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Entezami P, Rock AK, Topp GP, Heydari ES, Field NC, Boulos AS, Dalfino JC, Yamamoto J, Pilitsis JG, Cherukupalli D, McCallum SE, Paul AR. Developing a fast-track discharge protocol for patients with cerebral aneurysms treated via neuroendovascular techniques. Interv Neuroradiol 2024; 30:163-169. [PMID: 35648585 PMCID: PMC11095345 DOI: 10.1177/15910199221104616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/15/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION As we emerge from the current pandemic, hospitals, staff, and resources will need to continue to adjust to meet ongoing healthcare demands. Lessons learned during past shortages can be used to optimize peri-procedural protocols to safely improve the utilization of hospital resources. METHODS Retrospective review of patients who underwent elective endovascular intracranial aneurysm treatment was performed. Multivariable logistic regression was used to identify factors associated with patients who were able to be discharged within 24 h of elective procedures. Rates of complications (particularly readmission) were determined. RESULTS 330 patients underwent elective endovascular aneurysm treatment with 86 (26.1%) discharged within 24 h. Factors associated with earlier discharge included procedure years (2019-2021) and male sex. Patients were more likely to be discharged later (after 24 h) if they underwent stent-coil embolization or flow-diversion. There was no association between discharge timing and likelihood of readmission. DISCUSSION Our review highlights the safety of earlier discharge and allowed us to prepare a fast-track protocol for same-day discharge in these patients. This protocol will be studied prospectively in the next phase of this study. As we gain more comfort with emerging, minimally invasive endovascular therapies, we hope to safely achieve same-day discharge on a protocolized and routine basis, reducing the demand of elective aneurysm treatments on our healthcare system. CONCLUSION We retrospectively demonstrate that early discharge following elective aneurysm treatment is safe in our cohort and provide a fast-track pathway based on these findings for other centers developing similar protocols.
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Affiliation(s)
- Pouya Entezami
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Andrew K. Rock
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Gregory P. Topp
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | | | | | - Alan S. Boulos
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - John C. Dalfino
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Junichi Yamamoto
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Julie G. Pilitsis
- Department of Neuroscience, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Sarah E. McCallum
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
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van Munster J, Noordenbos MW, Halperin IJY, van den Hout WB, van Benthem PP, Seinen I, Moojen WA, Peul W. Impact of evidence-based guidelines on healthcare utilisation and costs for disc related sciatica in the Netherlands: a population-based, cross-sectional study. BMJ Open 2024; 14:e078459. [PMID: 38471686 DOI: 10.1136/bmjopen-2023-078459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE The aim of this study was to assess the impact of high-quality evidence supporting surgical treatment of lumbar disc herniation (LDH) on healthcare practice in the Netherlands by examining changes in healthcare utilisation, including the timing of surgery, and the healthcare costs for patients with LDH. DESIGN A retrospective, cross-sectional study was performed using population-based, longitudinal data obtained from the Dutch Healthcare Authority (2007-2020) and NIVEL's primary care (2012-2020) administrative databases. SETTING The study was conducted within the healthcare system of the Netherlands. PARTICIPANTS We included adults (≥18 years) who visited a Dutch hospital or a general practitioner (GP) for lumbar degenerative disc disease. Patients with LDH were identified based on registered diagnosis code, type of surgery (discectomy) and age (<56 years). MAIN OUTCOME MEASURES The primary outcome measure was the difference in the annual number of LDH procedures following the publication of evidence-based guidelines in 2009 (comparing the periods 2007-2009 to 2017-2019). Secondary outcome measures focused on the timing of surgery and associated healthcare costs. To validate the outcomes, secondary outcomes also include the number of discectomies and the number of procedures in the younger age group (discectomies, laminectomies, and fusion surgery). RESULTS The number of patients suffering from LDH increased from 55 581 to 68 997 (+24%) between 2007 and 2019. A decrease was observed in the annual number of LDH procedures (-18%), in the number of discectomies (-22%) and in the number of procedures for patients aged <56 years (-18%). This resulted in lower healthcare costs by €10.5 million annually. In 2012, 31% of all patients <56 years had surgery before 12 weeks from diagnosis at the GP, whereas 20% did in 2019. CONCLUSIONS Healthcare utilisation for LDH changed tremendously in the Netherlands between 2007 and 2020 and seemed to be associated with the publication and implementation of evidence-based guidelines. The observed decrease in the number of procedures has been accompanied by a corresponding reduction in healthcare costs. These findings underscore the importance of adhering to evidence-based guidelines to optimise the management of patients with LDH.
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Affiliation(s)
- Juliëtte van Munster
- Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - I J Y Halperin
- Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Peter Paul van Benthem
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingrid Seinen
- Dutch Healthcare Authority, Utrecht, The Netherlands
| | - Wouter A Moojen
- Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
- Neurosurgery, HAGA hospital, The Hague, The Netherlands
| | - Wilco Peul
- Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
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Ukachukwu AEK, Abu-Bonsrah N, Seas A, Petitt Z, Waguia-Kouam R, Ramos S, Edwards A, Deng DD, Haglund MM, Fuller AT. The impact of COVID-19 pandemic on global neurosurgery collaborations. World Neurosurg X 2024; 21:100244. [PMID: 38221953 PMCID: PMC10787299 DOI: 10.1016/j.wnsx.2023.100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/16/2023] [Accepted: 10/04/2023] [Indexed: 01/16/2024] Open
Affiliation(s)
- Alvan-Emeka K. Ukachukwu
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
- Department of Neurosurgery, Duke University Health System, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
| | - Nancy Abu-Bonsrah
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Andreas Seas
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
- Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Zoey Petitt
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Romaric Waguia-Kouam
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - Samantha Ramos
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
| | - Alyssa Edwards
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Di D. Deng
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
| | - Michael M. Haglund
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
- Department of Neurosurgery, Duke University Health System, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Anthony T. Fuller
- Duke Global Neurosurgery and Neurology, Duke University, Durham, NC, USA
- Department of Neurosurgery, Duke University Health System, Durham, NC, USA
- Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
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Snowdon E, Biswas S, Almansoor ZR, Aizan LNB, Chai XT, Reghunathan SM, MacArthur J, Tetlow CJ, Sarkar V, George KJ. Temporal trends in neurosurgical volume and length of stay in a public healthcare system: A decade in review with a focus on the COVID-19 pandemic. Surg Neurol Int 2023; 14:407. [PMID: 38053709 PMCID: PMC10695347 DOI: 10.25259/sni_787_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023] Open
Abstract
Background Over the past decade, neurosurgical interventions have experienced changes in operative frequency and postoperative length of stay (LOS), with the recent COVID-19 pandemic significantly impacting these metrics. Evaluating these trends in a tertiary National Health Service center provides insights into the impact of surgical practices and health policy on LOS and is essential for optimizing healthcare management decisions. Methods This was a single tertiary center retrospective case series analysis of neurosurgical procedures from 2012 to 2022. Factors including procedure type, admission urgency, and LOS were extracted from a prospectively maintained database. Six subspecialties were analyzed: Spine, Neuro-oncology, Skull base (SB), Functional, Cerebrospinal fluid (CSF), and Peripheral nerve (PN). Mann-Kendall temporal trend test and exploratory data analysis were performed. Results 19,237 elective and day case operations were analyzed. Of the 6 sub-specialties, spine, neuro-oncology, SB, and CSF procedures all showed a significant trend toward decreasing frequency. A shift toward day case over elective procedures was evident, especially in spine (P < 0.001), SB (tau = 0.733, P = 0.0042), functional (tau = 0.156, P = 0.0016), and PN surgeries (P < 0.005). Over the last decade, decreasing LOS was observed for neuro-oncology (tau = -0.648, P = 0.0077), SB (tau = -0.382, P = 0.012), and functional operations, a trend which remained consistent during the COVID-19 pandemic (P = 0.01). Spine remained constant across the decade while PN demonstrated a trend toward increasing LOS. Conclusion Most subspecialties demonstrate a decreasing LOS coupled with a shift toward day case procedures, potentially attributable to improvements in surgical techniques, less invasive approaches, and increased pressure on beds. Setting up extra dedicated day case theaters could help deal with the backlog of procedures, particularly with regard to the impact of COVID-19.
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Affiliation(s)
- Ella Snowdon
- Department of Neurosurgery, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sayan Biswas
- Department of Neurosurgery, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Zahra R. Almansoor
- Department of Neurosurgery, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Luqman Naim Bin Aizan
- Department of Colorectal Surgery, Warrington and Halton Foundation Trust, Warrington, United Kingdom
| | - Xin Tian Chai
- Department of Neurosurgery, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sharan Manikanda Reghunathan
- Department of Neurosurgery, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Joshua MacArthur
- Department of Neurosurgery, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Callum James Tetlow
- Department of Data Science, National Health Service (NHS) Northern Care Alliance, Manchester, United Kingdom
| | - Ved Sarkar
- Department of Data Science, College of Letters and Sciences, University of California, Berkeley, United Kingdom
| | - K. Joshi George
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Salford, United Kingdom
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Munda M, Velnar T, Bosnjak R, Zele T, Gradisnik L, Spazzapan P, Kos N, Kocivnik N, Benedicic M, Prestor B. COVID-19 and Surgical Practice in Slovenia: Managing the Crisis in Neurosurgery during the COVID-19 Pandemic. Life (Basel) 2023; 13:2095. [PMID: 37895476 PMCID: PMC10608538 DOI: 10.3390/life13102095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Worldwide, the novel coronavirus disease 2019 (COVID-19) has become a significant threat to global health. Worldwide, COVID-19 has affected the health service also in Slovenia. During this time, neurosurgery is facing difficulties in its service, both in emergency and elective surgeries. In the article, we describe the anti-COVID-19 measures taken at our neurosurgical department in a medical centre in Ljubljana, Slovenia, and analysed and compared the number of emergency and elective neurosurgical procedures during the time of the pandemic.
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Affiliation(s)
- Matic Munda
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
| | - Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
- AMEU-ECM Maribor, 2000 Maribor, Slovenia;
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
| | - Tilen Zele
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
- AMEU-ECM Maribor, 2000 Maribor, Slovenia;
| | - Lidija Gradisnik
- Institute of Biomedical Sciences, Medical Faculty Maribor, 2000 Maribor, Slovenia;
| | - Peter Spazzapan
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
| | - Natasa Kos
- AMEU-ECM Maribor, 2000 Maribor, Slovenia;
- Department of Rehabilitation, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Nina Kocivnik
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Mitja Benedicic
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
| | - Borut Prestor
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
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Teng H, Wang Z, Yang X, Wu X, Chen Z, Wang Z, Chen G. The impact of COVID-19 on clinical outcomes in people undergoing neurosurgery: a systematic review and meta-analysis. Syst Rev 2023; 12:137. [PMID: 37550713 PMCID: PMC10405503 DOI: 10.1186/s13643-023-02291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 07/17/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The coronavirus disease-2019 (COVID-19) pandemic has created a global crisis unique to the healthcare system around the world. It also had a profound impact on the management of neurosurgical patients. In our research, we investigated the effect of the COVID-19 pandemic on clinical outcomes in people undergoing neurosurgery, particularly vascular and oncological neurosurgery. METHOD Two investigators independently and systematically searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrail.Gov, and Web of Science to identify relevant studies respecting the criteria for inclusion and exclusion published up to June 30, 2022. The outcomes of our research included mortality rate, length of stay, modified Rankin Score, delay in care, Glasgow outcome scale, and major complications. The risk of bias was assessed using the Methodological Index for Non-randomized Studies (MINORS) checklist. RESULTS Two investigators independently and systematically searched 1378 results from MEDLINE, EMBASE, Cochrane database, ClinicalTrail.Gov, and Web of Science and extracted the detailed data from 13 studies that met the review's eligibility criteria. Two articles reported on patients with intracerebral hemorrhages, five on patients with subarachnoid hemorrhages, four on patients undergoing surgery for neuro-oncology, and in two studies the patients' conditions were unspecified. A total of 26,831 patients were included in our research. The number who died was significantly increased in the COVID-19 pandemic group (OR 1.52, 95% CI 1.36-1.69, P < 0.001). No significant difference was found between the two groups in terms of length of stay (SMD - 0.88, 95% CI - 0.18-0.02, P = 0.111), but it differed between regions, according to our subgroup analysis. CONCLUSION Compared to the pre-pandemic group, the number who died was significantly increased in the COVID-19 pandemic group. Meanwhile, the effect of the pandemic on clinical outcomes in people undergoing neurosurgery might differ in different regions, according to our subgroup analysis.
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Affiliation(s)
- Haiying Teng
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
- Suzhou Medical College of Soochow University, Suzhou, 215002, Jiangsu Province, China
| | - Zilan Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Xingyu Yang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Xiaoxiao Wu
- Suzhou Medical College of Soochow University, Suzhou, 215002, Jiangsu Province, China
| | - Zhouqing Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
| | - Gang Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
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Solé Florensa P, González Sanchez J, Gil Torrano A, Peroy Garcia J, Jové Talavera R, Mas Atance J. [Translated article] Impact of COVID-19 pandemia on spine surgery in 2nd level hospital. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T255-T262. [PMID: 36863518 PMCID: PMC9974204 DOI: 10.1016/j.recot.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/28/2022] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION The consequences of COVID-19 pandemic, like in any other field of medicine, had such a massive effect in the activity of spine surgeons. OBJECTIVES The main purpose of the study is quantifying the number of interventions done between 2016 and 2021 and analyze the time between the indication and the intervention as an indirect measurement of the waiting list. As secondary objectives we focused on variations of the length of stay and duration of the surgeries during this specific period. METHODS We performed a descriptive retrospective study including all the interventions and diagnosis made during a period including pre-pandemic data (starting on 2016) until 2021, when we considered the normalization of surgical activity was achieved. A total of 1039 registers were compiled. The data collected included age, gender, days in waiting list before the intervention, diagnosis, time of hospitalization and surgery duration. RESULTS We found that the total number of interventions during the pandemic has significantly decreased compared to 2019 (32.15% less in 2020 and 23.5% less in 2021). After data analysis, we found an increase of data dispersion, average waiting list time and for diagnosis after 2020. No differences were found regarding hospitalization time or surgical time. CONCLUSION The number of surgeries decreased during pandemic due to the redistribution of human and material resources to face the raising of critical COVID-19 patients. The increase of data dispersion and median of waiting time, is the consequence of a growing waiting list for non-urgent surgeries during the pandemic as the urgent interventions also raised, those with a shorter waiting time.
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Affiliation(s)
- P Solé Florensa
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
| | - J González Sanchez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - A Gil Torrano
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J Peroy Garcia
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - R Jové Talavera
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J Mas Atance
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
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Pejhan S, Tran C, Driman DK, Hammond R, Ang LC, Zhang Q. Impact of COVID-19 pandemic on neuropathology service: Experience at one Canadian center. J Neuropathol Exp Neurol 2023; 82:296-301. [PMID: 36718578 DOI: 10.1093/jnen/nlad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The COVID-19 pandemic has had a significant impact on medical services. Many countries postponed nonemergent procedures to preserve hospital resources for the unprecedented situation. Surgical backlogs caused by the COVID-19 pandemic have been evaluated by different groups. However, the impact of this pandemic on pathology and specifically neuropathology (NP) services has received limited attention. In this study, we reviewed all NP reports of the London Health Sciences Centre from January 2018 (2 years before the pandemic declaration) until the end of the year 2021. Demographic information and pathology details were collected. For tumors, site, histopathology types, and WHO grading were analyzed. In nontumoral specimens, pathological diagnoses were compared in pre- and postpandemic time. The total number of NP samples reached its lowest in April 2020, corresponding to the first Ontario provincial lockdown, and fluctuated throughout the studied period. Among the different types of NP surgical specimens, muscle and epilepsy-related specimens showed a more significant reduction, compared to neoplastic specimens. In 2020, the proportion of tumor specimens from patients older than 40 years of age increased. Similarly, the proportion of high-grade glioma and brain metastasis diagnoses also increased. Lastly, we observed a marked increase in biopsies for temporal arteritis and other inflammatory lesions.
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Affiliation(s)
- Shervin Pejhan
- Department of Pathology & Lab Medicine, London Health Sciences Centre, Schulich Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Christopher Tran
- Department of Pathology & Lab Medicine, London Health Sciences Centre, Schulich Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - David K Driman
- Department of Pathology & Lab Medicine, London Health Sciences Centre, Schulich Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Robert Hammond
- Department of Pathology & Lab Medicine, London Health Sciences Centre, Schulich Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Schulich Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Lee Cyn Ang
- Department of Pathology & Lab Medicine, London Health Sciences Centre, Schulich Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Schulich Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Qi Zhang
- Department of Pathology & Lab Medicine, London Health Sciences Centre, Schulich Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Schulich Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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Lacaud M, Leclerc A, Marguet F, Faisant M, Lesueur P, El Ouazzani H, Di Fiore F, Hanzen C, Emery E, Langlois O, Fontanilles M. Impact of Covid-19 pandemic on neuro-oncology multidisciplinary tumor board in the pre-vaccine era: the Normandy experience. Neurochirurgie 2023; 69:101429. [PMID: 36870566 PMCID: PMC9979624 DOI: 10.1016/j.neuchi.2023.101429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION The COVID19 pandemic had a strong impact on the healthcare system, particularly in oncology. Brain tumor are usually revealed by acute and life threatening symptoms. We wanted to evaluate the possible consequences of the COVID19 pandemic in 2020 on the activity of neuro-oncology multidisciplinary tumor board in a Normandy region (France). METHODS A descriptive, retrospective, multicenter study was conducted in the four referent centers (two universitary hospitals and two cancer centers). The main objective was to compare the average number of neuro-oncology patients presented per multidisciplinary tumor board per week between a pre-COVID19 reference period (period 1 from December 2018 to December 2019) and the pre-vaccination period (period 2 from December 2019 to November 2020). RESULTS Across Normandy, 1540 cases were presented in neuro-oncology multidisciplinary tumor board in 2019 and 2020. No difference was observed between period 1 and 2: respectively 9.8 per week versus 10.7, P=0.36. The number of cases per week also did not significantly differ during the lockdown periods: 9.1/week versus 10.4 during the non-lockdown periods, P=0.26. The only difference observed was a higher proportion of tumor resection during the lockdown periods: 81.4% (n=79/174) versus 64.5% (n=408/1366), P=0.001. CONCLUSION The pre-vaccination era of the COVID19 pandemic did not impact the activity of neuro-oncology multidisciplinary tumor board in the Normandy region. The possible consequences in terms of public health (excess mortality) due to this tumor location should now be investigated.
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Affiliation(s)
- M Lacaud
- Le Havre Hospital, Unit of Medical Oncology and Hematology, Le Havre, France; Rouen University Hospital, Department of Urology, Rouen, France
| | - A Leclerc
- Caen University Hospital, Department of Neurosurgery, Caen, France
| | - F Marguet
- Univ Rouen Normandie, Inserm U1245 Brain And Cancer Genomics, Department of Pathology, CHU de Rouen, 76000 Rouen, France
| | - M Faisant
- Caen University Hospital, Department of Pathology, Caen, France
| | - P Lesueur
- Cancer Centre François-Baclesse, Radiation Oncology Department, Caen, France; Centre Guillaume le Conquérant, Radiation Oncology Department, Le Havre, France; ISTCT UMR6030-CNRS, CEA, Université de Caen-Normandie, Équipe CERVOxy, Caen, France
| | - H El Ouazzani
- Le Havre Hospital, Clinical Research Unit, Le Havre, France
| | - F Di Fiore
- Rouen University Hospital, Department of Hepatogastroenterology, Rouen, France; Univ Rouen Normandie, Inserm U1245 Brain And Cancer Genomics, Normandy Centre for Genomic and Personalized Medicine, IRON group, 76000 Rouen, France
| | - C Hanzen
- Cancer Centre Henri-Becquerel, Radiotherapy Department, Rouen, France
| | - E Emery
- Caen University Hospital, Department of Neurosurgery, Caen, France
| | - O Langlois
- Rouen University Hospital, Department of Neurosurgery, Rouen, France
| | - M Fontanilles
- Le Havre Hospital, Unit of Medical Oncology and Hematology, Le Havre, France; Univ Rouen Normandie, Inserm U1245 Brain And Cancer Genomics, Normandy Centre for Genomic and Personalized Medicine, IRON group, 76000 Rouen, France; Cancer Centre Henri-Becquerel, Department of Medical Oncology, Rouen, France.
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10
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Karimov Z, Ozgiray E. The effect of COVID-19 in a university hospital neurosurgery clinic comparison to pre-pandemic period: a retrospective study with 6 months of data. World Neurosurg 2023; 173:e616-e621. [PMID: 36870446 PMCID: PMC9981517 DOI: 10.1016/j.wneu.2023.02.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The coronavirus disease 19 (COVID-19) pandemic affected all countries' health systems and people's lifestyles. In this study, we aimed to investigate its effects in a university hospital neurosurgery clinic. METHODS The 2019 year's six months' data as a pre-pandemic period compared to the 2020 year's same period as a pandemic date. Demographic data were collected. Operations were divided into seven groups: tumor, spinal, vascular, cerebrospinal fluid disorders, hematoma, local, and minor surgery respectively. We classified the hematoma cluster into subgroups to evaluate the etiology: epidural, acute subdural, subarachnoid hemorrhage, intracerebral hemorrhage, depressed skull fractures, and others. Patients' COVID-19 test results were collected. RESULTS Total operations decreased from 972 to 795 (Δ18.2%) during the pandemic. All groups, except minor surgery cases, decreased compared to the pre-pandemic period. Also, vascular procedures for females increased during the pandemic period. While focusing on the hematoma subgroups, there was decreasing in epidural and subdural hematomas, depressed skull fractures, and total case numbers; an increase in subarachnoid hemorrhage and intracerebral hemorrhage. Overall mortality significantly increased to 9.6% from 6.8% during the pandemic (p=0.033). Eight (1.0%) of 795 patients were COVID-19-positive; three of them died. Neurosurgery residents and academicians were unsatisfied with decreased number of operations, training, and research productivity. CONCLUSIONS The pandemic and restrictions affected negatively the health system and people's access to healthcare. Our retrospective controlled observational study aimed to evaluate these effects and take lessons for the next similar situations. People's access to health care should be considered when lockdown restrictions.
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Affiliation(s)
- Ziya Karimov
- Medicine Program, Ege University Faculty of Medicine, Izmir, Turkiye.
| | - Erkin Ozgiray
- Department of Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkiye.
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11
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Kuo CC, Aguirre AO, Kassay A, Donnelly BM, Bakr H, Aly M, Ezzat AA, Soliman MA. A look at the global impact of COVID-19 pandemic on neurosurgical services and residency training. Sci Afr 2023; 19:e01504. [PMID: 36531434 PMCID: PMC9747235 DOI: 10.1016/j.sciaf.2022.e01504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/18/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Background The COVID-19 pandemic has left an indelible effect on healthcare delivery and education system, including residency training. Particularly, neurosurgical departments worldwide had to adapt their operating model to the constantly changing pandemic landscape. This review aimed to quantify the reduction in neurosurgical operative volume and describe the impact of these trends on neurosurgical residency training. Methods We performed a comprehensive search of PubMed and EMBASE between December 2019 and October 2022 to identify studies comparing pre-pandemic and pandemic neurosurgical caseloads as well as articles detailing the impact of COVID-19 on neurosurgery residency training. Statistical analysis of quantitative data was presented as pooled odds ratio (OR) and 95% confidence intervals (CI). Results A total of 49 studies met the inclusion criteria, of which 12 (24.5%) were survey-based. The case volume of elective surgeries and non-elective procedures decreased by 70.4% (OR=0.296, 95%CI 0.210-0.418) and 68.2% (OR=0.318, 95%CI 0.193-0.525), respectively. A significant decrease was also observed in functional (OR=0.542, 95%CI 0.394-0.746), spine (OR=0.545, 95%CI 0.409-0.725), and skull base surgery (OR=0.545, 95%CI 0.409-0.725), whereas the caseloads for tumor (OR=1.029, 95%CI 0.838-1.263), trauma (OR=1.021, 95%CI 0.846-1.232), vascular (OR=1.001, 95%CI 0.870-1.152), and pediatric neurosurgery (OR=0.589, 95%CI 0.344-1.010) remained relatively the same between pre-pandemic and pandemic periods. The reduction in caseloads had caused concerns among residents and program directors in regard to the diminished clinical exposure, financial constraints, and mental well-being. Some positives highlighted were rapid adaptation to virtual educational platforms and increasing time for self-learning and research activities. Conclusion While COVID-19 has brought about significant disruptions in neurosurgical practice and training, this unprecedented challenge has opened the door for technological advances and collaboration that broaden the accessibility of resources and reduce the worldwide gap in neurosurgical education.
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Affiliation(s)
- Cathleen C. Kuo
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Alexander O. Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Andrea Kassay
- Department of Neurosurgery, Western University, Windsor, Canada
| | - Brianna M. Donnelly
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, NY, USA
| | | | - Mohamed Aly
- Department of Radiology, National Heart Institute, Giza, Egypt
| | - Ahmed A.M. Ezzat
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed A.R. Soliman
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA,Corresponding author at: Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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12
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Jankovic D, Krenzlin H, Keric N, Ottenhausen M. The impact of SARS-CoV-2 measures on patient samples and complication rates in spine surgery - A single center analysis. Front Surg 2023; 9:1086960. [PMID: 36733680 PMCID: PMC9886891 DOI: 10.3389/fsurg.2022.1086960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/06/2022] [Indexed: 01/19/2023] Open
Abstract
Objective Over the past two years during the pandemic, the German health system has taken drastic measures, like the continuous use of face masks for all staff, restrictions of hospital visits as well as cancellation of elective surgical procedures. As a potential side effect of these measures, a significant reduction of surgical site infections was reported for neurosurgical patients. The purpose of our study was to analyze the impact of these measures on spinal surgery. Methods We performed a retrospective analysis to compare patient samples, procedures and infection rates before (January 2019 - March 2020) and during (April 2020 - June 2021) the pandemic to evaluate the impact of the measures mentioned above. Demographic and clinical data were collected and correlated with the occurrence of postoperative complications, especially infection. Results Our analysis showed no relevant decrease of spine surgeries (838 surgeries in non-pandemic group vs. 831 surgeries pandemic group). The most common postoperative complication was wound infection in both groups, followed by urinary tract infection and pneumonia. In both patient groups, infections were more prevalent in surgeries of multilevel posterior instrumentation. Comparing the two groups of patients, a slight, non-significant (0.5%) reduction of overall postoperative complications in the pandemic group was observed. However, the number of spinal surgeries classified as emergencies in our institution increased by 10.2% during the last 15 months of the COVID-19 pandemic. In line with this finding the urgent transfer of patients from smaller hospitals increased by 14.2%, compared to previous years. Conclusion The volume of spinal surgeries remained high and complication rates stable during the pandemic. A reason why complication rates did not drop as reported previously might be a significant change in patient sample due to the increase of emergency surgeries. A decrease of complication rates, especially infections by the measures of infection prevention for the pandemic was not observed.
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13
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Le VT, Nguyen Dao LT, Nguyen AM. Transforaminal injection with autologous platelet-rich plasma in lumbar disc herniation: A single-center prospective study in Vietnam. Asian J Surg 2022:S1015-9584(22)00592-9. [PMID: 35637114 DOI: 10.1016/j.asjsur.2022.05.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/01/2022] [Accepted: 05/13/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Lumbar radiculopathy is a major health problem, which often treated by neurosurgery or guided lumbar epidural steroids for pain relief. We used autologous Platelet Rich Plasma (PRP) as a novel pharmaceutical agent that has strongly emerged in recent years to treat patients of lumbar disc herniation. From that, we evaluated the efficacy of PRP via transforaminal route in treatment of radicular pain in patients with lumbar disc herniation. METHODS Twenty-five patients were enrolled and injected with 4 ml of autologous platelet rich plasma under fluoroscopic guidance via transforaminal epidural injection into area of affected nerve root. They were followed using Visual Analogue Scale (VAS), Modified Oswestry Disability Index (ODI) and Straight Leg Raising Test (SLRT) for clinical assessment. RESULTS Patients who received transforaminal injections with autologous PRP showed statistically significant improvements on all three evaluation tools (VAS, ODI, SLRT). The improvements were sustained over twelve-month follow-up and there were no associated complications. CONCLUSION Transforaminal injection with autologous PRP helps patients relieve chronic pains and be able return to work. Besides, autologous PRP can be considered as a good alternative to epidural steroids in management of lumbar disc herniation.
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14
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Solé Florensa P, González Sanchez J, Gil Torrano A, Peroy Garcia J, Jové Talavera R, Mas Atance J. Impact of COVID-19 pandemia on spine surgery in 2nd level hospital. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022:S1888-4415(22)00348-4. [PMID: 36494012 PMCID: PMC9724500 DOI: 10.1016/j.recot.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The consequences of COVID-19 pandemic, like in any other field of medicine, had such a massive effect in the activity of spine surgeons. OBJECTIVES The main purpose of the study is quantifying the number of interventions done between 2016 and 2021 and analyze the time between the indication and the intervention as an indirect measurement of the waiting list. As secondary objectives we focused on variations of the length of stay and duration of the surgeries during this specific period. METHODS We performed a descriptive retrospective study including all the interventions and diagnosis made during a period including pre-pandemic data (starting on 2016) until 2021, when we considered the normalization of surgical activity was achieved. A total of 1039 registers were compiled. The data collected included age, gender, days in waiting list before the intervention, diagnosis, time of hospitalization and surgery duration. RESULTS We found that the total number of interventions during the pandemic has significantly decreased compared to 2019 (32.15% less in 2020 and 23.5% less in 2021). After data analysis, we found an increase of data dispersion, average waiting list time and for diagnosis after 2020. No differences were found regarding hospitalization time or surgical time. CONCLUSION The number of surgeries decreased during pandemic due to the redistribution of human and material resources to face the raising of critical COVID-19 patients. The increase of data dispersion and median of waiting time, is the consequence of a growing waiting list for non-urgent surgeries during the pandemic as the urgent interventions also raised, those with a shorter waiting time.
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15
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Airth A, Whittle JR, Dimou J. How has the COVID-19 pandemic impacted clinical care and research in Neuro-Oncology? J Clin Neurosci 2022; 105:91-102. [PMID: 36122487 PMCID: PMC9452416 DOI: 10.1016/j.jocn.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/08/2022] [Accepted: 09/03/2022] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic has challenged the continued delivery of healthcare globally. Due to disease risk, clinicians were forced to re-evaluate the safety and priorities of pre-pandemic care. Neuro-oncology presents unique challenges, as patients can deteriorate rapidly without intervention. These challenges were also observed in countries with reduced COVID-19 burden with centres required to rapidly develop strategies to maintain efficient and equitable care. This review aims to summarise the impact of the pandemic on clinical care and research within the practice of Neuro-oncology. A narrative review of the literature was performed using MEDLINE and EMBASS and results screened using PRISMA guidelines with relevant inclusion and exclusion criteria. Search strategies included variations of ‘Neuro-oncology’ combined with COVID-19 and other clinical-related terms. Most adult and paediatric neurosurgical centres experienced reductions in new referrals and operations for brain malignancies, and those who did present for treatment frequently had operations cancelled or delayed. Many radiation therapy and medical oncology centres altered treatment plans to mitigate COVID-19 risk for patients and staff. New protocols were developed that aimed to reduce in-person visits and reduce the risk of developing severe complications from COVID-19. The COVID-19 pandemic has presented many challenges to the provision of safe and accessible healthcare. Despite these challenges, some benefits to healthcare provision such as the use of telemedicine are likely to remain in future practice. Neuro-oncology staff must remain vigilant to ensure patient and staff safety.
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Affiliation(s)
- Angus Airth
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - James R Whittle
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia; Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - James Dimou
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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16
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Schöni D, Halatsch ME, Alfieri A. The impact of reduced operating room capacity on the time delay of urgent surgical care for neurosurgical patients during the COVID-19 pandemic. Interdiscip Neurosurg 2022; 29:101544. [PMID: 35317492 PMCID: PMC8926944 DOI: 10.1016/j.inat.2022.101544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 01/09/2023] Open
Abstract
Background The COVID-19 pandemic raised major challenges to the management of patient flows and medical staff resource allocation. To prevent the collapse of medical facilities, elective diagnostic and surgical procedures were drastically reduced, canceled or rescheduled. Methods We recorded all in-hospital treated patients and outpatient clinics visits of our neurosurgical department from March 2017 to February 2021. Changes of OR capacity, in-hospital neurosurgical treatments and outpatient clinics visits during the pandemic episode was compared on a monthly bases to the previous years. Results A total of 3'214 data points from in-house treated patients and 11'400 outpatient clinics visits were collected. The ratio of elective (73.5% ± 1.5) to emergency surgeries (26.5% ± 1.5) remained unchanged from 2017 to 2021. Significantly less neurosurgical interventions were performed in April 2020 (-42%), significantly more in July 2020 (+36%). Number of outpatient clinics visits remained in the expected monthly range (mean n = 211 ± 67). Total OR capacity was reduced to 30% in April 2020 and 55% in January 2021. No significant delay of urgent surgical treatments was detected during restricted (<85%) OR capacity. On average, the delay of rescheduled consultations was 58 days (range 3 - 183 days), three (6.5%) were referred as emergencies. Conclusions Dynamic monitoring and adjustment of resources is essential to maintain surgical care. The sharp restrictions of surgical activities resulted in significant fluctuations and 5% decrease of treated neurosurgical patients during the COVID-19 pandemic. However, urgent neurosurgical care was assured without significant time delay during periods of reduced OR capacity.
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Affiliation(s)
- Daniel Schöni
- Neurosurgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland,Corresponding author at: Department of Neurosurgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, Postfach, Winterthur 8401, Zurich, Switzerland
| | | | - Alex Alfieri
- Neurosurgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland,Neurocenter of Southern Switzerland EOC, Faculty of Biomedical Sciences, USI, Lugano, Switzerland
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17
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Benner D, Hendricks BK, Elahi C, White MD, Kocharian G, Albertini Sanchez LE, Zappi KE, Garton AL, Carnevale JA, Schwartz TH, Dowlati E, Felbaum DR, Sack KD, Jean WC, Chan AK, Burke JF, Mummaneni PV, Strong MJ, Yee TJ, Oppenlander ME, Ishaque M, Shaffrey ME, Syed HR, Lawton MT. Neurosurgery Subspecialty Practice During a Pandemic: A Multicenter Analysis of Operative Practice in 7 U.S. Neurosurgery Departments During Coronavirus Disease 2019. World Neurosurg 2022; 165:e242-e250. [PMID: 35724884 PMCID: PMC9212868 DOI: 10.1016/j.wneu.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Changes to neurosurgical practices during the coronavirus disease 2019 (COVID-19) pandemic have not been thoroughly analyzed. We report the effects of operative restrictions imposed under variable local COVID-19 infection rates and health care policies using a retrospective multicenter cohort study and highlight shifts in operative volumes and subspecialty practice. METHODS Seven academic neurosurgery departments' neurosurgical case logs were collected; procedures in April 2020 (COVID-19 surge) and April 2019 (historical control) were analyzed overall and by 6 subspecialties. Patient acuity, surgical scheduling policies, and local surge levels were assessed. RESULTS Operative volume during the COVID-19 surge decreased 58.5% from the previous year (602 vs. 1449, P = 0.001). COVID-19 infection rates within departments' counties correlated with decreased operative volume (r = 0.695, P = 0.04) and increased patient categorical acuity (P = 0.001). Spine procedure volume decreased by 63.9% (220 vs. 609, P = 0.002), for a significantly smaller proportion of overall practice during the COVID-19 surge (36.5%) versus the control period (42.0%) (P = 0.02). Vascular volume decreased by 39.5% (72 vs. 119, P = 0.01) but increased as a percentage of caseload (8.2% in 2019 vs. 12.0% in 2020, P = 0.04). Neuro-oncology procedure volume decreased by 45.5% (174 vs. 318, P = 0.04) but maintained a consistent proportion of all neurosurgeries (28.9% in 2020 vs. 21.9% in 2019, P = 0.09). Functional neurosurgery volume, which declined by 81.4% (41 vs. 220, P = 0.008), represented only 6.8% of cases during the pandemic versus 15.2% in 2019 (P = 0.02). CONCLUSIONS Operative restrictions during the COVID-19 surge led to distinct shifts in neurosurgical practice, and local infective burden played a significant role in operative volume and patient acuity.
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Affiliation(s)
- Dimitri Benner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Benjamin K. Hendricks
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Cyrus Elahi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael D. White
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Gary Kocharian
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | | | - Kyle E. Zappi
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Andrew L.A. Garton
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Joseph A. Carnevale
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Theodore H. Schwartz
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Ehsan Dowlati
- Department of Neurosurgery, Georgetown University, Washington, DC, USA
| | - Daniel R. Felbaum
- Department of Neurosurgery, Georgetown University, Washington, DC, USA
| | - Kenneth D. Sack
- Department of Neurosurgery, The George Washington University, Washington, DC, USA
| | - Walter C. Jean
- Department of Neurosurgery, The George Washington University, Washington, DC, USA
| | - Andrew K. Chan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - John F. Burke
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Praveen V. Mummaneni
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael J. Strong
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy J. Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark E. Oppenlander
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariam Ishaque
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mark E. Shaffrey
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Hasan R. Syed
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA,To whom correspondence should be addressed: Michael T. Lawton, M.D
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18
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Ikwuegbuenyi CA, Patil SN, Nie JW, Bankole OB, Mehta AI. Effects of COVID-19 on Neurosurgical Service: Perspective from a Tertiary Medical Center in Nigeria. J Neurosci Rural Pract 2022; 13:398-402. [PMID: 35946013 PMCID: PMC9357510 DOI: 10.1055/s-0042-1744472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background
The outbreak of COVID-19 caused a significant impact on neurosurgical case volume in Nigeria due to the widespread recommendation to minimize elective procedures and redistribute healthcare resources to support COVID-19 patients. This study aims to analyze the effect of COVID-19 in one tertiary care Nigerian hospital on the demographic characteristics, diagnostic classes, and elective/non-elective procedure statuses.
Methods
A retrospective single-center chart review study was conducted to review all patients undergoing a neurosurgical procedure between March to June in 2019 and 2020. Descriptive data on patient age, gender, sex, diagnosis, surgical procedure, elective/non-elective surgery status, and month and year of admission were recorded. Diagnoses were categorized into one of seven types by author review. Pearson's Chi-Square and Fisher's Exact Tests were utilized to test for independence of the categorical variables to the year of patient admission, and a Welch two-sample t-test was used to test for a significant difference in mean age between the two cohorts.
Results
A total of 143 cases were reviewed. There was a 59.8% reduction in overall neurosurgical case volume with an 82% reduction in elective procedures (39 vs. 7, p = 0.017, 95% CI: 1.15 – 8.77) between 2019 and 2020. No significant differences were noted in patient cohorts when comparing demographic characteristics, diagnosis type, or month of admission between the two years.
Conclusion
There was a significant reduction in elective neurosurgical procedures during the early months of COVID-19 in Nigeria. Further studies should consider examining the effects of COVID-19 into 2021.
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Affiliation(s)
| | - Shashank N. Patil
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, United States
| | - James W. Nie
- Department of Neurosurgery, College of Medicine University of Lagos, Lagos, Nigeria
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Olufemi B. Bankole
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Ankit I. Mehta
- Department of Neurosurgery, College of Medicine University of Lagos, Lagos, Nigeria
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States
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19
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Hussein K, Geoghegan A, Hassan M, Moore M. The impact of COVID-19 on neurosurgical theatre activity in the National Neurosurgical Centre of Ireland. Ir J Med Sci 2022; 192:823-827. [PMID: 35593997 DOI: 10.1007/s11845-022-03028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The global healthcare activity including neurosurgical services has been significantly impacted by the COVID-19 pandemic. AIM Compare neurosurgical theatre activity from 2019 (pre-pandemic) to that of the subsequent pandemic years (2020-2021) and explore how each wave of COVID-19 infection impacted activity levels. METHODS A retrospective analysis of neurosurgical theatre activity at the National Neurosurgical Centre of Ireland was performed from 1 January 2019 till 31 December 2021. The extracted data included date, surgical procedure, demographics of the patient and case scheduling (elective or emergency). RESULTS In total, 6139 neurosurgical procedures were recorded throughout the study period. Two thousand one hundred forty-four neurosurgical procedures were recorded in 2019, 2052 in 2020 and 1943 in 2021 corresponding to a reduction in theatre activity by 4.3% and 9.4% in 2020 and 2021 respectively. The lowest number of monthly caseloads was recorded in April 2020 during the first wave of the pandemic. The first quarter of 2021 recorded the lowest number of quarterly surgical procedures over the entire 3-year period contributing to just 19.4% of 2021 caseload. Subgroup analysis showed a significant reduction in trans-sphenoidal pituitary surgeries post-pandemic by 36% and 44% in 2020 and 2021 respectively. CONCLUSIONS Despite the exceptional stress imposed on our institution by COVID-19, the neurosurgical service managed to maintain comparable activity levels to 2019. The 2021 activity levels were more significantly impacted with 9.4% reduction when compared with pre-pandemic figures in 2019. Institutions need to develop a robust emergency plan to reduce the impact of any subsequent pandemics on healthcare delivery.
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Affiliation(s)
- Kareem Hussein
- Department of Anaesthesia, Beaumont Hospital, Dublin, Ireland.
| | - Aoife Geoghegan
- Department of Anaesthesia, Beaumont Hospital, Dublin, Ireland
| | - Mohammed Hassan
- Department of Anaesthesia, Beaumont Hospital, Dublin, Ireland
| | - Michael Moore
- Department of Anaesthesia, Beaumont Hospital, Dublin, Ireland
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20
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Seetahal-Maraj P, Arjoon SR, Ramnarine N, Thomas D, St Louis P. The Impact of COVID-19 on the Functioning of a Neurosurgical Service at a Tertiary Institute in a Low-Resource Setting. Cureus 2022; 14:e22294. [PMID: 35350500 PMCID: PMC8933042 DOI: 10.7759/cureus.22294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/05/2022] Open
Abstract
Objective During the COVID-19 pandemic, certain precautionary measures were implemented to limit its effect, including the cancellation of clinics and elective surgical lists. To determine the impact, if any, of the pandemic on the running of a neurosurgical service, an audit was performed on the volume of referrals, admissions and type of surgeries performed at a tertiary institute in a low-resource setting. Methods An audit of the neurosurgical department’s database was performed on the number of referrals, admissions, surgical procedures, and types of procedures done at the San Fernando General Hospital. This was divided into two 15-month periods, pre-pandemic (January 1, 2019 to March 31, 2020) and intra-pandemic (April 1, 2020 - June 30, 2021). Results During the pre-pandemic period (January 1, 2019 - March 31, 2020), 2,597 patients were referred to the service and 309 major procedures were performed. Two thousand and forty-two patients were referred during the intra-pandemic (April 4, 2020 - June 30, 2021) period, with 354 surgeries performed. More external ventricular drains (29 vs 50), craniotomies for trauma (73 vs 98), anterior cervical fusion (42 vs 47), lumbar fusions (9 vs 12), ventriculo-peritoneal shunts (16 vs 19) and aneurysm clipping (10 vs 13) were done during the intra-pandemic period. Conclusion Although elective surgical procedures and clinics were reduced, the number of patients seen and total procedures performed did not vary significantly. The neurosurgical pathology encountered remained constant during the pandemic. This shows the importance of maintaining a fully functional neurosurgical service, as we continue to adapt to the COVID-19 pandemic.
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21
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Greuter L, Zweifel C, Guzman R, Soleman J. Perioperative Complications of Patients with SARS-CoV-2 Infection in Neurosurgery. J Clin Med 2022; 11:657. [PMID: 35160106 DOI: 10.3390/jcm11030657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 12/10/2022] Open
Abstract
Background: The outbreak of coronavirus disease 2019 (COVID-19) has been rapidly evolving, resulting in a pandemic, with 270,031,622 infections according to the World Health Organization. Patients suffering from COVID-19 have also been described to suffer from neurologic and coagulopathic symptoms apart from the better-known flu-like symptoms. Some studies showed that patients suffering from COVID-19 were likely to developed intracranial hemorrhages. To our knowledge, only a few studies have investigated postoperative complications in COVID-19-positive neurosurgical patients and investigated the perioperative complications, either thrombotic or hemorrhagic, in patients with SARS-CoV-2 undergoing a neurosurgical intervention. Methods: We conducted a retrospective cohort study including patients from March 2020 to March 2021 undergoing neurosurgical interventions and suffering from COVID-19. Our primary outcome parameter was a hemorrhagic or thrombotic complication within 30 days after surgery. These outcomes were compared to those for a COVID-19-negative cohort of patients using propensity score matching. Results: We included ten COVID-19-positive patients with a mean age of 56.00 (±14.91) years. Twelve postoperative complications occurred in five patients. Three thrombotic complications (30%) were observed, with two cerebral sinus vein thromboses and one pulmonary embolus. Two patients suffered from a postoperative hemorrhagic complication (20%). The mean postoperative GCS was 14.30 (±1.57). COVID-19-positive patients showed a significantly higher rate of overall postoperative complications ((6 (60.0%) vs. 10 (19.2%), p = 0.021), thrombotic complications (3 (30.0%) vs. 1 (1.9%), p = 0.009), and mortality (2 (20.0%) vs. 0 (0.0%), p = 0.021) compared to the matched cohort of COVID-19-negative patients, treated at our institute before the SARS-CoV-2 pandemic. Conclusion: Patients undergoing neurosurgical operations with concomitant COVID-19 infection have higher rates of perioperative complications.
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22
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Singh BK, Dey B, Boruah DK, Mukherjee A, Kumar S, Sharma M, Phukan P. Challenges and Outcomes of COVID-19 Positive Neurosurgical Patients: An Institutional Experience With Emphasis on Modifications of Neurosurgical Practice. Cureus 2021; 13:e20287. [PMID: 35018273 PMCID: PMC8742154 DOI: 10.7759/cureus.20287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/05/2022] Open
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Horan J, Duddy JC, Gilmartin B, Amoo M, Nolan D, Corr P, Husien MB, Bolger C. Neurotrauma admissions and COVID-19: a National Centre experience. Ir J Med Sci 2021; 191:1871-1876. [PMID: 34554384 PMCID: PMC8458045 DOI: 10.1007/s11845-021-02784-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/11/2021] [Indexed: 11/28/2022]
Abstract
Background To investigate the impact of COVID-19 on trauma admissions to a National Neurosurgical Centre in Ireland. Methods Retrospective analysis of a prospectively maintained database of all trauma admissions to the National Neurosurgical Centre at Beaumont Hospital, Dublin, during the period March 1 to May 31, 2019 and 2020. Primary outcome was 30-day mortality rate. Secondary outcomes included time transfer time, time from admission to time of surgery, and intensive care unit (ICU) admissions. Patients under the age of 16 were excluded. Results A total of 32 and 39 patients were admitted to the National Neurosurgical Centre following trauma over the 3-month period in 2020 and 2019 respectively, giving a 17.9% reduction in admissions. The 30-day mortality rate increased from 7.7% in 2019 to 15.6% on 2020 (p = 0.45). Mean transfer time was 4 h 58 min in 2019 and 3 h 55 min in 2020 (0.22). Mean time from admission to time of surgery was 9 h 10 min in 2019 and 5 h 37 min in 2020 respectively (p = 0.35). In 2019, 20 patients (51.3%) were admitted to ICU. This increased to 23 patients (69.7%) in 2020 (p = 0.08). Conclusions Traumatic brain injury 30-day mortality rates increased during the first COVID-19 lockdown period. Trauma admission rates to ICU remained unchanged despite an overall reduction in trauma admissions. Transfer time, time to surgery, and length of stay were impacted by COVID-19. Despite the challenges COVID-19 has posed, it is important to maintain a fully functioning neurosurgical and neurocritical care service during the pandemic.
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Affiliation(s)
- Jack Horan
- Department of Neurosurgery, Beaumont Hospital, Dublin 9, Ireland.
| | - John C Duddy
- Department of Neurosurgery, Beaumont Hospital, Dublin 9, Ireland
| | - Brian Gilmartin
- Department of Neurosurgery, Beaumont Hospital, Dublin 9, Ireland
| | - Michael Amoo
- Department of Neurosurgery, Beaumont Hospital, Dublin 9, Ireland
| | - Deirdre Nolan
- Department of Neurosurgery, Beaumont Hospital, Dublin 9, Ireland
| | - Paula Corr
- Department of Neurosurgery, Beaumont Hospital, Dublin 9, Ireland
| | | | - Ciaran Bolger
- Department of Neurosurgery, Beaumont Hospital, Dublin 9, Ireland
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Christodoulides I, Syrris C, Lavrador JP, Chandler C. Infection of a sylvian Galassi II arachnoid cyst after craniotomy for resection of a parasagittal meningioma. BMJ Case Rep 2021; 14:14/8/e243405. [PMID: 34426424 PMCID: PMC8383888 DOI: 10.1136/bcr-2021-243405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Arachnoid cysts are CSF-containing entities that rarely are symptomatic or warrant neurosurgical intervention. In addition, infection of these lesions is an even rarer event, with only four reports in the literature capturing this. In this report, we present the case of a 79-year-old man presenting with paraparesis, secondary to a right parasagittal meningioma, with an incidental asymptomatic right sylvian arachnoid cyst (Galassi type II). The initially planned surgery was postponed for 3 months, due to COVID-19 restrictions, and he was kept on high dose of steroids. Following tumour resection, the patient developed bilateral subdural empyemas with involvement of the arachnoid cyst, requiring bilateral craniotomies for evacuation of the empyemas and drainage of the arachnoid cyst. Suppuration of central nervous system arachnoid cysts is a very rare complication following cranial surgery with the main working hypotheses including direct inoculation from surrounding inflamed meninges or haematogenous spread secondary to systemic bacteraemia, potentiated by steroid-induced immunosuppression. Even though being a rarity, infection of arachnoid cysts should be considered in immunosuppressed patients in the presence of risk factors such as previous craniotomy.
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Ataullah AHM, Rahman S, Rahman MM, Agrawal A, Moscote-Salazar LR. Neurosurgical challenges in the second wave of COVID-19; a global pandemic. Int J Surg Open 2021; 33:100356. [PMID: 34568621 PMCID: PMC8158347 DOI: 10.1016/j.ijso.2021.100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 10/27/2022]
Affiliation(s)
- A H M Ataullah
- Sher-E-Bangla Medical College Hospital, Barishal, Bangladesh
| | - Sabrina Rahman
- Department of Public Health, Independent University- Bangladesh, Dhaka, Bangladesh
| | - Md Moshiur Rahman
- Neurosurgery Department, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
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Lavrador JP, Pang G, Vergani F, Bhangoo R, Gullan R, Ashkan K. Letter to the Editor. Multidisciplinary meetings for neuro-oncology services. J Neurosurg 2021; 135:335-336. [PMID: 33636697 DOI: 10.3171/2020.12.jns204247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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