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Zanin L, Ius T, Panciani PP, Esposito F, Gori A, Fontanella MM, Tropeano MP, Raco A, Angileri FF, Sabatino G, Olivi A, Esposito V, Pessina F. The impact of COVID-19 pandemic on surgical neuro-oncology: A survey from the Italian society of neurosurgery (SINch). World Neurosurg X 2023; 20:100233. [PMID: 37456685 PMCID: PMC10289824 DOI: 10.1016/j.wnsx.2023.100233] [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: 02/26/2023] [Revised: 05/14/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background The COVID-19 pandemic and its impact on hospitals' activity and organization has imposed a vast change in standard neurosurgical oncology practice to accommodate for shifting resources. Aims This investigation aims to analyse the nationwide capability in reorganizing the surgical neuro-oncological activity during the COVID-19 pandemic to evaluate whether COVID-19-pandemic influenced the surgical management in these patients. Method A web-based dataset model organized by the Italian Neurosurgical Society (SINCh) was sent to all the Italian neurosurgical departments in May 2021, requesting to report the types and numbers of surgical procedures performed in the pre-pandemic period (from March 9th 2019 to March 9th 2020) compared to the pandemic period (from March 10th 2020 to March 10th 2021). Results This multicentre investigation included the surgical activity of 35 Italian Neurosurgical Departments in a pre-pandemic year versus a pandemic year. During the COVID period, 699 fewer neuro-oncological patients were operated on than in the pre-COVID period. We noted a slight increase in urgency and a more severe decrease in elective and benign pathology. None of these differences was statistically significant. Surgically treated patients who tested positive for SARS-CoV-2 were 36, of which 11 died. Death was found to be COVID-related only in 2 cases. Conclusion The reorganization of the Italian Neurosurgical Departments was able to guarantee a redistribution of the CNS tumors during the inter-pandemic periods, demonstrating that patients even in the pandemic era could be treated without compromising the efficacy and safety of the surgical procedure.
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Affiliation(s)
- Luca Zanin
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Tamara Ius
- Neurosurgery Unit, Department of Neurosciences, Santa Maria Della Misericordia University Hospital, Udine, Italy
| | - Pier Paolo Panciani
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Felice Esposito
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Napoli "Federico II", Naples, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Marco Maria Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Maria Pia Tropeano
- Neurosurgical Department-Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Mi, Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Antonino Raco
- Division of Neurosurgery, AOU Sant’Andrea, Department of NESMOS, Sapienza University, Rome, Italy
| | | | - Giovanni Sabatino
- Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
- Division of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | - Vincenzo Esposito
- Department of Neurosurgery "Giampaolo Cantore"-IRCSS Neuromed, Pozzilli, Italy
- Department of Human Neurosciences-"Sapienza" University of Rome, Italy
| | - Federico Pessina
- Neurosurgical Department-Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089, Rozzano, Mi, Italy
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
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Sharma R, Garg K, Katiyar V, Alam I, Tandon V, Raheja A, Mishra S, Veerabhadraiah P, Suri A, Chandra PS, Kale SS. Analysis of Neurosurgical Cases Before and During the Coronavirus Disease 2019 Pandemic from a Tertiary-Care Centre in India. World Neurosurg 2021; 152:e635-44. [PMID: 34129979 DOI: 10.1016/j.wneu.2021.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 12/20/2022]
Abstract
Objective We present the unique administrative issues as well as specific patient-related and surgeon-related challenges and solutions implemented while treating neurosurgical patients during the coronavirus disease 2019 (COVID-19) pandemic vis-à-vis pre-COVID-19 times at our tertiary-care center. Methods This is a retrospective study comparing the outcome of the neurosurgical patients treated from the beginning of lockdown in India on March 25, 2020 to November 30, 2020 with that of same period in the previous year, 2019. Results There were 687 neurosurgery admissions during the study period compared with 2550 admissions in 2019. The total number of surgeries performed in neurosurgery also showed a similar trend, with only 654 surgeries in 2020 compared with 3165 surgeries in 2019. During COVID-19 times, 474 patients were operated on including both trauma and nontrauma cases. Of the 50 patients with suspected/indeterminate COVID-19 who were operated on, 5 turned out to be positive for COVID-19. Significant differences were seen in the mortality (P < 0.01) and morbidity (P < 0.01) among patients with trauma on comparing COVID and pre-COVID periods. Similarly, a significant difference was observed in the mortality (P < 0.001) and morbidity (P < 0.001) in patients who did not have trauma. Conclusions The higher mortality and morbidity during the COVID pandemic is primarily attributable to poorer baseline clinical status. Our experience from this COVID period might not only help us in tackling subsequent waves but also help other institutions in the developing world to be better prepared for similar circumstances.
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Grassner L, Petr O, Warner FM, Dedeciusova M, Mathis AM, Pinggera D, Gsellmann S, Meiners LC, Freigang S, Mokry M, Resch A, Kretschmer T, Rossmann T, Navarro FR, Gruber A, Spendel M, Winkler PA, Marhold F, Sherif C, Wais JP, Rössler K, Pfisterer W, Mühlbauer M, Trivik-Barrientos FA, Rath S, Voldrich R, Krska L, Lipina R, Kerekanic M, Fiedler J, Kasik P, Priban V, Tichy M, Krupa P, Cesak T, Kroupa R, Callo A, Haninec P, Pohlodek D, Krahulik D, Sejkorova A, Sames M, Dvorak J, Suchomel P, Tomas R, Klener J, Juran V, Smrcka M, Linzer P, Kaiser M, Hrabovsky D, Jancalek R, Kälin V, Bozinov O, Niggli C, Serra C, Guatta R, Kuhlen DE, Wanderer S, Marbacher S, Lavé A, Schaller K, Esculier C, Raabe A, Kramer JLK, Thomé C, Netuka D. Trends and outcomes for non-elective neurosurgical procedures in Central Europe during the COVID-19 pandemic. Sci Rep 2021; 11:6171. [PMID: 33731753 DOI: 10.1038/s41598-021-85526-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/19/2021] [Indexed: 12/15/2022] Open
Abstract
The world currently faces the novel severe acute respiratory syndrome coronavirus 2 pandemic. Little is known about the effects of a pandemic on non-elective neurosurgical practices, which have continued under modified conditions to reduce the spread of COVID-19. This knowledge might be critical for the ongoing second coronavirus wave and potential restrictions on health care. We aimed to determine the incidence and 30-day mortality rate of various non-elective neurosurgical procedures during the COVID-19 pandemic. A retrospective, multi-centre observational cohort study among neurosurgical centres within Austria, the Czech Republic, and Switzerland was performed. Incidence of neurosurgical emergencies and related 30-day mortality rates were determined for a period reflecting the peak pandemic of the first wave in all participating countries (i.e. March 16th–April 15th, 2020), and compared to the same period in prior years (2017, 2018, and 2019). A total of 4,752 emergency neurosurgical cases were reviewed over a 4-year period. In 2020, during the COVID-19 pandemic, there was a general decline in the incidence of non-elective neurosurgical cases, which was driven by a reduced number of traumatic brain injuries, spine conditions, and chronic subdural hematomas. Thirty-day mortality did not significantly increase overall or for any of the conditions examined during the peak of the pandemic. The neurosurgical community in these three European countries observed a decrease in the incidence of some neurosurgical emergencies with 30-day mortality rates comparable to previous years (2017–2019). Lower incidence of neurosurgical cases is likely related to restrictions placed on mobility within countries, but may also involve delayed patient presentation.
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Mrugala MM, Ostrom QT, Pressley SM, Taylor JW, Thomas AA, Wefel JS, Coven SL, Acquaye AA, Haynes C, Agnihotri S, Lim M, Peters KB, Sulman EP, Salcido JT, Butowski NA, Hervey-Jumper S, Mansouri A, Oliver KR, Porter AB, Nassiri F, Schiff D, Dunbar EM, Hegi ME, Armstrong TS, van den Bent MJ, Chang SM, Zadeh G, Chheda MG. The state of neuro-oncology during the COVID-19 pandemic: a worldwide assessment. Neurooncol Adv 2021; 3:vdab035. [PMID: 34007966 PMCID: PMC7928618 DOI: 10.1093/noajnl/vdab035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/30/2022] Open
Abstract
Background It remains unknown how the COVID-19 pandemic has changed neuro-oncology clinical practice, training, and research efforts. Methods We performed an international survey of practitioners, scientists, and trainees from 21 neuro-oncology organizations across 6 continents, April 24-May 17, 2020. We assessed clinical practice and research environments, institutional preparedness and support, and perceived impact on patients. Results Of 582 respondents, 258 (45%) were US-based and 314 (55%) international. Ninety-four percent of participants reported changes in their clinical practice. Ninety-five percent of respondents converted at least some practice to telemedicine. Ten percent of practitioners felt the need to see patients in person, specifically because of billing concerns and pressure from their institutions. Sixty-seven percent of practitioners suspended enrollment for at least one clinical trial, including 62% suspending phase III trial enrollments. More than 50% believed neuro-oncology patients were at increased risk for COVID-19. Seventy-one percent of clinicians feared for their own personal safety or that of their families, specifically because of their clinical duties; 20% had inadequate personal protective equipment. While 69% reported increased stress, 44% received no psychosocial support from their institutions. Thirty-seven percent had salary reductions and 63% of researchers temporarily closed their laboratories. However, the pandemic created positive changes in perceived patient satisfaction, communication quality, and technology use to deliver care and mediate interactions with other practitioners. Conclusions The pandemic has changed treatment schedules and limited investigational treatment options. Institutional lack of support created clinician and researcher anxiety. Communication with patients was satisfactory. We make recommendations to guide clinical and scientific infrastructure moving forward and address the personal challenges of providers and researchers.
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Affiliation(s)
| | - Quinn T Ostrom
- Department of Medicine, Epidemiology & Population Sciences, Baylor College of Medicine, Houston, Texas, USA
| | | | - Jennie W Taylor
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Alissa A Thomas
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Jeffrey S Wefel
- Departments of Neuro-Oncology and Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Scott L Coven
- Division of Pediatric Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alvina A Acquaye
- Neuro-oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Chas Haynes
- Society for Neuro-oncology, Houston, Texas, USA
| | - Sameer Agnihotri
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Katherine B Peters
- Departments of Neurology and Neurosurgery, Duke University, Durham, North Carolina, USA
| | - Erik P Sulman
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, New York, USA.,Brain and Spine Tumor Center, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Joanne T Salcido
- Pediatric Brain Tumor Foundation, Asheville, North Carolina, USA
| | - Nicholas A Butowski
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania, USA
| | | | - Alyx B Porter
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA.,Departments of Neurologic Surgery and Hematology Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Farshad Nassiri
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Schiff
- Departments of Neurology, Neurological Surgery and Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | | | - Monika E Hegi
- Neuroscience Research Center, Lausanne University Hospital and University of Lausanne, Epalinges, Switzerland
| | - Terri S Armstrong
- Neuro-oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Susan M Chang
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Milan G Chheda
- Departments of Medicine and Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
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Deora H, Dange P, Patel K, Shashidhar A, Tyagi G, Pruthi N, Arivazhagan A, Shukla D, Dwarakanath S. Management of Neurosurgical Cases in a Tertiary Care Referral Hospital During the COVID-19 Pandemic: Lessons from a Middle-Income Country. World Neurosurg 2021; 148:e197-208. [PMID: 33385606 DOI: 10.1016/j.wneu.2020.12.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 12/21/2022]
Abstract
Background The novel coronavirus disease 2019 (COVID-19) pandemic has been at its peak for the past 8 months and has affected more than 215 countries around the world. India is now the second most-affected nation with more than 48,000,000 cases and 79,000 deaths. Despite this, and the fact that it is a lower-middle-income nation, the number of deaths is almost one third that of the United States and one half that of Brazil. However, there has been no experience published from non−COVID-19−designated hospitals, where the aim is to manage noninfected cases with neurosurgical ailments while keeping the number of infected cases to a minimum. Methods We analyzed the number of neurosurgical cases (nontrauma) done in the past 5 months (March−July 2020) in our institute, which is the largest neurosurgical center by volume in southern India, and compared the same to the concurrent 5 months in 2019 and 5 months preceding the pandemic. We also reviewed the total number of cases infected with COVID-19 managed during this time. Results We operated a total of 630 cases (nontrauma) in these 5 months and had 9 COVID-19 infected cases operated during this time. There was a 57% (P = 0.002) reduction in the number of cases operated as compared with the same 5 months in the preceding year. We employed a dual strategy of rapid antigen testing and surgery for cases needing emergency intervention and reverse transcriptase-polymerase chain reaction test for elective cases. The hospital was divided into 3 zones (red, orange, and green) depending on infectivity level with minimal interaction. Separate teams were designated for each zone, and thus we were able to effectively manage even infected cases despite the absence of pulmonology/medical specialists. Conclusions We present a patient management protocol for non−COVID-19−designated hospitals in high-volume centers with the constraints of a lower-middle-income nation and demonstrate its effectiveness. Strict zoning targeted testing and effective triage can help in management during the pandemic.
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Raheja A, Agarwal N, Mohapatra S, Tandon V, Borkar SA, Chandra PS, Kale SS, Suri A. Preparedness and guidelines for neurosurgery in the COVID-19 era: Indian perspective from a tertiary care referral hospital. Neurosurg Focus 2020; 49:E3. [PMID: 33260133 DOI: 10.3171/2020.9.focus20564] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 06/18/2020] [Accepted: 09/24/2020] [Indexed: 11/06/2022]
Abstract
The COVID-19 pandemic has severely impacted healthcare systems globally. The need of the hour is the development of effective strategies for protecting the lives of healthcare providers (HCPs) and judicious triage for optimal utilization of human and hospital resources. During this pandemic, neurosurgery, like other specialties, must transform, innovate, and adopt new guidelines and safety protocols for reducing the risk of cross-infection of HCPs without compromising patient care. In this article, the authors discuss the current neurosurgical practice guidelines at a high-volume tertiary care referral hospital in India and compare them with international guidelines and global consensus for neurosurgery practice in the COVID-19 era. Additionally, the authors highlight some of the modifications incorporated into their clinical practice, including those for stratification of neurosurgical cases, patient triaging based on COVID-19 testing, optimal manpower management, infrastructure reorganization, evolving modules for resident training, and innovations in operating guidelines. The authors recommend the use of their blueprint for stratification of neurosurgical cases, including their protocol for algorithmic patient triage and management and their template for manpower allocation to COVID-19 duty, as a replicable model for efficient healthcare delivery.
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Affiliation(s)
| | | | - Sarita Mohapatra
- 2Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Doglietto F, Vezzoli M, Biroli A, Saraceno G, Zanin L, Pertichetti M, Calza S, Agosti E, Aliaga Arias JM, Assietti R, Bellocchi S, Bernucci C, Bistazzoni S, Bongetta D, Fanti A, Fioravanti A, Fiorindi A, Franzin A, Locatelli D, Pugliese R, Roca E, Sicuri GM, Stefini R, Venturini M, Vivaldi O, Zattra C, Zoia C, Fontanella MM. Anxiety in neurosurgical patients undergoing nonurgent surgery during the COVID-19 pandemic. Neurosurg Focus 2020; 49:E19. [PMID: 33260119 DOI: 10.3171/2020.9.focus20681] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 08/01/2020] [Accepted: 09/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has forced many countries into lockdown and has led to the postponement of nonurgent neurosurgical procedures. Although stress has been investigated during this pandemic, there are no reports on anxiety in neurosurgical patients undergoing nonurgent surgical procedures. METHODS Neurosurgical patients admitted to hospitals in eastern Lombardy for nonurgent surgery after the lockdown prospectively completed a pre- and postoperative structured questionnaire. Recorded data included demographics, pathology, time on surgical waiting list, anxiety related to COVID-19, primary pathology and surgery, safety perception during hospital admission before and after surgery, and surgical outcomes. Anxiety was measured with the State-Trait Anxiety Inventory. Descriptive statistics were computed on the different variables and data were stratified according to pathology (oncological vs nononcological). Three different models were used to investigate which variables had the greatest impact on anxiety, oncological patients, and safety perception, respectively. Because the variables (Xs) were of a different nature (qualitative and quantitative), mostly asymmetrical, and related to outcome (Y) by nonlinear relationships, a machine learning approach composed of three steps (1, random forest growing; 2, relative variable importance measure; and 3, partial dependence plots) was chosen. RESULTS One hundred twenty-three patients from 10 different hospitals were included in the study. None of the patients developed COVID-19 after surgery. State and trait anxiety were reported by 30.3% and 18.9% of patients, respectively. Higher values of state anxiety were documented in oncological compared to nononcological patients (46.7% vs 25%; p = 0.055). Anxiety was strongly associated with worry about primary pathology, surgery, disease worsening, and with stress during waiting time, as expected. Worry about positivity to SARS-CoV-2, however, was the strongest factor associated with anxiety, even though none of the patients were infected. Neuro-oncological disease was associated with state anxiety and with worry about surgery and COVID-19. Increased bed distance and availability of hand sanitizer were associated with a feeling of safety. CONCLUSIONS These data underline the importance of psychological support, especially for neuro-oncological patients, during a pandemic.
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Affiliation(s)
- Francesco Doglietto
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Marika Vezzoli
- 2Biostatistics, Department of Molecular and Translational Medicine, University of Brescia
| | - Antonio Biroli
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Giorgio Saraceno
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Luca Zanin
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | | | - Stefano Calza
- 2Biostatistics, Department of Molecular and Translational Medicine, University of Brescia
| | - Edoardo Agosti
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,4Neurosurgery, University of Insubria, Varese
| | - Jahard Mijail Aliaga Arias
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,5Neurosurgery, Cremona Hospital, Cremona
| | | | | | | | | | | | - Andrea Fanti
- 8Neurosurgery, Papa Giovanni XXIII Hospital, Bergamo
| | | | - Alessandro Fiorindi
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | | | | | | | - Elena Roca
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,9Neurosurgery, Fondazione Poliambulanza Hospital, Brescia
| | | | | | | | - Oscar Vivaldi
- 9Neurosurgery, Fondazione Poliambulanza Hospital, Brescia
| | - Costanza Zattra
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,9Neurosurgery, Fondazione Poliambulanza Hospital, Brescia
| | - Cesare Zoia
- 10Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia; and
| | - Marco Maria Fontanella
- 1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
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8
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Bernucci C, Fanti A, Veiceschi P, Costi E, Sicignano AM, Brembilla C. Neurosurgeons on the front line: experience from the center of the storm in Italy. Neurosurg Focus 2020; 49:E6. [PMID: 33260135 DOI: 10.3171/2020.9.focus20577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/27/2020] [Accepted: 09/19/2020] [Indexed: 11/06/2022]
Abstract
In this tumultuous time, the entire world has been shaken up by the COVID-19 outbreak. Italy has had one of the highest infection-related mortality rates. Bergamo, a city in eastern Lombardy, was among the most affected. Here, the authors describe the main healthcare actions taken at their institution to stem the crisis, with particular concern regarding the fate of their neurosurgery department. Among the different topics, the authors particularly focus on the retraining of neurosurgeons, organization of activities, and what should be the role of neurosurgeons during a pandemic.
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Affiliation(s)
- Claudio Bernucci
- 1Department of Neurosurgery, ASST Papa Giovanni XXIII Hospital, Bergamo
| | - Andrea Fanti
- 1Department of Neurosurgery, ASST Papa Giovanni XXIII Hospital, Bergamo.,2Department of Neurosurgery, Scuola di Specializzazione in Neurochirurgia, Università degli Studi di Pavia; and
| | - Pierlorenzo Veiceschi
- 2Department of Neurosurgery, Scuola di Specializzazione in Neurochirurgia, Università degli Studi di Pavia; and.,3Department of Neurosurgery, Scuola di Specializzazione in Neurochirurgia, Università degli Studi dell'Insubria, Varese, Italy
| | - Emanuele Costi
- 1Department of Neurosurgery, ASST Papa Giovanni XXIII Hospital, Bergamo
| | | | - Carlo Brembilla
- 1Department of Neurosurgery, ASST Papa Giovanni XXIII Hospital, Bergamo
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9
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Giampreti A, Eleftheriou G, Gallo M, Butera R, Contessa G, Faraoni L, Sangiovanni A, Negri G, Falchi G, Bacis G. Medications prescriptions in COVID-19 pregnant and lactating women: the Bergamo Teratology Information Service experience during COVID-19 outbreak in Italy. J Perinat Med 2020; 48:1001-1007. [PMID: 33055313 DOI: 10.1515/jpm-2020-0339] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023]
Abstract
Objectives The severe acute respiratory syndrome coronavirus 2 (COVID-19) outbreak in Italy, especially in Lombardy and Bergamo city, represented probably nowadays one of the first major clusters of COVID-19 in the world. The aim of this report is to describe the activity of Bergamo Teratology Information Service (TIS) in supporting the public and health-care personnel in case of drug prescriptions in suspected/confirmed COVID-19 pregnant and lactating patients during COVID-19 outbreak in Italy. Methods All Bergamo TIS requests concerning COVID-19 pregnant and lactating women have been retrospectively evaluated from 1 March to 15 April 2020. Type of medications, drug's safety profile and compatibility with pregnancy and lactation are reported. Results Our service received information calls concerning 48 (9 pregnant, 35 lactating) patients. Among pregnant and lactating women, the requests of information were related to 16 and 60 drugs prescriptions respectively. More than half concerned drugs prescriptions during the first and second trimester (13/16) and during the first six months of lactation (37/60). Hydroxychloroquine and azithromycin were the most involved. Conclusions Hydroxychloroquine and azithromycin at dosages used for COVID-19 may be considered compatible and reasonably safe either in pregnancy and lactation. Antivirals may be considered acceptable in pregnancy. During lactation lopinavir and ritonavir probably exhibit some supportive data from literature that darunavir and cobicistat do not. Tocilizumab may be considered for COVID-19 treatment because no increased malformation rate were observed until now. However caution may be advised because human data are limited and the potential risk of embryo-fetal toxicity cannot be excluded.
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Affiliation(s)
- Andrea Giampreti
- Bergamo Teratology Information Service, Papa Giovanni XXIII Hospital, 24100 BergamoItaly
| | - Georgios Eleftheriou
- Bergamo Teratology Information Service, Papa Giovanni XXIII Hospital, 24100 BergamoItaly
| | - Mariapina Gallo
- Bergamo Teratology Information Service, Papa Giovanni XXIII Hospital, 24100 BergamoItaly
| | - Raffaella Butera
- Bergamo Teratology Information Service, Papa Giovanni XXIII Hospital, 24100 BergamoItaly
| | - Gioia Contessa
- Bergamo Teratology Information Service, Papa Giovanni XXIII Hospital, 24100 BergamoItaly
| | - Lorella Faraoni
- Bergamo Teratology Information Service, Papa Giovanni XXIII Hospital, 24100 BergamoItaly
| | - Anna Sangiovanni
- Bergamo Teratology Information Service, Papa Giovanni XXIII Hospital, 24100 BergamoItaly
| | - Giulia Negri
- Bergamo Teratology Information Service, Papa Giovanni XXIII Hospital, 24100 BergamoItaly
| | - Giovanna Falchi
- Bergamo Teratology Information Service, Papa Giovanni XXIII Hospital, 24100 BergamoItaly
| | - Giuseppe Bacis
- Bergamo Teratology Information Service, Papa Giovanni XXIII Hospital, 24100 BergamoItaly
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10
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Gallardo FC, Martin C, Targa Garcia AA, Bustamante JL, Nuñez M, Feldman SE. Home Program for Acquisition and Maintenance of Microsurgical Skills During the Coronavirus Disease 2019 Outbreak. World Neurosurg 2020; 143:557-563.e1. [PMID: 32711150 PMCID: PMC7375971 DOI: 10.1016/j.wneu.2020.07.114] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 06/02/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND During the current global crisis unleashed by the severe acute respiratory syndrome coronavirus 2 outbreak, surgical departments have considerably reduced the amount of elective surgeries. This decrease leads to less time in the surgical room to develop and improve the surgical skills of residents. In this study, we developed a training program to obtain and maintain microsurgical skills at home, using a smartphone camera and low-cost materials, affordable for everyone. METHODS Using a smartphone camera as a magnification device, 6 participants performed 5 exercises (coloring grids, grouping colors, unraveling of a gauze, knots with suture threads, and tower of Hanoi), both with the dominant and with the nondominant hand, for 4 weeks. We compared performance at the beginning and at the end of the training process. Each participant filled out an anonymous survey. RESULTS When we compared the performance at the beginning and at the end of the training process, we found significant improvements (P = 0.05) with the dominant as well as the nondominant hand in all the exercises. All participants were satisfied or very satisfied with the definition of the objectives of the training process, material availability, the exercises performed, the choice of the time to train, and general satisfaction with the training program. CONCLUSIONS We developed a microsurgical skills training program to be performed at home, which can be easily reproduced. It allows residents to improve manual coordination skills and is regarded as a feasible adjunct for ongoing training for surgical residents.
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Affiliation(s)
| | - Clara Martin
- Department of Neurosurgery, Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina
| | | | - Jorge Luis Bustamante
- Department of Neurosurgery, Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina
| | - Maximiliano Nuñez
- Department of Neurosurgery, Hospital de Alta Complejidad El Cruce, Buenos Aires, Argentina
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11
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Agarwal N, Raheja A, Suri A. Guidelines for Preoperative Testing for Neurosurgery in Coronavirus Disease 2019 (COVID-19) Era: Indian Viewpoint Amidst Global Practice. World Neurosurg 2020; 146:103-112. [PMID: 33283759 PMCID: PMC7584495 DOI: 10.1016/j.wneu.2020.10.086] [Citation(s) in RCA: 4] [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: 08/30/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 12/18/2022]
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.
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Affiliation(s)
- Nitish Agarwal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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12
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Deora H, Sadashiva N, Tripathi M, Yagnick NS, Mohindra S, Batish A, Patil NR, Aggarwal A, Jangra K, Bhagat H, Panda N, Panigrahi M, Behari S, Chandra PS, Shukla DP, Singh L, Math SB, Gupta SK. The Aftermath of COVID-19 Lockdown- Why and How Should We Be Ready? Neurol India 2020; 68:774-791. [PMID: 32859813 DOI: 10.4103/0028-3886.293471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction Severe acute respiratory syndrome, coronavirus 2 (SARS-COV 2) has inexplicably and irreversibly changed the way of neurosurgery practice. There has been a substantial reduction in neurosurgical operations during the period of lockdown. The lockdown might be the most effective measure to curtail viral transmission. Once we return to the normalization of the lifestyle, there will be a backlog of unoperated pending cases along with the possibility of further spread of the coronavirus. Methods We reviewed the available literature and protocols for neurosurgical practice in different geographic locations. We drafted a consensus statement based on the literature and protocols suggested by the World Health Organization (WHO) and various professional societies to prevent the spread of SARS-COV2 while streamlining the neurosurgical practice. Results The consensus statement suggests the patient triage, workflow, resource distribution, and operational efficacy for care providers at different stages of management. The priority is set at personal protection while ensuring patients' safety, timely management, and capacity building. We performed a detailed subsection analysis for the management of trauma and set up for COVID-free hospitals for simultaneous management of routine neurosurgical indications. In this time of medicolegal upheaval, special consent from the patients should be taken in view of the chances of delay in management and the added risk of corona infection. The consensus statements are applicable to neurosurgical setups of all capacities. Conclusion Along with the glaring problem of infection, there is another threat of neurosurgery emergency building up. This wave may overwhelm the already stretched systems to the hilt. We need to flatten this curve while avoiding contagion. These measures may guide neurosurgery practitioners to effectively manage patients ensuring the safety of caregivers and care seekers both.
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Affiliation(s)
- Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Sandeep Mohindra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Batish
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ninad R Patil
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Aggarwal
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kiran Jangra
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hemant Bhagat
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Panda
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manas Panigrahi
- Department of Neurosurgery, KIMS, Hyderabad, Telangana, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Dhaval P Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Lokendra Singh
- Department of Neurosurgery, Central India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Suresh Bada Math
- Department of TeleMedicine, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sunil Kumar Gupta
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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13
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Degeneffe A, Bruneau M, Spitaels J, Gilis N, De Witte O, Lubansu A. Acute Hemorrhage After Intracerebral Biopsy in COVID-19 Patients: Report of 3 Cases. World Neurosurg 2020; 141:157-161. [PMID: 32526365 PMCID: PMC7280117 DOI: 10.1016/j.wneu.2020.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND When Belgium's coronavirus disease 2019 (COVID-19) outbreak began in March 2020, our neurosurgical department followed the protocol of most surgical departments in the world and postponed elective surgery. However, patients with tumor-like brain lesions requiring urgent surgery still received treatment as usual, in order to ensure ongoing neurooncologic care. From a series of 31 patients admitted for brain surgery, 3 were confirmed as infected by the novel severe acute respiratory syndrome coronavirus 2. CASE DESCRIPTION We present the clinical outcomes of these 3 COVID-19 patients, who underwent an intracerebral biopsy in our department during April 2020. All suffered from a diffuse intraparenchymal hemorrhage postoperatively. Unfortunately, we were not able to identify a clear etiology of these postoperative complications. It could be hypothesized that an active COVID-19 infection status may be related to a higher bleeding risk. The remaining 28 neurooncologic non-COVID-19 patients underwent uneventful surgery during the same period. CONCLUSIONS This case series reports the previously unreported and unexpected outcomes of COVID-19 patients suffering from acute hemorrhage after intracerebral biopsy procedures. Although no direct relation can yet be established, we recommend the neurosurgical community be cautious in such cases.
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Affiliation(s)
| | - Michaël Bruneau
- Department of Neurosurgery, Erasmus Hospital, Brussels, Belgium
| | - Julien Spitaels
- Department of Neurosurgery, Erasmus Hospital, Brussels, Belgium
| | - Nathalie Gilis
- Department of Neurosurgery, Erasmus Hospital, Brussels, Belgium
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14
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Raffa G, Germanò A. In Reply to the Letter to the Editor Regarding “Coronavirus Disease 2019 (COVID-19) and Neurosurgery: Literature and Neurosurgical Societies Recommendations Update”. World Neurosurg 2020; 141:538. [PMID: 32871718 PMCID: PMC7444945 DOI: 10.1016/j.wneu.2020.06.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy.
| | - Antonino Germanò
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
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15
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Ozoner B, Gungor A, Hasanov T, Toktas ZO, Kilic T. Neurosurgical Practice During Coronavirus Disease 2019 (COVID-19) Pandemic. World Neurosurg 2020; 140:198-207. [PMID: 32474101 PMCID: PMC7255756 DOI: 10.1016/j.wneu.2020.05.195] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/12/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly contagious life-threatening condition with unprecedented impacts for worldwide societies and health care systems. Since the first detection in China, it has spread rapidly worldwide. The increased burden has substantially affected neurosurgical practice and intensive modifications have been required in surgical scheduling, inpatient and outpatient clinics, management of emergency cases, and even in academic activities. In some systems, nonoverlapping teams have been created to minimize transmission among health care workers. In cases of a massive burden, neurosurgeons may need to be reassigned to COVID-19 wards, or teams from other regions may need to be sent to severely affected areas. Recommendations are as following. In outpatient practice, if possible, appointments should be undertaken via telemedicine. All staff assigned to the non-COVID treatment unit should be clothed in level 1 personal protective equipment. If possible, postponement is recommended for operations that do not require urgent or emergent intervention. All patients indicated for surgery must receive COVID-19 screening, including a nasopharyngeal swab and thorax computed tomography. Level 2 protection measures are appropriate during COVID-19-negative patients' operations. Operations of COVID-19-positive patients and emergency operations, in which screening cannot be obtained, should be performed after level 3 protective measures. During surgery, the use of high-speed drills and electrocautery should be reduced to minimize aerosol production. Screening is crucial in all patients because the surgical outcome is highly mortal in patients with COVID-19. All educational and academic conferences can be undertaken as virtual webinars.
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Affiliation(s)
- Baris Ozoner
- Department of Neurosurgery, School of Medicine, Bahcesehir University, Istanbul, Turkey.
| | - Abuzer Gungor
- Department of Neurosurgery, Umraniye Research and Education Hospital, University of Medical Sciences, Istanbul, Turkey
| | - Teyyup Hasanov
- Department of Neurosurgery, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Zafer Orkun Toktas
- Department of Neurosurgery, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Turker Kilic
- Department of Neurosurgery, School of Medicine, Bahcesehir University, Istanbul, Turkey
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16
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Zoia C, Raffa G, Somma T, Della Pepa GM, La Rocca G, Zoli M, Bongetta D, De Divitiis O, Fontanella MM. COVID-19 and neurosurgical training and education: an Italian perspective. Acta Neurochir (Wien) 2020; 162:1789-94. [PMID: 32556815 DOI: 10.1007/s00701-020-04460-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/11/2020] [Indexed: 01/08/2023]
Abstract
Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has an impact also on neurosurgical training and education, especially in most affected countries. We surveyed Italian neurosurgical residents, asking them to provide a brief description and analyze the situation they are experiencing and how the educational system reacted to the pandemic in one of the most affected countries all over the world. Methods An 18-question, web-based survey was administered to Italian neurosurgical residents from May 3 to May 11, 2020, by web-link or e-mail invitation. Closed-ended, multiple choice questions were focused on the experience of neurosurgical residents in the last 2 months (from March to May 2020) concerning both clinical and educational aspects. Results Among 331 Italian neurosurgical residents invited to participate, 192 responded to the survey (58%). According to the participants’ responses, in the whole country, only 29.7% of residents were directly involved in the clinical management of COVID-19 patients. Time spent in the clinic and surgical activity was significantly reduced in most of the cases. Educational activities as well as scientific activity and time spent for studying, on the other hand, were reported to be significantly increased by the majority of respondents. Conclusions Most Italian neurosurgical residents reported significant changes on both training and education, highlighting a prompt reaction of the educational system in the whole country, regardless the local and regional diffusion of the pandemic. Electronic supplementary material The online version of this article (10.1007/s00701-020-04460-0) contains supplementary material, which is available to authorized users.
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17
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Germanò A, Raffa G, Angileri FF, Cardali SM, Tomasello F. Coronavirus Disease 2019 (COVID-19) and Neurosurgery: Literature and Neurosurgical Societies Recommendations Update. World Neurosurg 2020; 139:e812-e817. [PMID: 32360733 PMCID: PMC7192081 DOI: 10.1016/j.wneu.2020.04.181] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
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.
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Affiliation(s)
- Antonino Germanò
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
| | - Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy.
| | | | | | - Francesco Tomasello
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
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18
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Fontanella MM, De Maria L, Zanin L, Saraceno G, Terzi di Bergamo L, Servadei F, Chaurasia B, Olivi A, Vajkoczy P, Schaller K, Cappabianca P, Doglietto F. Neurosurgical Practice During the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic: A Worldwide Survey. World Neurosurg 2020; 139:e818-e826. [PMID: 32380337 PMCID: PMC7198421 DOI: 10.1016/j.wneu.2020.04.204] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has consistently changed medical practice throughout specialties, regardless of their contribution in facing the disease itself. We surveyed neurosurgeons worldwide to investigate the situation they are experiencing. METHODS A 17-question, web-based survey was administered to neurosurgeons worldwide through the World Federation of Neurosurgical Societies and the Neurosurgery Cocktail from March 28 to April 5, 2020, by web link or e-mail invitation. Questions were divided into 3 subgroups: general information, health system organization, and institutional plans for the SARS-CoV-2 outbreak. Collected data were initially elaborated using SurveyMonkey software. Country-specific data were extracted from the World Health Organization website. Statistical analysis was performed using R, version 3.6.3. RESULTS Of the 446 respondents, most were from Italy (20%), India (19%), and Pakistan (5%). Surgical activity was significantly reduced in most centers (79%) and dedicated in-hospital routes were created for patients with SARS-CoV-2 (58%). Patient screening was performed only when there were symptoms (57%) and not routinely before surgery (18%). The preferred methods included a nasopharyngeal swab and chest radiograph. Health professionals were rarely screened (20%) and sometimes, even if SARS-CoV-2 positive, were asked to work if asymptomatic (26%). Surgical planning was changed in most institutions (92%), whereas indications were modified for nonurgent procedures (59%) and remained unchanged for subarachnoid hemorrhages (85%). CONCLUSIONS Most neurosurgeons worldwide reported work reorganization and practices that respond to current international guidelines. Differences in practice might be related to the perception of the pandemic and significant differences in the health systems. Sharing data and experiences will be of paramount importance to address the present moment and challenges in the near future.
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Affiliation(s)
| | | | - Luca Zanin
- Neurosurgery, University of Brescia, Brescia, Italy
| | | | | | - Franco Servadei
- Neurosurgery, Humanitas University and Research Institute, Milan, Italy
| | - Bipin Chaurasia
- Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Peter Vajkoczy
- Neurosurgery, Charité University Medicine, Berlin, Germany
| | - Karl Schaller
- Neurosurgery, University of Geneva, Geneva, Switzerland
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19
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Daggubati LC, Eichberg DG, Ivan ME, Hanft S, Mansouri A, Komotar RJ, D'Amico RS, Zacharia BE. Telemedicine for Outpatient Neurosurgical Oncology Care: Lessons Learned for the Future During the COVID-19 Pandemic. World Neurosurg 2020; 139:e859-e863. [PMID: 32450309 PMCID: PMC7243783 DOI: 10.1016/j.wneu.2020.05.140] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022]
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.
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Affiliation(s)
- Lekhaj C Daggubati
- Department of Neurosurgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Daniel G Eichberg
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurosurgery, University of Miami, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Simon Hanft
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alireza Mansouri
- Department of Neurosurgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA; Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Ricardo J Komotar
- Department of Neurosurgery, University of Miami, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA
| | - Brad E Zacharia
- Department of Neurosurgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA; Penn State Cancer Institute, Hershey, Pennsylvania, USA.
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20
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Brembilla C, Veiceschi P, Fanti A, Costi E, Passoni M, Sicignano AM, Bernucci C. The Eclipse of Degenerative Spine Pathology During COVID-19 Pandemic. Neurospine 2020; 17:354-356. [PMID: 32408728 PMCID: PMC7338948 DOI: 10.14245/ns.2040268.134] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Carlo Brembilla
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Pierlorenzo Veiceschi
- Department of Neurosurgery, Scuola di Specializzazione in Neurochirurgia, Università degli Studi dell'Insubria, Varese, Italy.,Department of Neurosurgery Scuola di Specializzazione in Neurochirurgia, Università degli Studi di Pavia, Pavia, Italy
| | - Andrea Fanti
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.,Department of Neurosurgery Scuola di Specializzazione in Neurochirurgia, Università degli Studi di Pavia, Pavia, Italy
| | - Emanuele Costi
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Maurizio Passoni
- Departments of Anesthesia and Intensive Care, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Angelo Mirco Sicignano
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Claudio Bernucci
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
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21
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Tsamakis K, Gavriatopoulou M, Schizas D, Stravodimou A, Mougkou A, Tsiptsios D, Sioulas V, Spartalis E, Sioulas AD, Tsamakis C, Charalampakis N, Mueller C, Arya D, Zarogoulidis P, Spandidos DA, Dimopoulos MA, Papageorgiou C, Rizos E. Oncology during the COVID-19 pandemic: challenges, dilemmas and the psychosocial impact on cancer patients. Oncol Lett 2020; 20:441-447. [PMID: 32565968 PMCID: PMC7285823 DOI: 10.3892/ol.2020.11599] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [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: 04/13/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022] Open
Abstract
COVID-19 has caused unprecedented societal turmoil, triggering a rapid, still ongoing, transformation of healthcare provision on a global level. In this new landscape, it is highly important to acknowledge the challenges this pandemic poses on the care of the particularly vulnerable cancer patients and the subsequent psychosocial impact on them. We have outlined our clinical experience in managing patients with gastrointestinal, hematological, gynaecological, dermatological, neurological, thyroid, lung and paediatric cancers in the COVID-19 era and have reviewed the emerging literature around barriers to care of oncology patients and how this crisis affects them. Moreover, evolving treatment strategies and novel ways of addressing the needs of oncology patients in the new context of the pandemic are discussed.
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Affiliation(s)
- Konstantinos Tsamakis
- Second Department of Psychiatry, University of Athens, 'ATTIKON' University Hospital, 12462 Athens, Greece.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, London SE5 8AF, UK
| | - Maria Gavriatopoulou
- Department of Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Athina Stravodimou
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital, CH-1011 Lausanne, Switzerland
| | - Aikaterini Mougkou
- Paediatric Infectious Diseases Dept, Karolinska University Hospital, 171 77 Stockholm, Sweden
| | - Dimitrios Tsiptsios
- Department of Neurophysiology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR47TP, UK
| | - Vasileios Sioulas
- Department of Gynaecologic Oncology MITERA Hospital, 15123 Athens, Greece
| | - Eleftherios Spartalis
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens School of Medicine, 11527 Athens, Greece
| | | | - Charalampos Tsamakis
- Department of Dermatology, Luton and Dunstable University Hospital, Bedfordshire Hospitals NHS Foundation Trust, Luton LU4 0DZ, UK
| | | | - Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Donna Arya
- Thornford Park, Elysium Healthcare, Berkshire RG19 8ET, UK
| | - Paul Zarogoulidis
- 3rd Department of Surgery, 'AHEPA' University Hospital, Aristotle University of Thessaloniki, Medical School, 54621 Thessaloniki, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Meletios A Dimopoulos
- Hematology and Medical Oncology, Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, 11527 Athens, Greece
| | - Charalabos Papageorgiou
- First Department of Psychiatry, University of Athens, 'EGINITION' Hospital, 11528 Athens, Greece
| | - Emmanouil Rizos
- Second Department of Psychiatry, University of Athens, 'ATTIKON' University Hospital, 12462 Athens, Greece
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Molliqaj G, Schaller K. How Neurosurgeons Are Coping with COVID-19 and How It Impacts Our Neurosurgical Practice: Report from Geneva University Medical Center. World Neurosurg 2020; 139:624-7. [PMID: 32414671 DOI: 10.1016/j.wneu.2020.04.149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Fontanella MM, Saraceno G, Lei T, Bederson JB, You N, Rubiano AM, Hutchinson P, Wiemeijer-Timmer F, Servadei F. Neurosurgical activity during COVID-19 pandemic: an experts' opinion from China, South Korea, Italy, the USA, Colombia, and the UK. J Neurosurg Sci 2020; 64:383-388. [PMID: 32347685 DOI: 10.23736/s0390-5616.20.04994-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND More than a million and a half people are infected worldwide with more than 90,000 casualties. The ongoing COVID-19 pandemic is radically altering both socio-economic and health care scenarios. METHODS On April 4th, 2020, at 13:30 CET, a webinar was broadcasted, organized by Global Neuro and supported by WFNS. Expert neurosurgeons from six different countries (China, Italy, South Korea, the USA, Colombia, and the UK) reported on the impact of the COVID-19 pandemic on their health care systems and neurosurgical activity. RESULTS The first part focused on the epidemiology until that date. The USA were the most affected State with 450,000 cases, followed by Italy (140,000 cases and 19,000 casualties), China (83,305 cases and 3345 have died), South Korea (10,156 cases with 177 casualties), the UK (38,168 cases and 3605 deaths) and Colombia (1267 cases and 25 deaths). The second part concerned Institution and staff reorganization. In every country all surgical plans have been modified. The third part was about neurosurgical practice during the COVID-19 pandemic. The fourth and last part touched upon how to perform safe surgery and re-start after the pandemic. CONCLUSIONS In general, the pandemic scenario was presented as a thought-provoking challenge in all countries which requires tireless efforts for both maintaining emergency and elective neurosurgical procedures.
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Affiliation(s)
- Marco M Fontanella
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giorgio Saraceno
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy -
| | - Ting Lei
- Neurosurgical Department, Tongji Hospital, Wuhan, China
| | - Joshua B Bederson
- Department of Neurosurgery, The Mount Sinai Health System, New York, NY, USA
| | - Namkyu You
- Department of Neurosurgery, Ajou University College of Medicine, Suwon, South Korea
| | - Andres M Rubiano
- Neuroscience Institute, INUB-MEDITECH Research Group, El Bosque University, Bogota, Colombia.,Neurological Surgery Service, Valle Salud Clinic, Cali, Colombia
| | - Peter Hutchinson
- Department of Neurosurgery, University of Cambridge, Royal College of Surgeons of England, Cambridge, UK
| | | | - Franco Servadei
- Humanitas Clinical and Research Center - IRCCS, Milan, Italy.,Department of Biomedical Science, Humanitas University, Milan, Italy
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