Awake craniotomy for glioblastoma in COVID-19-positive patients and delivering the standard of care: illustrative case.
J Neurosurg Case Lessons
; 2(1): CASE21246, 2021 Jul 05.
Article
in English
| MEDLINE | ID: covidwho-1952158
ABSTRACT
BACKGROUND:
Providing the standard of care to patients with glioblastoma (GBM) during the novel coronavirus of 2019 (COVID-19) pandemic is a challenge, particularly if a patient tests positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Further difficulties occur in eloquent cortex tumors because awake speech mapping can theoretically aerosolize viral particles and expose staff. Moreover, microscopic neurosurgery has become difficult because the use of airborne-level personal protective equipment (PPE) crowds the space between the surgeon and the eyepiece. However, delivering substandard care will inevitably lead to disease progression and poor outcomes. OBSERVATIONS A 60-year-old man with a left insular and frontal operculum GBM was found to be COVID-19 positive. Treatment was postponed pending a negative SARS-CoV-2 result, but in the interim, he developed intratumoral hemorrhage with progressive expressive aphasia. Because the tumor was causing dominant hemisphere language symptomatology, an awake craniotomy was the recommended surgical approach. With the use of airborne-level PPE and a surgical drape to protect the surgeon from the direction of potential aerosolization, near-total gross resection was achieved. LESSONS Delaying the treatment of patients with GBM who test positive for COVID-19 will lead to further neurological deterioration. Optimal and timely treatment such as awake speech mapping for COVID-19-positive patients with GBM can be provided safely.
CDC = Centers for Disease Control and Prevention; COVID-19; CT = computed tomography; FLAIR = fluid-attenuated inversion recovery; FOV = field of view; GBM = glioblastoma; IMRT = intensity-modulated radiation therapy; MRI = magnetic resonance imaging; PAPR = personal air purification respirators; PPE = personal protective equipment; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; TMZ = temozolomide; awake craniotomy; glioblastoma; neuro-oncology
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Type of study:
Case report
/
Observational study
/
Prognostic study
Language:
English
Journal:
J Neurosurg Case Lessons
Year:
2021
Document Type:
Article
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