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1.
Adv Drug Deliv Rev ; 181: 114033, 2022 02.
Article in English | MEDLINE | ID: covidwho-1520626

ABSTRACT

Neurosurgery as one of the most technologically demanding medical fields rapidly adapts the newest developments from multiple scientific disciplines for treating brain tumors. Despite half a century of clinical trials, survival for brain primary tumors such as glioblastoma (GBM), the most common primary brain cancer, or rare ones including primary central nervous system lymphoma (PCNSL), is dismal. Cancer therapy and research have currently shifted toward targeted approaches, and personalized therapies. The orchestration of novel and effective blood-brain barrier (BBB) drug delivery approaches, targeting of cancer cells and regulating tumor microenvironment including the immune system are the key themes of this review. As the global pandemic due to SARS-CoV-2 virus continues, neurosurgery and neuro-oncology must wrestle with the issues related to treatment-related immune dysfunction. The selection of chemotherapeutic treatments, even rare cases of hypersensitivity reactions (HSRs) that occur among immunocompromised people, and number of vaccinations they have to get are emerging as a new chapter for modern Nano neurosurgery.


Subject(s)
Brain Neoplasms/surgery , COVID-19/surgery , Neurosurgery/methods , Animals , Blood-Brain Barrier/surgery , Glioblastoma/surgery , Humans , Nanotechnology/methods , Pandemics/statistics & numerical data , Tumor Microenvironment/physiology
2.
PLoS One ; 16(7): e0254958, 2021.
Article in English | MEDLINE | ID: covidwho-1331994

ABSTRACT

BACKGROUND: The COVID-19 pandemic forced a reconsideration of surgical patient management in the setting of scarce resources and risk of viral transmission. Herein we assess the impact of implementing a protocol of more rigorous patient education, recovery room assessment for non-ICU admission, earlier mobilization and post-discharge communication for patients undergoing brain tumor surgery. METHODS: A case-control retrospective review was undertaken at a community hospital with a dedicated neurosurgery and otolaryngology team using minimally invasive surgical techniques, total intravenous anesthesia (TIVA) and early post-operative imaging protocols. All patients undergoing craniotomy or endoscopic endonasal removal of a brain, skull base or pituitary tumor were included during two non-overlapping periods: March 2019-January 2020 (pre-pandemic epoch) versus March 2020-January 2021 (pandemic epoch with streamlined care protocol implemented). Data collection included demographics, preoperative American Society of Anesthesiologists (ASA) status, tumor pathology, and tumor resection and remission rates. Primary outcomes were ICU utilization and hospital length of stay (LOS). Secondary outcomes were complications, readmissions and reoperations. FINDINGS: Of 295 patients, 163 patients were treated pre-pandemic (58% women, mean age 53.2±16 years) and 132 were treated during the pandemic (52% women, mean age 52.3±17 years). From pre-pandemic to pandemic, ICU utilization decreased from 92(54%) to 43(29%) of operations (p<0.001) and hospital LOS≤1 day increased from 21(12.2%) to 60(41.4%), p<0.001, respectively. For craniotomy cohort, median LOS was 2 days for both epochs; median ICU LOS decreased from 1 to 0 days (p<0.001), ICU use decreased from 73(80%) to 29(33%),(p<0.001). For endonasal cohort, median LOS decreased from 2 to 1 days; median ICU LOS was 0 days for both epochs; (p<0.001). There were no differences pre-pandemic versus pandemic in ASA scores, resection/remission rates, readmissions or reoperations. CONCLUSION: This experience suggests the COVID-19 pandemic provided an opportunity for implementing a brain tumor care protocol to facilitate safely decreasing ICU utilization and accelerating discharge home without an increase in complications, readmission or reoperations. More rigorous patient education, recovery room assessment for non-ICU admission, earlier mobilization and post-discharge communication, layered upon a foundation of minimally invasive surgery, TIVA anesthesia and early post-operative imaging are possible contributors to these favorable trends.


Subject(s)
Brain Neoplasms/surgery , COVID-19/prevention & control , Pandemics/prevention & control , Case-Control Studies , Craniotomy/methods , Enhanced Recovery After Surgery , Female , Hospitalization , Humans , Length of Stay , Male , Middle Aged , Minimally Invasive Surgical Procedures/methods , Patient Discharge , Patient Readmission , Postoperative Complications/prevention & control , Postoperative Period , Reoperation/methods , Retrospective Studies
3.
J Neurosurg ; 136(1): 40-44, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1304576

ABSTRACT

OBJECTIVE: Elective surgical cases generally have lower costs, higher profit margins, and better outcomes than nonelective cases. Investigating the differences in cost and profit between elective and nonelective cases would help hospitals in planning strategies to withstand financial losses due to potential pandemics. The authors sought to evaluate the exact cost and profit margin differences between elective and nonelective supratentorial tumor resections at a single institution. METHODS: The authors collected economic analysis data in all patients who underwent supratentorial tumor resection at their institution between January 2014 and December 2018. The patients were grouped into elective and nonelective cases. Propensity score matching was used to adjust for heterogeneity of baseline characteristics between the two groups. RESULTS: There were 143 elective cases and 232 nonelective cases over the 5 years. Patients in the majority of elective cases had private insurance and in the majority of nonelective cases the patients had Medicare/Medicaid (p < 0.01). The total charges were significantly lower for elective cases ($168,800.12) compared to nonelective cases ($254,839.30, p < 0.01). The profit margins were almost 6 times higher for elective than for nonelective cases ($13,025.28 vs $2,128.01, p = 0.04). After propensity score matching, there was still a significant difference between total charges and total cost. CONCLUSIONS: Elective supratentorial tumor resections were associated with significantly lower costs with shorter lengths of stay while also being roughly 6 times more profitable than nonelective cases. These findings may help future planning for hospital strategies to survive financial losses during future pandemics that require widespread cancellation of elective cases.


Subject(s)
Brain Neoplasms/economics , Brain Neoplasms/surgery , Costs and Cost Analysis/trends , Elective Surgical Procedures/economics , Elective Surgical Procedures/trends , Propensity Score , Female , Humans , Insurance Coverage/economics , Insurance Coverage/trends , Length of Stay/economics , Length of Stay/trends , Male , Middle Aged , Postoperative Complications/economics , Postoperative Complications/prevention & control , Retrospective Studies , Risk Factors
4.
J Appl Clin Med Phys ; 22(6): 274-280, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1239974

ABSTRACT

Thermoplastic masks, used along with surgical masks, enable immobilization methods to reduce the risk of infection in patients undergoing intracranial stereotactic radiosurgery and stereotactic radiotherapy (SRS/SRT) during the COVID-19 crisis. The purpose of this study was to investigate the feasibility of thermoplastic mask immobilization with a surgical mask using an ExacTrac system. Twelve patients each with brain metastases were immobilized using a thermoplastic mask and a surgical mask and only a thermoplastic mask. Two x-ray images were acquired to correct (XC) and verify (XV) the patient's position at a couch angle of 0°. Subsequently, the XC and XV images were acquired at each planned couch angle for non-coplanar beams. When the position errors were detected after couch rotation for non-coplanar beams, the errors were corrected at each planned couch angle until a clinically acceptable tolerance was attained. The position errors in the translational and rotational directions (vertical, lateral, longitudinal, pitch, roll, and yaw) were retrospectively investigated using data from the ExacTrac system database. A standard deviation of XC translational and rotational position errors with and without a surgical mask in the lateral (1.52 vs 2.07 mm), longitudinal (1.59 vs 1.87 mm), vertical (1.00 vs 1.73 mm), pitch (0.99 vs 0.79°), roll (1.24 vs 0.68°), and yaw (1.58 vs 0.90°) directions were observed at a couch angle of 0°. Most of patient positioning errors were less than 1.0 mm or 1.0° after the couch was rotated to the planned angle for non-coplanar beams. The overall absolute values of the translational and rotational XV position errors with and without the surgical mask were less than 0.5 mm and 0.5°, respectively. This study showed that a thermoplastic mask with a surgical mask is a feasible immobilization technique for brain SRS/SRT patients using the ExacTrac system.


Subject(s)
Brain Neoplasms , COVID-19 , Radiosurgery , Brain Neoplasms/radiotherapy , Brain Neoplasms/surgery , Humans , Immobilization , Masks , Patient Positioning , Radiotherapy Planning, Computer-Assisted , Radiotherapy Setup Errors/prevention & control , Retrospective Studies , SARS-CoV-2 , Uncertainty
5.
Neuroreport ; 32(9): 771-775, 2021 06 09.
Article in English | MEDLINE | ID: covidwho-1231060

ABSTRACT

Since coronavirus disease 2019 (COVID-19) swept all over the world, several studies have shown the susceptibility of a patient with cancer to COVID-19. In this case, the removed glioblastoma multiforme (GBM)-adjacent (GBM-A), GBM-peritumor and GBM-central (GBM-C) tissues from a convalescent patient of COVID-19, who also suffered from glioblastoma meanwhile, together with GBM-A and GBM tissues from a patient without COVID-19 history as negative controls, were used for RNA ISH, electron microscopy observing and immunohistochemical staining of ACE2 and the virus antigen (N protein). The results of RNA ISH, electron microscopy observing showed that SARS-CoV-2 directly infects some cells within human GBM tissues and SARS-CoV-2 in GBM-C tissue still exists even when it is cleared elsewhere. Immunohistochemical staining of ACE2 and N protein showed that the expressions of ACE2 are significantly higher in specimens, including GBM-C tissue from COVID-19 patient than other types of tissue. The unique phenomenon suggests that the surgical protection level should be upgraded even if the patient is in a convalescent period and the pharyngeal swab tests show negative results. Furthermore, more attention should be paid to confirm whether the shelter-like phenomenon happens in other malignancies due to the similar microenvironment and high expression of ACE2 in some malignancies.


Subject(s)
Brain Neoplasms/virology , COVID-19/metabolism , Coronavirus Nucleocapsid Proteins/metabolism , Glioblastoma/virology , SARS-CoV-2/metabolism , Adult , Angiotensin-Converting Enzyme 2/metabolism , Brain Neoplasms/metabolism , Brain Neoplasms/surgery , Brain Neoplasms/ultrastructure , COVID-19/virology , COVID-19 Nucleic Acid Testing , Convalescence , Glioblastoma/metabolism , Glioblastoma/surgery , Glioblastoma/ultrastructure , Humans , In Situ Hybridization , Male , Microscopy, Electron, Transmission , Phosphoproteins/metabolism , RNA, Viral/metabolism , Receptors, Coronavirus/metabolism , SARS-CoV-2/ultrastructure , Virion/ultrastructure
6.
World Neurosurg ; 148: e172-e181, 2021 04.
Article in English | MEDLINE | ID: covidwho-1078227

ABSTRACT

BACKGROUND: The institution-wide response of the University of California San Diego Health system to the 2019 novel coronavirus disease (COVID-19) pandemic was founded on rapid development of in-house testing capacity, optimization of personal protective equipment usage, expansion of intensive care unit capacity, development of analytic dashboards for monitoring of institutional status, and implementation of an operating room (OR) triage plan that postponed nonessential/elective procedures. We analyzed the impact of this triage plan on the only academic neurosurgery center in San Diego County, California, USA. METHODS: We conducted a de-identified retrospective review of all operative cases and procedures performed by the Department of Neurosurgery from November 24, 2019, through July 6, 2020, a 226-day period. Statistical analysis involved 2-sample z tests assessing daily case totals over the 113-day periods before and after implementation of the OR triage plan on March 16, 2020. RESULTS: The neurosurgical service performed 1429 surgical and interventional radiologic procedures over the study period. There was no statistically significant difference in mean number of daily total cases in the pre-versus post-OR triage plan periods (6.9 vs. 5.8 mean daily cases; 1-tail P = 0.050, 2-tail P = 0.101), a trend reflected by nearly every category of neurosurgical cases. CONCLUSIONS: During the COVID-19 pandemic, the University of California San Diego Department of Neurosurgery maintained an operative volume that was only modestly diminished and continued to meet the essential neurosurgical needs of a large population. Lessons from our experience can guide other departments as they triage neurosurgical cases to meet community needs.


Subject(s)
COVID-19/epidemiology , Hospitals, University/organization & administration , Neurosurgery/organization & administration , Neurosurgical Procedures/statistics & numerical data , Academic Medical Centers/organization & administration , Brain Neoplasms/surgery , COVID-19/diagnosis , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , California/epidemiology , Cerebrospinal Fluid Shunts/statistics & numerical data , Elective Surgical Procedures , Endovascular Procedures/statistics & numerical data , Hospital Bed Capacity , Hospital Departments/organization & administration , Humans , Infection Control , Information Dissemination/methods , Intensive Care Units , Laboratories, Hospital , Multi-Institutional Systems , Operating Rooms , Organizational Policy , Personal Protective Equipment/supply & distribution , Retrospective Studies , Risk Assessment , SARS-CoV-2 , Surge Capacity , Triage , Vascular Surgical Procedures/statistics & numerical data , Ventilators, Mechanical/supply & distribution , Wounds and Injuries/surgery
7.
World Neurosurg ; 148: e689-e694, 2021 04.
Article in English | MEDLINE | ID: covidwho-1062634

ABSTRACT

BACKGROUND: Cessation of elective procedures and lower bed capacity during the COVID-19 pandemic have led to a rise in the waiting lists for surgery, but it is unclear if workload has recovered sufficiently to account for this backlog. We describe the change in neurosurgical workload at a tertiary neurosciences center in the United Kingdom after the first pandemic wave in comparison with the months before and during the first wave. METHODS: A retrospective review of theatre records and electronic referrals-between December 1, 2019, and August 31, 2020-was performed. The months of December 2019-February 2020 were designated as pre-COVID months and March-May 2020 were designated as COVID months. The time period from June to August 2020 was designated as post-wave months. Statistical analyses were performed on SPSS v22 (IBM). RESULTS: Referrals declined from 572 in January to a nadir of 352 in April before a steady rise to August. Referral volumes for degenerative spinal disease and traumatic brain injuries showed a statistically significant change during the year. On average, 212 procedures per month were performed in the pre-COVID months, 167 procedures per month during COVID months, and 232 procedures per month in the post-wave months. The number of patients on the waiting list for scheduled operations rose from March (785 patients) onward to a peak of 997 patients in July. CONCLUSIONS: In the aftermath of COVID-19, higher referral volumes and operative procedures were apparent in the post-wave months as services returned to normal. With the expectation of a second wave of infections, it is unclear whether this will be sustainable.


Subject(s)
COVID-19/epidemiology , Neurosurgical Procedures/trends , Workload , Brain Injuries, Traumatic/surgery , Brain Neoplasms/surgery , Female , Hemorrhagic Stroke/surgery , Humans , Ischemic Stroke/surgery , Male , Middle Aged , Referral and Consultation/trends , Retrospective Studies , SARS-CoV-2 , Spinal Diseases/surgery , Spinal Neoplasms/surgery , Subarachnoid Hemorrhage/surgery , Tertiary Care Centers , United Kingdom/epidemiology , Waiting Lists
8.
J Clin Neurosci ; 82(Pt A): 49-51, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1023664

ABSTRACT

There has been a growing anxiety in carrying out awake craniotomy surgeries during the SARS-CoV-2 pandemic, not only due to airway management but also close proximity to the team in theatre. We set out to safely perform the first documented awake craniotomy in the UK since the beginning of lockdown. We performed a thorough workup of the patient with minimal hospital visits, using remote communication wherever possible. We modified our existing awake craniotomy protocol/technique guided by local/national policies. An asleep-awake-asleep craniotomy for tumour resection was performed successfully without compromising patient and staff safety with excellent post-operative outcome. With appropriate pre- and peri-operative modifications to established protocols, awake craniotomies with functional mapping can be safely carried out. By incorporating novel aspects to our technique, we believe that this service can safely resume in carefully selected patients.


Subject(s)
Brain Neoplasms/surgery , COVID-19/epidemiology , Craniotomy/methods , Glioma/surgery , Adult , Feasibility Studies , Female , Humans , Male , Pandemics , SARS-CoV-2/isolation & purification , Wakefulness
9.
World Neurosurg ; 148: e282-e293, 2021 04.
Article in English | MEDLINE | ID: covidwho-1009939

ABSTRACT

OBJECTIVE: In the wake of the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) has recommended the temporary cessation of all elective surgeries. The effects on patients' interest of elective neurosurgical procedures are currently unexplored. METHODS: Using Google Trends, search terms of 7 different neurosurgical procedure categories (trauma, spine, tumor, movement disorder, epilepsy, endovascular, and miscellaneous) were assessed in terms of relative search volume (RSV) between January 2015 and September 2020. Analyses of search terms were performed for over the short term (February 18, 2020, to April 18, 2020), intermediate term (January 1, 2020, to May 31, 2020), and long term (January 2015 to September 2020). State-level interest during phase I reopening (April 28, 2020, to May 31, 2020) was also evaluated. RESULTS: In the short term, RSVs of 4 categories (epilepsy, movement disorder, spine, and tumor) were significantly lower in the post-CMS announcement period. In the intermediate term, RSVs of 5 categories (miscellaneous, epilepsy, movement disorder, spine, and tumor) were significantly lower in the post-CMS announcement period. In the long term, RSVs of nearly all categories (endovascular, epilepsy, miscellaneous, movement disorder, spine, and tumor) were significantly lower in the post-CMS announcement period. Only the movement disorder procedure category had significantly higher RSV in states that reopened early. CONCLUSIONS: With the recommendation for cessation of elective surgeries, patient interests in overall elective neurosurgical procedures have dropped significantly. With gradual reopening, there has been a resurgence in some procedure types. Google Trends has proven to be a useful tracker of patient interest and may be used by neurosurgical departments to facilitate outreach strategies.


Subject(s)
Elective Surgical Procedures , Information Seeking Behavior , Internet , Neurosurgical Procedures , Search Engine , Brain Neoplasms/surgery , COVID-19 , Cerebrovascular Disorders/surgery , Craniocerebral Trauma/surgery , Deep Brain Stimulation , Endovascular Procedures , Epilepsy/surgery , Humans , Movement Disorders/therapy , Prosthesis Implantation , SARS-CoV-2 , Spinal Diseases/surgery
10.
World Neurosurg ; 147: e272-e274, 2021 03.
Article in English | MEDLINE | ID: covidwho-1009938

ABSTRACT

OBJECTIVES: Craniotomies/craniostomies have been categorized as aerosol-generating procedures and are presumed to spread coronavirus disease 2019 (COVID-19). However, the presence of severe acute respiratory distress syndrome coronavirus 2 virus in the generated bone dust has never been proved. Our objective is to evaluate the presence of virus in the bone dust (aerosol) generated during emergency neurosurgical procedures performed on patients with active COVID-19. This would determine the true risk of disease transmission during the surgery. METHODS: Ten patients with active COVID-19 infection admitted to our institute in 1 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 reverse transcription polymerase chain reaction. The entire surgical team was observed for any symptoms related to COVID-19 for 14 days following surgery. RESULTS: Nine patients had moderate viral load in their nasopharyngeal cavity, as detected on reverse transcription polymerase chain reaction. None of the samples of bone dust from these 10 patients tested positive. Mucosal scrapping obtained in 1 patient in which mastoid air cells were inadvertently opened tested negative as well. No health workers from the operating room developed COVID-19-related symptoms. CONCLUSIONS: 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. However, a study with larger cohort would be confirmatory.


Subject(s)
Bone and Bones/virology , COVID-19/transmission , Craniotomy , Dust , Nasopharynx/virology , Paranasal Sinuses/virology , Respiratory Mucosa/virology , SARS-CoV-2/genetics , Adolescent , Adult , Aged , Brain Neoplasms/secondary , Brain Neoplasms/surgery , COVID-19 Nucleic Acid Testing , Child , Child, Preschool , Decompressive Craniectomy , Female , Hematoma, Epidural, Cranial/surgery , Hematoma, Subdural, Chronic/surgery , Humans , Hydrocephalus/surgery , Infectious Disease Transmission, Patient-to-Professional , Male , Mastoid , Middle Aged , Ventriculoperitoneal Shunt , Viral Load , Young Adult
11.
World Neurosurg ; 148: e197-e208, 2021 04.
Article in English | MEDLINE | ID: covidwho-989401

ABSTRACT

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic has been at its peak for the past 8 months and has affected more than 215 countries around the world. India is now the second most-affected nation with more than 48,000,000 cases and 79,000 deaths. Despite this, and the fact that it is a lower-middle-income nation, the number of deaths is almost one third that of the United States and one half that of Brazil. However, there has been no experience published from non-COVID-19-designated hospitals, where the aim is to manage noninfected cases with neurosurgical ailments while keeping the number of infected cases to a minimum. METHODS: We analyzed the number of neurosurgical cases (nontrauma) done in the past 5 months (March-July 2020) in our institute, which is the largest neurosurgical center by volume in southern India, and compared the same to the concurrent 5 months in 2019 and 5 months preceding the pandemic. We also reviewed the total number of cases infected with COVID-19 managed during this time. RESULTS: We operated a total of 630 cases (nontrauma) in these 5 months and had 9 COVID-19 infected cases operated during this time. There was a 57% (P = 0.002) reduction in the number of cases operated as compared with the same 5 months in the preceding year. We employed a dual strategy of rapid antigen testing and surgery for cases needing emergency intervention and reverse transcriptase-polymerase chain reaction test for elective cases. The hospital was divided into 3 zones (red, orange, and green) depending on infectivity level with minimal interaction. Separate teams were designated for each zone, and thus we were able to effectively manage even infected cases despite the absence of pulmonology/medical specialists. CONCLUSIONS: We present a patient management protocol for non-COVID-19-designated hospitals in high-volume centers with the constraints of a lower-middle-income nation and demonstrate its effectiveness. Strict zoning targeted testing and effective triage can help in management during the pandemic.


Subject(s)
COVID-19/epidemiology , Neurosurgical Procedures/trends , Telemedicine/trends , Tertiary Care Centers/organization & administration , Ambulatory Care/trends , Aneurysm, Ruptured/surgery , Brain Neoplasms/surgery , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , Cerebrovascular Disorders/surgery , Humans , India/epidemiology , Infection Control , Intracranial Aneurysm/surgery , Neural Tube Defects/surgery , Patient Selection , Personal Protective Equipment , Radiosurgery , SARS-CoV-2 , Spinal Diseases , Spinal Injuries
12.
J Clin Neurosci ; 85: 1-5, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-978342

ABSTRACT

BACKGROUND: During the coronavirus 19 (COVID-19) pandemic, physicians have begun adapting their daily practices to prevent transmissions. In this study we aimed to provide surgical neuro-oncologists with practice guidelines during the COVID-19 pandemic based on objective data from a high-volume brain tumor surgeon at the current COVID-19 epicenter. METHODS: All outpatient visits and surgeries performed by the senior author during the COVID-19 pandemic were compared between the initial quarantine (3/23/20-5/4/20), the plateau period following quarantine (5/5/20-6/27/20), and the second peak (6/28/20-7/20/20). In-person and telemedicine visits were evaluated for crossovers. Surgeries were subdivided based on lesion type and evaluated across the same time period. RESULTS: From 3/23/20-7/20/20, 469 clinic visits and 196 surgeries were identified. After quarantine was lifted, face-to-face visits increased (P < 0.01) yet no change in telehealth visits occurred. Of 327 telehealth visits, only 5.8% converted to in-person during the 4-month period with the most cited reason being patient preference (68.4%). Of the 196 surgeries performed during the pandemic, 29.1% occurred during quarantine, 49.0% during the plateau, and 21.9% occurred in the second peak. No COVID negative patients developed symptoms at follow-up. 55.6% were performed on malignant tumors and 31.6% were benign with no difference in case volumes throughout the pandemic. CONCLUSIONS: Despite exceptional challenges, we have maintained a high-volume surgical neuro-oncology practice at the epicenter of the COVID-19 pandemic. We provide the protocols implemented at our institution in order to maximize neuro-oncology care while mitigating risk of COVID-19 exposure to both patients and providers.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/methods , Oncologists , Patient Preference , Telemedicine/standards , Brain Neoplasms/surgery , Humans , Neurosurgical Procedures , Pandemics/prevention & control , Surgeons
13.
Neurosurg Focus ; 49(6): E10, 2020 12.
Article in English | MEDLINE | ID: covidwho-953584

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has changed the way in which cancer is treated. Patients with high-grade glioma (HGG) are believed to be in a vulnerable category. The aim of this study was to describe the experience of a hub cancer center and the measures that were put in place for treatment of patients with newly diagnosed and recurrent glioma. METHODS: To prevent in-hospital contagion and preserve the safety of health professionals and patients, specific protocols and strict regulations were introduced. Physical distancing, use of surgical masks, and diligent hand hygiene were adopted. Each case was discussed in a multidisciplinary board meeting before treatment. All patient candidates for surgical procedures were tested for SARS-CoV-2 with a nasopharyngeal swab and a chest CT scan. Indications for surgery were the radiological suspicion of HGG in patients with a good performance status and/or the rapid and progressive occurrence of neurological deficits. Adjuvant treatments were performed only in cases of HGG. This therapy consisted of conventional fractional radiotherapy (RT; 60 Gy/30 fractions) with concomitant and adjuvant temozolomide chemotherapy (TMZCHT) in younger patients; in elderly patients, a short course of RT was employed (40.5 Gy/15 fractions). For recurrent HGG, treatments were assessed after a careful evaluation of the patient's general condition, neurological status, and risk of early impairment in neurological status if not treated. During simulation CT for the RT plan, each patient underwent a chest CT study. In cases in which an imaging study was suspicious for COVID-19 pneumonia, the patient was immediately isolated and rapidly underwent nasopharyngeal swab testing. RESULTS: Between March 1 and April 30, 2020, 23 HGGs were treated, and these cases are included in the present evaluation. Fifteen patients harboring newly diagnosed glioblastoma (GBM) underwent resection followed by a regimen of chemotherapy and RT, and 3 patients with newly diagnosed anaplastic oligodendroglioma underwent surgery followed by adjuvant RT. Five patients were treated for recurrent GBM, and they received surgery plus adjuvant RT. One patient in whom the simulation CT study was suspicious for COVID pneumonia was tested with a nasopharyngeal swab, which proved positive for SARS-CoV-2 infection. No patients contracted COVID-19 during hospitalization for surgery or during RT treatment. Corticosteroid therapy was administered to all patients beginning on the 1st day of RT. CONCLUSIONS: The authors' experience during the COVID-19 pandemic showed that patients with HGG can be treated in the most effective manner without a compromise in safety. Careful selection criteria and a multidisciplinary evaluation are pivotal to assessing the optimal therapeutic strategy.


Subject(s)
Brain Neoplasms/surgery , COVID-19/epidemiology , Glioma/surgery , Infection Control/organization & administration , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , COVID-19/prevention & control , COVID-19/transmission , Female , Humans , Italy , Male , Middle Aged , Neurosurgical Procedures
14.
Ir J Med Sci ; 190(3): 905-911, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-911936

ABSTRACT

BACKGROUND: The COVID-19 pandemic has resulted in a significant disruption in the provision of healthcare globally. The aim of this study was to assess the implications of the COVID-19 pandemic on the provision of neuro-oncology surgery and comparison with a similar 3-month period in 2019. METHODS: Retrospective review of prospectively curated database of patients requiring neuro-oncology surgery at our tertiary referral centre between 1st March 2020 and 31st May 2020. We also analysed data for the same time period (1st March-31st May) in 2019 for comparison. Number and type of tumours operated on, postoperative morbidity and mortality, COVID-19-related complications and delays in treatment were recorded. RESULTS: During the 3-month periods studied in 2020 and 2019, there were 127 and 139 admissions for neuro-oncological surgery, respectively. Sixty patients underwent surgery for gliomas during the 2020 period vs 56 in the 2019 period. We observed no increase in mean length of time from referral to inter-hospital transfer (mean of 76 h in 2020 vs 93 h in 2019 (p = 0.10)) or in mean length of time from admission to surgery in the acute admissions (2.39 days in 2020 vs 2.89 days in 2019). The postoperative 30-day morbidity and mortality rates were lower in 2020; 8.7% (n = 11) compared with 10.1% (n = 14) in 2019. There was one COVID-19-related death which occurred in a patient with B cell lymphoma with negative preoperative COVID-19 test. CONCLUSION: The provision of neuro-oncological surgery can be safely continued during respiratory illness epidemic or pandemic if a rigorous testing and staffing framework is implemented.


Subject(s)
Brain Neoplasms , COVID-19 , Glioma , Neurosurgery , Brain Neoplasms/epidemiology , Brain Neoplasms/surgery , Female , Glioma/epidemiology , Glioma/surgery , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2
15.
World Neurosurg ; 144: e710-e713, 2020 12.
Article in English | MEDLINE | ID: covidwho-773190

ABSTRACT

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic has set a huge challenge to the delivery of neurosurgical services, including the transfer of patients. We aimed to share our strategy in handling neurosurgical emergencies at a remote center in Borneo island. Our objectives included discussing the logistic and geographic challenges faced during the COVID-19 pandemic. METHODS: Miri General Hospital is a remote center in Sarawak, Malaysia, serving a population with difficult access to neurosurgical services. Two neurosurgeons were stationed here on a rotational basis every fortnight during the pandemic to handle neurosurgical cases. Patients were triaged depending on their urgent needs for surgery or transfer to a neurosurgical center and managed accordingly. All patients were screened for potential risk of contracting COVID-19 prior to the surgery. Based on this, the level of personal protective equipment required for the health care workers involved was determined. RESULTS: During the initial 6 weeks of the Movement Control Order in Malaysia, there were 50 urgent neurosurgical consultations. Twenty patients (40%) required emergency surgery or intervention. There were 9 vascular (45%), 5 trauma (25%), 4 tumor (20%), and 2 hydrocephalus cases (10%). Eighteen patients were operated at Miri General Hospital, among whom 17 (94.4%) survived. Ninety percent of anticipated transfers were avoided. None of the medical staff acquired COVID-19. CONCLUSIONS: This framework allowed timely intervention for neurosurgical emergencies (within a safe limit), minimized transfer, and enabled uninterrupted neurosurgical services at a remote center with difficult access to neurosurgical care during a pandemic.


Subject(s)
Brain Neoplasms/surgery , Craniocerebral Trauma/surgery , Emergencies , Hemorrhagic Stroke/surgery , Hydrocephalus/surgery , Neurosurgery , Neurosurgical Procedures/statistics & numerical data , Patient Transfer/statistics & numerical data , Air Ambulances , Borneo/epidemiology , COVID-19/epidemiology , Central Nervous System Vascular Malformations/surgery , Female , Hospitals, General , Humans , Malaysia/epidemiology , Male , Personal Protective Equipment , Skull Base Neoplasms/surgery , Transportation of Patients , Triage
17.
BMJ Open ; 10(8): e040898, 2020 08 16.
Article in English | MEDLINE | ID: covidwho-721211

ABSTRACT

OBJECTIVES: Pressures on healthcare systems due to COVID-19 has impacted patients without COVID-19 with surgery disproportionally affected. This study aims to understand the impact on the initial management of patients with brain tumours by measuring changes to normal multidisciplinary team (MDT) decision making. DESIGN: A prospective survey performed in UK neurosurgical units performed from 23 March 2020 until 24 April 2020. SETTING: Regional neurosurgical units outside London (as the pandemic was more advanced at time of study). PARTICIPANTS: Representatives from all units were invited to collect data on new patients discussed at their MDT meetings during the study period. Each unit decided if management decision for each patient had changed due to COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measures included number of patients where the decision to undergo surgery changed compared with standard management usually offered by that MDT. Secondary outcome measures included changes in surgical extent, numbers referred to MDT, number of patients denied surgery not receiving any treatment and reasons for any variation across the UK. RESULTS: 18 units (75%) provided information from 80 MDT meetings that discussed 1221 patients. 10.7% of patients had their management changed-the majority (68%) did not undergo surgery and more than half of this group not undergoing surgery had no active treatment. There was marked variation across the UK (0%-28% change in management). Units that did not change management could maintain capacity with dedicated oncology lists. Low volume units were less affected. CONCLUSION: COVID-19 has had an impact on patients requiring surgery for malignant brain tumours, with patients receiving different treatments-most commonly not receiving surgery or any treatment at all. The variations show dedicated cancer operating lists may mitigate these pressures. STUDY REGISTRATION: This study was registered with the Royal College of Surgeons of England's COVID-19 Research Group (https://www.rcseng.ac.uk/coronavirus/rcs-covid-research-group/).


Subject(s)
Brain Neoplasms/surgery , Clinical Decision-Making , Coronavirus Infections/epidemiology , Patient Care Team/organization & administration , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Delivery of Health Care , England/epidemiology , Health Care Surveys , Humans , Pandemics , Prospective Studies , SARS-CoV-2
18.
World Neurosurg ; 142: e183-e194, 2020 10.
Article in English | MEDLINE | ID: covidwho-689877

ABSTRACT

OBJECTIVE: In the present study, we quantified the effect of the coronavirus disease 2019 (COVID-19) on the volume of adult and pediatric neurosurgical procedures, inpatient consultations, and clinic visits at an academic medical center. METHODS: Neurosurgical procedures, inpatient consultations, and outpatient appointments at Vanderbilt University Medical Center were identified from March 23, 2020 through May 8, 2020 (during COVID-19) and March 25, 2019 through May 10, 2019 (before COVID-19). The neurosurgical volume was compared between the 2 periods. RESULTS: A 40% reduction in weekly procedural volume was demonstrated during COVID-19 (median before, 75; interquartile range [IQR], 72-80; median during, 45; IQR, 43-47; P < 0.001). A 42% reduction occurred in weekly adult procedures (median before, 62; IQR, 54-70; median during, 36; IQR, 34-39; P < 0.001), and a 31% reduction occurred in weekly pediatric procedures (median before, 13; IQR, 12-14; median during, 9; IQR, 8-10; P = 0.004). Among adult procedures, the most significant decreases were seen for spine (P < 0.001) and endovascular (P < 0.001) procedures and cranioplasty (P < 0.001). A significant change was not found in the adult open vascular (P = 0.291), functional (P = 0.263), cranial tumor (P = 0.143), or hydrocephalus (P = 0.173) procedural volume. Weekly inpatient consultations to neurosurgery decreased by 24% (median before, 99; IQR, 94-114; median during, 75; IQR, 68-84; P = 0.008) for adults. Weekly in-person adult and pediatric outpatient clinic visits witnessed a 91% decrease (median before, 329; IQR, 326-374; median during, 29; IQR, 26-39; P < 0.001). In contrast, weekly telehealth encounters increased from a median of 0 (IQR, 0-0) before to a median of 151 (IQR, 126-156) during COVID-19 (P < 0.001). CONCLUSIONS: Significant reductions occurred in neurosurgical operations, clinic visits, and inpatient consultations during COVID-19. Telehealth was increasingly used for assessments. The long-term effects of the reduced neurosurgical volume and increased telehealth usage on patient outcomes should be explored.


Subject(s)
Ambulatory Care/trends , Coronavirus Infections , Neurosurgery , Neurosurgical Procedures/trends , Pandemics , Pneumonia, Viral , Referral and Consultation/trends , Telemedicine/trends , Academic Medical Centers , Adolescent , Aged , Betacoronavirus , Brain Neoplasms/surgery , COVID-19 , Child , Child, Preschool , Craniotomy/trends , Device Removal , Endovascular Procedures/trends , Epilepsy/surgery , Female , Humans , Hydrocephalus/surgery , Infant , Male , Middle Aged , Prosthesis Implantation , Reconstructive Surgical Procedures/trends , SARS-CoV-2 , Spinal Diseases/surgery , Spinal Injuries/surgery , Tennessee , Vascular Surgical Procedures/trends
19.
World Neurosurg ; 141: 157-161, 2020 09.
Article in English | MEDLINE | ID: covidwho-648118

ABSTRACT

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.


Subject(s)
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
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