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1.
Neurochirurgie ; 67(2): 99-103, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1046196

ABSTRACT

OBJECTIVE: The objective of this study was to relate the neurosurgical activity during a time of sanitary crisis such as experienced during the SARS-CoV-2 pandemic. METHODS: A monocentric retrospective analysis was made based on a prospectively gathered cohort of all patients requiring neurosurgical care between March 15th and May 12th, 2020. Local impact of SARS-CoV-2 was analysed regarding number of patients admitted in ICU. RESULTS: One hundred and sixty patients could benefit from neurosurgical care with a wide-ranging profile of clinical and surgical activities performed during the study that seemed similar to last year profile activity. Surgical indications were restricted to non-deferrable surgeries, leading to a drop in operative volume of 50%. Only 1.3% of patients required transfer to other units due to the impossibility of providing gold standard neurosurgical care in our centre. CONCLUSION: Despite the challenges represented by the SARS-CoV-2 pandemic, it was proven possible to ensure the routine neurosurgical continuity and provide high standards of neurosurgical care without compromising patients' access to the required treatments.


Subject(s)
COVID-19 , Neurosurgery/statistics & numerical data , Pandemics , Critical Care/statistics & numerical data , Elective Surgical Procedures/statistics & numerical data , Humans , Neurosurgery/standards , Neurosurgical Procedures , Patient Transfer , Registries , Retrospective Studies
2.
Neurosurg Focus ; 49(6): E2, 2020 12.
Article in English | MEDLINE | ID: covidwho-954867

ABSTRACT

OBJECTIVES: Coronavirus disease (COVID-19) is a potentially severe respiratory illness that has threatened humanity globally. The pediatric neurosurgery practice differs from that of adults in that it treats children in various stages of physical and psychological development and contemplates diseases that do not exist in other areas. The aim of this study was to identify the level of knowledge and readiness of the healthcare providers, as well as to evaluate new preventive practices that have been introduced, psychological concerns, and the impact of the COVID-19 pandemic on pediatric neurosurgical units in Brazil. METHODS: Pediatric neurosurgeons were given an online questionnaire developed by the Brazilian Society of Pediatric Neurosurgery to evaluate the impact of the COVID-19 pandemic on their clinical practice. RESULTS: Of a cohort of 110 active members of the Brazilian Society of Pediatric Neurosurgery, 76 completed the survey (69%). Ninety-six percent were aware of the correct use of and indication for the types of personal protective equipment in clinical and surgical practices, but only 73.7% of them had unrestricted access to this equipment. Ninety-eight percent of participants agreed or strongly agreed that the pandemic had affected their pediatric neurosurgical practice. The COVID-19 pandemic interfered with outpatient care in 88% of the centers, it affected neurosurgical activity in 90.7%, and it led to the cancellation of elective neurosurgical procedures in 57.3%. Concerning the impact of COVID-19 on surgical activity, 9.2% of the centers had less than 25% of the clinical practice affected, 46.1% had 26%-50% of their activity reduced, 35.5% had a 51%-75% reduction, and 9.2% had more than 75% of their surgical work cancelled or postponed. Sixty-three percent affirmed that patients had been tested for COVID-19 before surgery. Regarding the impact of the COVID-19 pandemic on the mental health of those interviewed, 3.9% reported fear and anxiety with panic episodes, 7.9% had worsening of previous anxiety symptoms, 60.5% reported occasional fear, 10.5% had sadness and some depressive symptoms, and 2.6% reported depressive symptoms. CONCLUSIONS: The COVID-19 pandemic has posed unprecedented challenges to healthcare services worldwide, including neurosurgical units. Medical workers, pediatric neurosurgeons included, should be aware of safety measures and follow the recommendations of local healthcare organizations, preventing and controlling the disease. Attention should be given to the psychological burden of exposure to SARS-CoV-2 in healthcare workers, which carries a high risk of anxiety and depression.


Subject(s)
COVID-19/epidemiology , Health Personnel/standards , Neurosurgery/standards , Pediatrics/standards , Practice Guidelines as Topic/standards , Societies, Medical/standards , Brazil/epidemiology , COVID-19/prevention & control , Child , Health Personnel/psychology , Humans , Neurosurgeons/psychology , Neurosurgeons/standards , Neurosurgical Procedures/standards , Pandemics/prevention & control , Personal Protective Equipment/standards , Surveys and Questionnaires
3.
World Neurosurg ; 146: 103-112, 2021 02.
Article in English | MEDLINE | ID: covidwho-929431

ABSTRACT

Preoperative testing and evaluation for coronavirus disease 2019 (COVID-19) have been an enigmatic challenge for the neurosurgical community during the pandemic. Since the beginning of the pandemic, laboratory diagnostic methods have evolved substantially, and with them has been the necessity for readily available, fast, and accurate preoperative testing methods. In this article, we provide an overview of the various laboratory testing methods that are presently available and a comprehensive literature review how various institutes and neurosurgical communities across the globe are employing them to ensure safe and effective delivery of surgical care to patients. Through this review, we highlight the guiding principles for preoperative testing, which may serve as a road map for other medical institutions to follow. In addition, we provide an Indian perspective of preoperative testing and share our experience in this regard.


Subject(s)
COVID-19 Testing/standards , COVID-19/epidemiology , Neurosurgeons/standards , Neurosurgical Procedures/standards , Practice Guidelines as Topic/standards , Preoperative Care/standards , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19 Testing/methods , Humans , India/epidemiology , Neurosurgery/methods , Neurosurgery/standards , Neurosurgical Procedures/methods , Personal Protective Equipment/standards , Preoperative Care/methods , Telemedicine/methods , Telemedicine/standards
4.
World Neurosurg ; 146: 20-25, 2021 02.
Article in English | MEDLINE | ID: covidwho-894259

ABSTRACT

The COVID-19 outbreak has led to fundamental disruptions of health care and its delivery with sweeping implications for patients and physicians of all specialties, including neurosurgery. In an effort to conserve hospital resources, neurosurgical procedures were classified into tiers to determine which procedures have to be performed in a timely fashion and which ones can be temporarily suspended to aid in the hospital's reallocation of resources when equipment is scarce. These guidelines were created quickly based on little existing evidence, and thus were initially variable and required refinement. As the early wave can now be assessed in retrospect, the authors describe the lessons learned and the protocols established based on published global evidence to continue to practice neurosurgery sensibly and minimize disruptions. These operational protocols can be applied in a surge of COVID-19 or another airborne pandemic.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Neurosurgical Procedures/standards , Practice Guidelines as Topic/standards , Humans , Neurosurgery/standards , Neurosurgery/trends , Neurosurgical Procedures/trends , Pandemics/prevention & control , Personal Protective Equipment/standards , Personal Protective Equipment/trends
5.
J Neurosurg Sci ; 65(1): 1-7, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-593345

ABSTRACT

The Coronavirus (COVID-19) pandemic has fast spread throughout the world in more than 200 countries, resulting in the need for a de-prioritization of elective medical care to face the demands of the global health crisis. Although the acute and catastrophic phase of the pandemic seems to have been left behind, it is also clear that the virus will not disappear soon, and we must live with it for a period of unpredictable length, the COVID-19 era. In this setting, a common coordinated approach to treat patients harboring brain tumors is urgently required to guarantee the best updated oncological care and to reduce the risk of viral infection during hospitalization. The study group on Neuro-oncology of Italian Society of Neurosurgery, SINCh gathered pieces of evidence and data and would like to suggest a practice protocol of care for neurosurgical oncologic procedures in the COVID-19 era. The present document aimed at summarizing current evidence and expert opinions to help neurosurgeons in taking decisions on their patients harboring different brain tumors.


Subject(s)
Brain Neoplasms/therapy , COVID-19 , Clinical Trials, Phase II as Topic , Neurosurgery/trends , Pandemics , Brain Neoplasms/surgery , Clinical Decision-Making , Disease Management , Glioma/surgery , Glioma/therapy , Guidelines as Topic , Humans , Italy , Neoplasm Metastasis , Neurosurgery/standards , Neurosurgical Procedures
6.
World Neurosurg ; 139: e848-e858, 2020 07.
Article in English | MEDLINE | ID: covidwho-478741

ABSTRACT

BACKGROUND: The novel coronavirus disease (COVID-19) is a life-threatening illness, which represents a challenge to all health care workers. Neurosurgeons worldwide are affected in different ways. OBJECTIVE: This is the first study regarding the readiness of neurosurgery residents for the COVID-19 pandemic and its impact. The aim is to identify the level of knowledge and readiness and the impact of this virus among neurosurgery residents in different programs. METHODS: A cross-sectional analysis was performed in which 52 neurosurgery residents from different centers were selected to complete a questionnaire-based survey. The questionnaire comprised 3 sections and 27 questions that ranged from knowledge to impact of the pandemic on various features. RESULTS: The median knowledge score was 4 out of 5. The proportion of participants with a satisfactory level of knowledge was 60%. There was a statistically significant difference between the knowledge score and location of the program. Around 48% of the neurosurgery residents dealt directly with patients with COVID-19. Receiving a session about personal protective equipment was reported by 57.7%. Neurosurgery training at the hospital was affected. About 90% believed that this pandemic had influenced their mental health. CONCLUSIONS: Neurosurgery residents have a relatively good knowledge about COVID-19. The location of the program was associated with knowledge level. Most participants did not receive sufficient training about personal protective equipment. Almost all responders agreed that their training at the hospital had been affected. Further studies are needed to study the impact of this pandemic on neurosurgery residents.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Health Knowledge, Attitudes, Practice , Internship and Residency/standards , Neurosurgery/standards , Pandemics , Pneumonia, Viral/epidemiology , Adult , COVID-19 , Coronavirus Infections/therapy , Cross-Sectional Studies , Female , Humans , Male , Neurosurgeons/psychology , Neurosurgeons/standards , Neurosurgery/education , Pneumonia, Viral/therapy , SARS-CoV-2 , Surveys and Questionnaires , Young Adult
7.
World Neurosurg ; 139: e859-e863, 2020 07.
Article in English | MEDLINE | ID: covidwho-367037

ABSTRACT

BACKGROUND: The coronavirus 2019 (COVD-19) pandemic has drastically disrupted the delivery of neurosurgical care, especially for the already at-risk neuro-oncology population. The sudden change to clinic visits has rapidly spurned the implementation of telemedicine. A recommendation care paradigm of neuro-oncologic patients limited by telemedicine has not been reported. METHODS: A summary of a multi-institution experience detailing the potential benefits, pitfalls, and the necessary considerations to outpatient care of neurosurgical oncology patients. RESULTS: There are limitations and advantages to incorporating telemedicine into the outpatient care of neuro-oncology patients. Telemedicine-specific considerations for each step and stakeholder of the appointment (physician, patient, scheduling, previsit, imaging, and physical examination) are examined. CONCLUSIONS: Telemedicine, pushed to prominence during this COVID-19 pandemic, is a powerful and possibly preferential tool for the future of outpatient neuro-oncologic care.


Subject(s)
Ambulatory Surgical Procedures/trends , Betacoronavirus , Coronavirus Infections/surgery , Medical Oncology/trends , Neurosurgery/trends , Pneumonia, Viral/surgery , Telemedicine/trends , Ambulatory Surgical Procedures/standards , COVID-19 , Coronavirus Infections/epidemiology , Forecasting , Humans , Medical Oncology/standards , Neurosurgery/standards , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Telemedicine/standards
8.
Neurol India ; 68(2): 246-254, 2020.
Article in English | MEDLINE | ID: covidwho-270267

ABSTRACT

BACKGROUND: The COVID-19 infection outbreak has aroused increasing attention and affected thousands of people nationwide. The long incubation period, high infectious rate, varied manifestation, and absence of effective treatment make it difficult to manage the disease transmission. OBJECTIVE: The intended goals are to encourage efficient management of neurological and neurosurgical patients, resource utilization, and protecting the healthcare provider during the COVID-19 epidemic. Herein, we present a consensus statement from various centers in India. METHODOLOGY: In addition to the literature review, recommendations were included from neurologists and neurosurgeons from various centers in India. RESULTS: Every patient presenting for treatment should be treated as a potential asymptomatic infected case. Patients should be categorized based upon the priority as acute (require immediate treatment/surgery within 24 h), sub-acute (requiring treatment within a maximum of 7-10 days), or chronic (requiring treatment within a month). Non-essential elective surgeries and outpatient clinics should be avoided after informing the patient(s). There is a high risk of aerosol dispersion during intubation and certain neurosurgical procedures particularly those involving drills and endoscopes. These procedures should be performed wearing full personal protective equipment. The workflow of the operating rooms should also be modified significantly. Minor modifications in personal and professional lifestyles and routine training to use the PPE will ensure efficient management of resources. CONCLUSION: These recommendations could be used to mitigate the risks and reduce exposure to other patients, public, and healthcare staff.


Subject(s)
Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Infection Control/standards , Neurology/standards , Neurosurgery/standards , Pandemics , Patient Care/standards , Pneumonia, Viral , COVID-19 , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Neurosurgical Procedures , Pandemics/prevention & control , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission
9.
World Neurosurg ; 139: 289-293, 2020 07.
Article in English | MEDLINE | ID: covidwho-232517

ABSTRACT

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.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Hospitals, Urban/standards , Neurosurgery/standards , Neurosurgical Procedures/standards , Pneumonia, Viral/epidemiology , COVID-19 , Coronavirus Infections/surgery , Health Personnel/standards , Humans , Neurosurgery/methods , Neurosurgical Procedures/methods , New York City/epidemiology , Pandemics , Pneumonia, Viral/surgery , SARS-CoV-2
10.
World Neurosurg ; 139: e812-e817, 2020 07.
Article in English | MEDLINE | ID: covidwho-176727

ABSTRACT

BACKGROUND: Since January 2020, when the pathogen causing the coronavirus disease was identified in humans, the literature on coronavirus disease 2019 (COVID-19) has grown exponentially to more than 4000 publications. There is the need to provide an update for each single medical discipline, including neurosurgery, to be used by single professionals or to be distributed through the neurosurgical community and to be used by governments in designing new scenario of care. METHODS: A review of the MEDLINE database was performed on April 13, 2020. Search terms included "COVID-19," "neurosurgery," and "surgery." A review of documents published on the webpage of the WFNS (World Federation of Neurosurgical Societies) and of the 5 continental associations of neurosurgical societies, AANS (American Association of Neurological Surgeons), AASNS (Asian Australasian Society of Neurological Surgeons), CAANS (Continental Association of African Neurosurgical Societies), EANS (European Association of Neurosurgical Societies), and FLANC (Latin American Federation of Neurosurgical Societies), representing the 119 national neurosurgical societies around the world, was performed. RESULTS: The literature search yielded 38 results that were manually reviewed. Fourteen manuscripts were considered eligible. They described suggestions and considerations to optimize care of neurosurgical patients, editorials on operational models, perspectives from neurosurgical departments, letters to the editor describing experiences on how to help medical staff to be prepared in advance for pandemic situations, and descriptions of regional or departmental models and/or organizational schemes. The webpages of the searched societies reported a total of 57 documents. CONCLUSIONS: The neurosurgical scientific community has promptly reacted to the COVID-19 outbreak by producing a growing number of documents that could serve as guidance for neurosurgeons all over the world. Neurosurgical societies will represent the key institutions for guiding the neurosurgical community to overcome the COVID-19 crisis.


Subject(s)
Betacoronavirus , Coronavirus Infections/surgery , Neurosurgery/standards , Pneumonia, Viral/surgery , Practice Guidelines as Topic/standards , Societies, Medical/standards , COVID-19 , Coronavirus Infections/epidemiology , Humans , Neurosurgery/methods , Neurosurgical Procedures/methods , Neurosurgical Procedures/standards , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2
11.
J Neurooncol ; 148(2): 211-219, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-175869

ABSTRACT

The challenges of neurosurgical patient management and surgical decision-making during the 2019-2020 COVID-19 worldwide pandemic are immense and never-before-seen in our generation of neurosurgeons. In this case-based formatted report, we present the Mount Sinai Hospital (New York, NY) Department of Neurosurgery institutional experience in the epicenter of the pandemic and the guiding principles for our current management of intracranial, skull base, and spine tumors. The detailed explanations of our surgical reasoning for each tumor case is tailored to assist neurosurgeons across the United States as they face these complex operative decisions put forth by the realities of the pandemic.


Subject(s)
Betacoronavirus/isolation & purification , Brain Neoplasms/surgery , Coronavirus Infections/complications , Neurosurgery/standards , Neurosurgical Procedures/methods , Pneumonia, Viral/complications , Spinal Neoplasms/surgery , Triage/standards , Brain Neoplasms/virology , COVID-19 , Coronavirus Infections/virology , Disease Management , Humans , Pandemics , Pneumonia, Viral/virology , SARS-CoV-2 , Spinal Neoplasms/virology
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