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2.
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
4.
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
5.
World Neurosurg ; 144: e380-e388, 2020 12.
Article in English | MEDLINE | ID: covidwho-741539

ABSTRACT

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.


Subject(s)
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
6.
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
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