. To predict the incidence of early postoperative complications, a score was developed including the number of secondary diagnoses, BMI, and incision closure time, termed the SOS score. According to this score, 0.3% of the patients were at low risk, 2.5% at intermediate risk, and 12% at high risk (p < 0.001). CONCLUSIONS: Postoperative surveillance in cranial and spinal tumor neurosurgery might only be required in a distinct patient collective. In this study, the authors present a new score allowing efficient prediction of the likelihood of early adverse events in patients undergoing neurooncological procedures, thus helping to stratify the necessity for ICU or intermediate care unit beds. Nevertheless, validation of the score in a multicenter prospective setting is needed.

A 6-Year Retrospective Study on the Postoperative Admission of Skull-Base Meningioma Resection Patients to the Neuroscience Ward versus ICU

Background: The intensive care unit (ICU) has traditionally been the default recovery unit after skull-base meningioma resections. Objective(s): To retrospectively assess the outcomes of 44 skull-base meningioma patients from the period of 2016 to 2022: particularly, the outcomes, during the crisis standards of care declared by the state of Idaho during the COVID-19 pandemic. Method(s): We retrospectively analyzed the clinical outcomes of 44 skull-base meningioma patients treated by resection from 2016 to 2022 who had a length of stay (LOS) of less than 7 days. Result(s): The average LOS came out to be 1.77 days in the neuroscience ward, after discharge from the PACU. Additionally, only one 30-day readmission was recorded during the time period. The expected financial cost to patients was found to have significantly decreased by over $10,000. Conclusion(s): Admitting skull-base meningioma patients straight to the neuroscience ward is on average associated with 1.77 LOS and over $10,000 in reduced expected costs to a patient. Additionally, it can be a viable approach during crisis standards of care.

Two Cases of Rare Intratumoral Hemorrhage Following COVID-19 Vaccination.

The increase in the rate of mRNA vaccination against coronavirus disease 2019 (COVID-19) worldwide has been accompanied by reports of an increase in the side effects of the vaccine. In the field of neurosurgery, several cases of venous thrombosis have been reported as possible complications after COVID-19 vaccination. However, no such side effects have been reported in patients with brain tumors, and COVID-19 vaccination is considered safe for this patient population. In this report, we present the cases of two patients with brain tumors who experienced intratumoral hemorrhage as a possible side effect of the COVID-19 vaccine. In the first case, a 54-year-old man who had received CyberKnife treatment for a vestibular schwannoma eight years prior presented with tongue discomfort, right-side facial numbness, and dizziness since the day after his COVID-19 vaccination. MRI revealed intratumoral hemorrhage of the vestibular schwannoma. The second patient was a 60-year-old woman who presented with a sudden-onset headache and vomiting that had started three days after her COVID-19 vaccination. CT revealed a meningioma with intratumoral hemorrhage. Both patients had undergone surgery prior to this presentation, and their symptoms had improved. They had no risk factors for intratumoral hemorrhage, suggesting that it may be a side effect of the mRNA vaccine against COVID-19. Although the causal relationship is unclear, acute inflammation with predominantly lymphocytic infiltration and thrombogenicity after COVID-19 vaccination may damage the fragile microcirculation of the tumor.

COVID19-induced immunosuppression and aggressive progression of primary cranial vault lymphoma presenting as a management challenge, a case report, and a literature review.

Background: We needs to study Primary Large cell Non-Hodgkin's Lymphoma of the cranial vault, which is rare, and its association with COVID19 has not been reported, which may have an immunosuppressive effect to aggravate its progression. Patient details: Our patient, a 53-year-old male, noticed fast growth of posterior cranial vault lesion from 2 to 10 cm size in last 6 months after COVID 19 affliction. MRI brain with contrast revealed lesions suggesting meningioma. The whole-body PET scan was normal. Following Subtotal excision of the mass, histopathology revealed large B-cell Non-Hodgkin's lymphoma (DLBCL). Immunohistochemistry showed positive results for CD10, CD20, CD45 (LCA), ALK, and BCL-VE with a Ki-67 index of 90-95%. Following radiotherapy and chemotherapy patient is disease-free on imaging and doing well at 5 months of follow-up. Conclusions: Early intervention with excisional biopsy and timely chemo and radiotherapy in favorable immunostaining may add survival benefits even in malignant features induced by immunosuppressing diseases such as COVID19 in diffuse large B-cell lymphoma (DLBCL) of the scalp.

Impact of COVID-19 on Intracranial Meningioma Resection: Results from California State Inpatient Database.

PURPOSE: To assess the effects of COVID-19 on hospitalizations for intracranial meningioma resection using a large database. METHODS: We conducted a retrospective analysis of the California State Inpatient Database (SID) 2019 and 2020. All adult (18 years or older) hospitalizations were included for the analysis. The primary outcomes were trends in hospitalization for intracranial meningioma resection between 2019 and 2020. Secondary outcomes were Clavien-Dindo grade IV complications, in-hospital mortality, and prolonged length of stay, which was defined as length of stay ≥75 percentile. RESULTS: There were 3,173,333 and 2,866,161 hospitalizations in 2019 and 2020, respectively (relative decrease, 9.7%), of which 921 and 788 underwent intracranial meningioma resection (relative decrease, 14.4%). In 2020, there were 94,114 admissions for COVID-19 treatment. Logistic regression analysis showed that year in which intracranial meningioma resection was performed did not show significant association with Clavien-Dindo grade IV complications and in-hospital mortality (OR, 1.23, 95% CI: 0.78-1.94) and prolonged length of stay (OR, 1.05, 95% CI: 0.84-1.32). CONCLUSION: Our findings show that neurosurgery practice in the US successfully adapted to the unforeseen challenges posed by COVD-19 and ensured the best quality of care to the patients.

Sudden Death with Dual Organ Pathologies–An Autopsy-based Case Report

Sudden death due to cardiac cause is considered as a major health problem worldwide accounting for 15–20% of all deaths and cardiomyopathies account for 10–15% of the cases.According to the 2016 WHO classification, angiomatous meningioma is a rare subtype of meningioma classified as Grade I. It is an aggressive variety with a fair prognosis, with typical symptoms including headache and seizures. We present a case of a 60-year-old man brought to the morgue for autopsy with a history of progressive left-sided weakness and headache for several months with no prior diagnosis or treatment for the same because of current pandemic of COVID-19.On conducting medicolegal autopsy significant pathologies in heart and brain were found which could have contributed to the cause of death.

Intraparenchymal fiberoptic intracranial pressure monitoring and decompressive craniectomy in meningioma case with critical intracranial pressure: A case report during COVID-19 pandemic.

Introduction: Meningioma is a slow-growing tumor that can cause neurological emergency due to intracranial hypertension. The definitive therapy is indeed emergency resection, but it is not always possible in several countries due to limited capacity and/or capability of the emergency operating room. The use of intraparenchymal fiberoptic intracranial pressure (ICP) monitoring and decompressive craniectomy (DC) in cases of brain tumors might be possible, but it is uncommon. We report a meningioma patient in whom immediate meningioma resection was considered too risky due to intensive care unit (ICU) shortage during COVID-19 pandemic and, therefore, underwent these procedures as life-saving measures. Case presentation: A 24-year-old man was brought to the emergency room with a chief complaint of seizure. Physical examination was notable for decreased consciousness (Glasgow Coma Scale (GCS) 11) and a dilated left pupil with intact light reflex. A contrasted Brain CT Scan revealed extra-axial mass on the left sphenoid with extensive tentacle edema, which pushed the midline structures 2 cm toward the contralateral side. Discussion: The patient was diagnosed with Left Sphenoid Meningioma. We decided to perform intraparenchymal fiberoptic ICP monitor insertion and DC considering the situation, device availability, safety, and efficacy. The patient slowly regained consciousness in the recovery room after the procedure. The best-observed GCS was 12. Two weeks afterward, the patient came back to our outpatient clinic neurologically intact. The patient was then planned for elective tumor resection. Conclusion: ICP monitoring and DC are not commonly performed on brain tumor cases. However, in suboptimal situations, these procedures might save lives. The present case showed that ICP monitor and DC were helpful in times of ICU shortage.

Use of Novel Telemedicine Software to Automate Cranial Nerve and Neuro-Ophthalmic Remote Testing

INTRODUCTION: Despite the rapid surge in telemedicine use due to the COVID-19 pandemic, there is still a paucity of telemedicine tools for the remote assessment of patients with neurological diagnoses. Current telemedicine platforms lack the capabilities to perform thorough cranial nerve and neuro-ophthalmic testing. To address this need, we developed a novel software that patients can use to undergo cranial nerve and neuro-ophthalmic testing remotely via their own personal computer. METHODS: We conducted a pilot study of patients above 18 years old diagnosed with a brain tumor who receive their care at our institution. Ten patients were enrolled to undergo a comprehensive cranial nerve and neuro-ophthalmic testing using our proprietary telemedicine software. We assessed visual acuity, visual fields, extraocular movements, facial sensitivity, facial symmetry, hearing, uvula/palatal movement, shoulder elevation, tongue deviation, and speech. Their performance on the telemedicine software to physical examination by their treating physician. All patients were given a patient satisfaction survey upon completion of the telemedicine visit. RESULTS: Ten patients have been enrolled so far with a mean age of 47±14.3 years old (4 males, 6 females). Diagnoses included brain metastases, pituitary adenoma, craniopharyngioma and meningiomas. Visual acuity, facial sensitivity, facial symmetry, shoulder elevation, tongue deviation were consistent with physical examination findings in all six patients. Extraocular movements were consistent in 80% of patients. Assessment of the uvula was the most challenging, comparable to physical examination in only 20% of patients. Visual fields were equivalent in 80% of patients and superior than confrontation testing in 10% of patients. CONCLUSION: While this is a very early experience with a new telemedicine software, we demonstrate the feasibility of performing comprehensive cranial nerve and neuro-ophthalmic testing. We provide a detailed account of the challenges encountered, the patient experience and satisfaction results.

Foramen magnum meningioma presented as cervical myelopathy in a pregnant COVID-19 patient: A case report.

Introduction: Meningioma is the second most common primary brain tumor. There are approximately 5.6 cases of meningioma per 100,000 pregnant women. Foramen magnum meningioma is rare, and the diagnosis, treatment, and prognosis are complex in pregnant women. Case presentation: Herein, we report a case of foramen magnum meningioma in a pregnant woman at 32 weeks of gestation, who presented with chronic neck pain and cervical myelopathy. She tested positive for COVID-19 infection. Magnetic resonance imaging findings were compatible with foramen magnum meningioma, and the pathologic analysis revealed a WHO grade-I meningioma. The patient underwent cesarean section followed by tumor excision due to fetal distress and rapid deterioration. Clinical discussion: Management of meningioma during pregnancy requires a multidisciplinary approach. No guidelines for surgical intervention, timing of pregnancy termination, or mode of delivery for pregnant patients with foramen magnum meningioma have been established. While it is best to prolong the pregnancy for as long as possible, a cesarean delivery is preferred to avoid increased intracranial pressure. Operative management of meningioma is warranted if the tumor is growing or symptomatic. This patient died due to the added complication of COVID-19. Although the prognosis of foramen magnum meningioma is usually favorable, COVID-19 comorbidity can increase illness severity. Conclusion: Maternal and fetal health status must be evaluated to decide whether surgical excision and pregnancy termination are needed. In this case, COVID-19 infection and meningioma disease course required further investigation.

Brain surgical tissue for advanced tumour models in precision medicine: Developing the brain-stat pathway

AIMS: There are approximately four thousand neuro-oncology procedures in the UK per annum. Many of these result in tissue and biofluid specimens that are surplus to diagnostic requirement and can be collected as standard of clinical care. However, developing technologies and treatments for precision medicine require access to a range of individualised biospecimens paired with deep clinical phenotyping data. Here, we present Brain Surgical Tissue for Advanced Tumour Models (BRAINSTAT) programme, an infrastructure that has been established between Queen Elizabeth Hospital, Birmingham and the University of Birmingham, to collect, structure and store these resources and also maximise their value for research over the long-term. Using this approach our aim is to provide high-quality, annotated resources to help develop novel treatments for patients with brain tumours. METHOD: BRAINSTAT infrastructure allows: Prospective consent Biospecimens, including tumour tissue (brain and other primary in the case of metastasis), cyst fluid, dura, skin, CSF, blood (matched "germ-line" and for circulating cell free tumour DNA analysis), urine and saliva can be collected. Consent for long term follow-up, is either via clinic or NHS digital. More limited consent for non-oncological neurosurgical cohorts (e.g. epilepsy or vascular) and healthy volunteers allow healthy access-tissue and biofluids to be collected. B. Rapid transfer of fresh surgical tissue samples: Strong collaborative links and close physical proximity between operating theatre and laboratory allows rapid transfer of biospecimens minimising transit time. C. Standardised annotation across disciplines The RedCAP database system allows granular control over data-access, and each specialist research team is provided access only to the sub-sections relevant to them. All users must have Good Clinical Practice certification and GDPR training, prior to access of the BRAINSTAT database. RESULTS: Between 25/11/2019-16/03/2020 and 27/07/2020-16/11/2020, 65 patients were consented for BRAINSTAT at the weekly neurosurgical oncology clinic. (Recruitment gaps due to the SARS-COVID 19 pandemic). Pathological diagnosis of surplus tissue collected included: 37 high grade glioma, 3 low grade glioma and 16 brain metastasis including: (6 lung, 6 breast, 2 colorectal, 1 oesophageal, 1 endometrial). Meningioma (5 WHO I;1 WHO III) 1 patient undergoing anterior temporal lobectomy for hippocampal sclerosis contributed access tissue from the lateral neocortex. 1 patient had a non-neoplastic, non-diagnostic sample. All patients had matched "germline" blood samples. Median time from resection to arrival in the laboratory was 10 minutes (range 4-31). Standardised operating protocols to optimise this have been developed. Glioblastoma and breast-brain metastasis tumourspheres and cerebral organoids are currently being validated. CONCLUSION: Despite the challenges of the pandemic we have established a viable tissue pipeline from neurosurgical operating theatre to our university laboratories. We are developing clinically annotated human brain tumour cell lines, stem cells and 3D organoid models, principally for commonly encountered brain tumours such as glioma and metastasis. The research sets the foundation for a multitude of downstream applications including:-Building more complex organoid cultures e.g. by including other cell types such as healthy brain cells and endothelial cells allowing future experiments to more accurately model tumour growth.-Developing high-throughput, patient-specific drug screens of novel drugs and drug combinations using these 3D tumour models aiming to more effectively treat tumour proliferation and spread. These patient avatars will help inform and test more "stratified" personal medical treatments and will provide opportunities to allow earlier intervention with the aim of improving survival, coupled with a better quality of life.

Clinical presentation of neuroendocrine cancer metastasis to an anterior clinoid process meningioma invading superior orbital fissure. A case report.

Metastasis to a meningioma is an uncommon phenomenon however reported in the literature. Meningiomas are common primary intracranial tumours which most frequently occur to be a recepient of metastases. A 66-year-old female presented with rapid development of visual acuity and visual field loss in the right eye with ipsilateral oculomotor nerve palsy. Magnetic resonance imaging (MRI) showed well-defined tumour intensely enhanced with contrast like a typical skull base meningioma. The neuropathological examination revealed two different morphological fragments of the tumour. In the cell-rich part of the tumour, immunopositivity for CK, chromogranin, and SY were detected. The less cellular portion of the tumour, immunopositivity to epithelial membrane antigen (EMA) and vimentin were detected. To our knowledge, we present the first rare metastasis of neuroendocrine carcinoma to the medial sphenoid meningioma that preceded the clinical symptoms of systemic neuroendocrine carcinoma.

Negative Impact of COVID-19 Upon Primary Brain Tumor Care.

Meningiomas are the most common primary central nervous system tumors, as they can account for up to one-third of all primary brain tumors. Most meningiomas are benign, although up to one-fourth of such tumors are classified as atypical or malignant. Atypical and malignant meningiomas are associated with an increased risk of local recurrence and decreased overall survival. Our patient is a 57-year-old male with a history of recurrent malignant meningioma, with metastasis to the liver. He underwent multiple surgical interventions, radiation treatments, and systemic therapies for a malignant meningioma, ultimately requiring transfer to hospice care. Not only did a positive novel coronavirus (COVID-19) infection delay his ability to receive radiation therapy, the infection in itself may have had an impact on the course of care for this patient. Treatment targeting the patient's COVID-19 infection may have suppressed the immune system, and as a result, caused the progression of metastatic disease. Palliative care was needed in the setting of losing all functional goals for quality of life due to malignant neoplasm.

Not all anosmia and fever was COVID-19 infection: a case report.

COVID-19 pandemic touch all part of world to the date more than fifteen millions of patients are infected by virus including about 1,388,926 deaths (European Centre for Disease Prevention and Control an agency of the European Union). Morocco has put in place strict containment measures to control the disease and prevent the saturation of health systems. One of the great difficulties is to quickly identify asymptomatic and paucisymptomatic cases which function as an important vector of contagion. Anosmia and fever are one of revealed mode for the young patient but is not all the case. We report one case in the sense. A 40-year-old man without medical history was admitted in the hospital after complaining 3 days ago clinical symptoms of fever, cough, headache and anosmia. Immediately, the patient benefits of COVID-19 protocol, measure of fever, nasal swab and polymerase chain reaction (PCR) test. Despite the negativity of PCR test of COVID-19, the patient was placed in isolation. Two days later, he presented a generalized seizures, then we performed a cerebral computed tomography scan (CT scan) which showed a bilateral frontal oedema. The cerebral magnetic resonance imaging (MRI) revealed the presence of 4x4x4 cm well enhanced meningeal extra axial mass of the anterior skull base with peri-tumoral oedema corresponding to an olfactory groove meningioma. The tumour was totally resected through a left fronto-lateral approach. The postoperative courses were uneventful with the persistence of totally anosmia.

The Zap-X Radiosurgical System in the Treatment of Intracranial Tumors: A Technical Case Report.

BACKGROUND AND IMPORTANCE: The Zap-X system (Zap Surgical Systems Inc, San Carlos, California) is a radically new surgical robot designed for brain and head and neck radiosurgery. It represents the first new dedicated brain stereotactic radiosurgery platform in almost half a century optimizing the goals of safety, speed, and accuracy. The Zap-X system was used in a required Chinese National Medical Products Administration clinical study. In early January 2020, 2 patients were treated with the Zap-X robot prior to a national COVID-19 lockdown. Both were closely followed via clinical exam and magnetic resonance imaging (MRI) imaging. Prospectively collected data were used to generate this report. CLINICAL PRESENTATION: Two female patients, each harboring either a trigeminal schwannoma or petroclival meningioma, were treated with the Zap-X robot. Respective tumor volumes were 2.60 and 4.02 cm3. A radiation dose of 13 Gy was prescribed to the 50% isodose line. At 8 mo of follow-up, preoperative symptoms were either resolved or stable and MRI imaging demonstrated a 31% and 56% reduction in lesion volume, respectively. In both patients, symptoms improved, and tumor volumes decreased, whereas no major complication was observed. CONCLUSION: Given only 2 patients and short-term follow-up, any conclusions about the safety and efficacy of the Zap-X radiosurgery robot are preliminary. However, in the absence of any other published outcomes to date, this small case series may be of interest to many radiosurgical specialists.

Psychological Burden in Meningioma Patients under a Wait-and-Watch Strategy and after Complete Resection Is High-Results of a Prospective Single Center Study.

The diagnosis of intracranial meningiomas as incidental findings is increasing by growing availability of MRI diagnostics. However, the psychological distress of patients with incidental meningiomas under a wait-and-watch strategy is unknown. Therefore, we aimed to compare the psychosocial situation of meningioma patients under wait-and-watch to patients after complete resection to bridge this gap. The inclusion criteria for the prospective monocenter study were either an incidental meningioma under a wait-and-watch strategy or no neurologic deficits after complete resection. Sociodemographic, clinical, and health-related quality of life and clinical data were assessed. Psychosocial factors were measured by the Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI), and the Short Form (SF-36). A total of 62 patients were included (n = 51 female, mean age 61 (SD 13) years). According to HADS, the prevalence of anxiety was 45% in the postoperative and 42% in the wait-and-watch group (p = 0.60), and depression was 61% and 87%, respectively (p = 0.005). In total, 43% of patients under wait-and-watch and 37% of patients in the postoperative group scored ≥6 on the DT scale. SF-36 scores were similar in all categories except general health (p = 0.005) and physical component aggregate score (43.7 (13.6) vs. 50.5 (9.5), (p = 0.03), both lower in the wait-and-watch group. Multivariate analysis revealed the wait-and-watch strategy was associated with a 4.26-fold higher risk of a pathological depression score based on HADS (p = 0.03). This study demonstrates a high prevalence of psychological distress in meningioma patients. Further evaluation is necessary to identify the patients in need of psychooncological support.

A Roadmap to Reopening a Neurosurgical Practice in the Age of COVID-19.

BACKGROUND: The Coronavirus disease 2019 (COVID-19) outbreak has left a lasting mark on medicine globally. METHODS: Here we outline the steps that the Lenox Hill Hospital/Northwell Health Neurosurgery Department-located within the epicenter of the pandemic in New York City-is currently taking to recover our neurosurgical efforts in the age of COVID-19. RESULTS: We outline measurable milestones to identify the transition to the recovery period and hope these recommendations may serve as a framework for an effective path forward. CONCLUSIONS: We believe that recovery following the COVID-19 pandemic offers unique opportunities to disrupt and rebuild the historical patient and office experience as we evolve with modern medicine in a post-COVID-19 world.

Inpatient and outpatient case prioritization for patients with neuro-oncologic disease amid the COVID-19 pandemic: general guidance for neuro-oncology practitioners from the AANS/CNS Tumor Section and Society for Neuro-Oncology.

The Coronavirus pandemic has created unprecedented strain on medical resources at health care institutions around the world. At many institutions, this has resulted in efforts to prioritize cases with an attempt to balance the acuity of medical needs with available resources. Here, we provide a framework for institutions and governments to help adjudicate treatment allocations to patients with neuro-oncologic disease.