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Axenhus M, Schedin-Weiss S, Tjernberg L, Winblad B. The impact of the COVID-19 pandemic on neurosurgery in the elderly population in Sweden. BMC Public Health 2024; 24:823. [PMID: 38491396 PMCID: PMC10941451 DOI: 10.1186/s12889-024-18332-0] [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] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic prompted a refocus of health care resources to acute care which has impacted on the capacity of healthcare systems to conduct neurological surgeries. The elderly population has been shown to be particularly vulnerable to the consequences of the pandemic. Less neurosurgery can result in great impact on public health by increasing morbidity and mortality in patients with malignancies and traumatic injuries. The aim of this study was to investigate the effects of the COVID-19 pandemic on neurosurgical procedures in the elderly population in Sweden. METHODS In this retrospective observational study, the reported incidence of all neurosurgical procedures registered in the 21 Regions of Sweden during 2015-2021 in people aged 65 year or older was collected. Surgical procedures were classified according to the NOMESCO system of classification. Neurosurgery incidence was defined as the number of NOMESCO associated interventions per 100.000 inhabitants. ICD-10 codes associated with neurosurgery-related diagnoses and deaths were also collected. Expected incidence of neurosurgery, neurosurgery-associated deaths and brain cancer diagnoses was estimated and compared to actual outcomes. Decrease in the incidence of neurosurgery was compared to regional COVID-19 incidence, other types of surgery and surgery waiting times. RESULTS The incidence of several categories of neurosurgery decreased in Sweden during 2020 and 2021, although not as much as other surgical categories. Women were more affected than men by the decrease in neurosurgery which could be partly explained by a decrease in brain cancer diagnoses amongst women. There was an association between regional decrease in neurosurgery incidence and longer surgery waiting time. COVID-19 incidence in the region did not have an effect on regional decreases in neurosurgery incidence. CONCLUSIONS The COVID-19 pandemic resulted in a reduction in the number of neurosurgical procedures performed in Sweden during 2020-2021, although not as much as in other European countries. There was regional difference in Sweden with respect to number of surgeries, and waiting time for elective surgeries although there was no increase in mortality.
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Affiliation(s)
- Michael Axenhus
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Sophia Schedin-Weiss
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lars Tjernberg
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University hospital, Huddinge, Sweden
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Hsieh CJ, Wu CY, Lin YH, Huang YC, Yang WC, Chen TWW, Ma WL, Lin WH, Hsu FM, Xiao F, Yang SH, Lai DM, Chen CM, Chao SY, Tsuang FY. Delay of Surgery for Spinal Metastasis due to the COVID-19 Outbreak Affected Patient Outcomes. Neurospine 2023; 20:1431-1442. [PMID: 38171309 PMCID: PMC10762398 DOI: 10.14245/ns.2346726.363] [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: 07/03/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE The present study is to analyze the effects of the coronavirus disease 2019 (COVID 2019) outbreak and the subsequent lockdown on the outcomes of spinal metastasis patients. METHODS The study was a retrospective analysis of data from a prospective cohort study. All patients underwent surgical intervention for spinal metastases between January 2019 and December 2021 and had at least 3 months of postoperative follow-up. The primary outcome was overall mortality during the 4 different stages (pre-COVID-19 era, COVID-19 pandemic except in Taiwan, national lockdown, lifting of the lockdown). The secondary outcomes were the oncological severity scores, medical/surgical accessibility, and patient functional outcome during the 4 periods as well as survival/mortality. RESULTS A total of 233 patients were included. The overall mortality rate was 41.20%. During the Taiwan lockdown, more patients received palliative surgery than other surgical methods, and no total en bloc spondylectomy was performed. The time from surgeon visit to operation was approximately doubled after the COVID-19 outbreak in Taiwan (75.97, 86.63, 168.79, and 166.91 hours in the 4 periods, respectively). The estimated survival probability was highest after the national lockdown was lifted and lowest during the lockdown. In the multivariate analysis, increased risk of mortality was observed with delay of surgery, with emergency surgery having a higher risk with delays above 33 hours, urgent surgery (below 59 and above 111 hours), and elective surgery (above 332 hours). CONCLUSION The COVID-19 pandemic and related policies have altered daily clinical practice and negatively impacted the survival of patients with spinal metastases.
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Affiliation(s)
- Chia-Jung Hsieh
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu County, Taiwan
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chun-Yu Wu
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
- Department of Anesthesiology, National Taiwan University Hospital, Taipei City, Taiwan
- Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu County, Taiwan
| | - Yen-Heng Lin
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yu-Cheng Huang
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital, Taipei City, Taiwan
| | - Wen-Chi Yang
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tom Wei-Wu Chen
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Wei-Li Ma
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Wei-Hsin Lin
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Feng-Ming Hsu
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Furen Xiao
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Shih-Hung Yang
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Dar-Ming Lai
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chang-Mu Chen
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Shin-Yi Chao
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Fon-Yih Tsuang
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
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Uche E, Sundblom J, Uko UK, Kamalo P, Nah Doe A, Eriksson L, Sandvik U, Revesz DF, Ryttlefors M, Tisell M. Global neurosurgery over a 60-year period: Conceptual foundations, time reference, emerging Co-ordinates and prospects for collaborative interventions in low and middle income countries. Brain Spine 2022; 2:101187. [PMID: 36506294 PMCID: PMC9729807 DOI: 10.1016/j.bas.2022.101187] [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] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/27/2022] [Accepted: 09/07/2022] [Indexed: 11/15/2022]
Abstract
Introduction We evaluated salient initiatives invested in global neurosurgery over a 60-year period. Research question What are the Phases, Achievements, Challenges, and Lessons of Global Neurosurgery. Methods A 60-year retrospective study from 1960 to 2020 analyzing the major phases, lessons, and progress notes. We reviewed the foundational need questions and innovated tools used to answer them. Results Three phases defining our study period were identified. In the early phase, birthing academic units and the onset of individual volunteerism were dominant concepts. The 2nd phase is summarized by the rise of volunteerism and surgical camps.The third phase is heralded by advocacy and strategies for achieving care equity. The defining moment is the Lancet commission for global surgery summit in 2015. Lessons include the need for evaluation of the resources of recipient and donor locations using novel global surgery tools. Conclusion Global neurosurgery over the 60-year study period is summarized by indelible touchstones of personal and group efforts as well as triumphs derived from innovations in the face of formidable challenges.
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Affiliation(s)
- E.O. Uche
- Neurosurgery Unit, Faculty of Medical Sciences, University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu, Nigeria,Corresponding author. Neurosurgery Unit, Faculty of MedicalSciences, College of Medicine, University of Nigeria, Ituku/Ozalla, Enugu 40001, Nigeria.
| | - Jimmy Sundblom
- Department of Neurosurgery, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Uko Kalu Uko
- Neurosurgery Unit, Faculty of Medical Sciences, University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu, Nigeria
| | - Patrick Kamalo
- Department of Neurosurgery, Blantyre Institute of Neurological Sciences, Malawi
| | - Alvin Nah Doe
- Neurosurgery Unit, Department of Surgery, John F. Kennedy Memorial Hospital, Monrovia, Liberia
| | - Linn Eriksson
- Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden
| | - Ulrika Sandvik
- Department of Neurosurgery/ Clinical Neuroscience, The Karolinska University Hospital/Karolinska Institute, Stockholm, Sweden
| | - David F Revesz
- Department of Neurosurgery, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Mats Ryttlefors
- Department of Neurosurgery, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Magnus Tisell
- Department of Neurosurgery, Sahlgrenska University Hospital, 13 45, Gothenburg, Sweden
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Alam I, Garg K, Raheja A, Tandon V, Sharma R, Singh M, Singh GP, Mishra S, Singh PK, Agrawal D, Soni KD, Suri A, Chandra PS, Kale SS. Managing Traumatic Brain Injury During the Coronavirus Disease 2019 Pandemic-A Case-Matched Controlled Analysis of Immediate Outcomes. World Neurosurg 2022; 165:e59-e73. [PMID: 35643408 PMCID: PMC9131442 DOI: 10.1016/j.wneu.2022.05.076] [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: 03/23/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The primary objective of this study was to evaluate the outcome of patients with traumatic brain injury (TBI) during the coronavirus disease 2019 (COVID-19) pandemic and to compare their outcome with case-matched controls from the prepandemic phase. METHODS This is a retrospective case-control study in which all patients with TBI admitted during COVID-19 pandemic phase (Arm A) from March 24, 2020 to November 30, 2020 were matched with age and Glasgow Coma Scale score-matched controls from the patients admitted before March 2020 (Arm B). RESULTS The total number of patients matched in each arm was 118. The length of hospital stay (8 days vs. 5 days; P < 0.001), transit time from emergency room to operation room (150 minutes vs. 97 minutes; P = 0.271), anesthesia induction time (75 minutes vs. 45 minutes; P = 0.002), and operative duration (275 minutes vs. 180 minutes; P = 0.002) were longer in arm A. Although the incidence of fever and pneumonia was significantly higher in arm A than in arm B (50% vs. 26.3%, P < 0.001 and 27.1% vs. 1.7%, P < 0.001, respectively), outcome (Glasgow Outcome Scale-Extended) and mortality (18.6% vs. 14.4% respectively; P = 0.42) were similar in both the groups. CONCLUSIONS The outcome of the patients managed for TBI during the COVID-19 pandemic was similar to matched patients with TBI managed at our center before the onset of the COVID-19 pandemic. This finding suggests that the guidelines followed during the COVID-19 pandemic were effective in dealing with patients with TBI. This model can serve as a guide for any future pandemic waves for effective management of patients with TBI without compromising their outcome.
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Affiliation(s)
- Intekhab Alam
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- 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
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India,To whom correspondence should be addressed: Vivek Tandon, M.B.B.S., M.S., M.Ch
| | - Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Gyaninder Pal Singh
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Kumar Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Castaño-Leon AM, Paredes I, Lagares A, Gomez PA, González-Leon P, Perez-Nuñez A, Jiménez-Roldán L, Delgado-Fernández J, Eiriz Fernández C, García-Pérez D, Moreno-Gómez LM, Esteban-Sinovas O, Delgado-López PD, Martín-Alonso J, Kaen A, Tirado-Caballero J, Ordóñez-Carmona M, Arteaga-Romero F, González-Pombo M, F Alén J, Gil-Simoes R, Torres CV, Navas-García M, Blasco García de Andoain G, Frade-Porto N, González-Tarno P, Martin Segura A, Gelabert-González M, Menéndez-Cortezón B, Rodríguez-Botana B, Pérez-Alfayate R, Fernández-García C, Ferrández-Pujante B, Vargas-Jiménez AC, Cotúa C, de la Lama A, Calero Félix L, Ruiz-Juretschke F, García-Leal R, Valera-Melé M, Casitas Hernando V, Rivero B, Orduna-Martínez J, Casado Pellejero J, Fustero De Miguel D, Díaz Molina J, Moles Herbera J, Castelló-Ruiz MJ, Gomar-Alba M, García-Pérez F, Hernández-García BJ, Villaseñor-Ledezma JJ, Otero-Rodríguez Á, Ailagas de Las Heras JJ, Gonçalves-Estella J, Sousa-Casasnovas P, Pascual-Argente D, Ruiz Martín L, Roa Montes de Oca JC, Arandia Guzmán D, García Martín A, Torres Carretero L, Garrido Ruiz A, Calvo M, Miranda-Lloret P, Rodríguez-Cadarso M, Antón J, Roca Barber A, Quiroz-Tejada A, Carbayo-Lozano G, Bermúdez G, Paternain Martin C, De la Fuente Villa P, Fidalgo De la Rosa M, Sistiaga-Gracia ÍL, Zabalo G. Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study. BMJ Open 2022; 12:e061208. [PMID: 35977759 PMCID: PMC9388715 DOI: 10.1136/bmjopen-2022-061208] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery. DESIGN This was an observational retrospective study. SETTINGS A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020. PARTICIPANTS A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection. RESULTS More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p<0.001), degenerative spine (OR=0.296, p=0.027) and expedited indications (OR=6.095, p<0.001) were independent factors for being operated on during the pandemic. CONCLUSIONS Patients awaiting neurosurgery experienced significant collateral damage even when they were considered for scheduled procedures.
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Affiliation(s)
- Ana M Castaño-Leon
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Igor Paredes
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Lagares
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro A Gomez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Pedro González-Leon
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Angel Perez-Nuñez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Jiménez-Roldán
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Daniel García-Pérez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis M Moreno-Gómez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Ariel Kaen
- Neurosurgery Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | | | | | | | - Marta González-Pombo
- Neurosurgery Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - José F Alén
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ricardo Gil-Simoes
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Cristina V Torres
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Marta Navas-García
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Natalia Frade-Porto
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | - Miguel Gelabert-González
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Beatriz Menéndez-Cortezón
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Brais Rodríguez-Botana
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | - Carlos Cotúa
- Neurosurgery Department, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Adolfo de la Lama
- Neurosurgery Department, Complejo Hospitalario de Vigo Alvaro Cunqueiro, Vigo, Spain
| | - Lourdes Calero Félix
- Neurosurgery Department, Complejo Hospitalario de Vigo Alvaro Cunqueiro, Vigo, Spain
| | | | - Roberto García-Leal
- Neurosurgery Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Marc Valera-Melé
- Neurosurgery Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | | | - Belén Rivero
- Neurosurgery Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | - Jorge Díaz Molina
- Neurosurgery Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Jesús Moles Herbera
- Neurosurgery Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Maria J Castelló-Ruiz
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | - Mario Gomar-Alba
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | - Fernando García-Pérez
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | | | | | - Álvaro Otero-Rodríguez
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | | | - Pablo Sousa-Casasnovas
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Daniel Pascual-Argente
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Laura Ruiz Martín
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Daniel Arandia Guzmán
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Andoni García Martín
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Luis Torres Carretero
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Alejandra Garrido Ruiz
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Marta Calvo
- Neurosurgery Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Pablo Miranda-Lloret
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | | | - Joan Antón
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - Amparo Roca Barber
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - Arnold Quiroz-Tejada
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | | | - Garazi Bermúdez
- Neurosurgery Department, Hospital Universitario Cruces, Barakaldo, Spain
| | | | | | | | | | - Gorka Zabalo
- Neurosurgery Department, Hospital Universitario Cruces, Barakaldo, Spain
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Chawla S, Devi S, Calvachi P, Gormley WB, Rueda-Esteban R. Evaluation of simulation models in neurosurgical training according to face, content, and construct validity: a systematic review. Acta Neurochir (Wien) 2022; 164:947-966. [PMID: 35122126 PMCID: PMC8815386 DOI: 10.1007/s00701-021-05003-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 05/25/2021] [Accepted: 08/30/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Neurosurgical training has been traditionally based on an apprenticeship model. However, restrictions on clinical exposure reduce trainees' operative experience. Simulation models may allow for a more efficient, feasible, and time-effective acquisition of skills. Our objectives were to use face, content, and construct validity to review the use of simulation models in neurosurgical education. METHODS PubMed, Web of Science, and Scopus were queried for eligible studies. After excluding duplicates, 1204 studies were screened. Eighteen studies were included in the final review. RESULTS Neurosurgical skills assessed included aneurysm clipping (n = 6), craniotomy and burr hole drilling (n = 2), tumour resection (n = 4), and vessel suturing (n = 3). All studies assessed face validity, 11 assessed content, and 6 assessed construct validity. Animal models (n = 5), synthetic models (n = 7), and VR models (n = 6) were assessed. In face validation, all studies rated visual realism favourably, but haptic realism was key limitation. The synthetic models ranked a high median tactile realism (4 out of 5) compared to other models. Assessment of content validity showed positive findings for anatomical and procedural education, but the models provided more benefit to the novice than the experienced group. The cadaver models were perceived to be the most anatomically realistic by study participants. Construct validity showed a statistically significant proficiency increase among the junior group compared to the senior group across all modalities. CONCLUSION Our review highlights evidence on the feasibility of implementing simulation models in neurosurgical training. Studies should include predictive validity to assess future skill on an individual on whom the same procedure will be administered. This study shows that future neurosurgical training systems call for surgical simulation and objectively validated models.
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Affiliation(s)
- Shreya Chawla
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sharmila Devi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paola Calvachi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - William B Gormley
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roberto Rueda-Esteban
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Universidad de los Andes School of Medicine, Bogotá, Colombia.
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Pascual JSG, Ignacio KHD, Castillo MRL, Khu KJO. Practice Patterns in Surgical Neuro-Oncology Among Low- and Middle-Income Countries During the Coronavirus Disease 2019 Pandemic: A Scoping Review and Situational Report from the Philippines. World Neurosurg 2022; 159:189-197.e7. [PMID: 34902600 DOI: 10.1016/j.wneu.2021.12.020] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the outcomes of surgical neuro-oncology patients worldwide. We aimed to review the practice patterns in surgical neuro-oncology in low- and middle-income countries (LMICs). We also present a situational report from our own country. METHODS A scoping review was performed following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. RESULTS Twelve studies were included in the review. Most of the studies were from Asia (India, China, Iran, and Turkey), and 1 was from Brazil. Quantitative reports showed a decrease in the number of surgical neuro-oncology operations between pre-COVID-19 and post-COVID-19 time frames, but similar proportions of neuro-oncology procedures. Qualitative review showed similar practice patterns between LMICs and high-income countries, except for limitations in resources such as negative-pressure operating rooms and intensive care units, and maintenance of face-to-face consults despite the adoption of telemedicine. Limited data on adjuvant therapy were available in LMICs. CONCLUSIONS In our review, we found that the practice patterns in surgical neuro-oncology in LMICs during the COVID-19 pandemic are similar to those in high-income countries, except for a few modifications because of resource limitation and patient preferences.
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Ramieri A, Alshafeei O, Trungu S, Raco A, Costanzo G, Miscusi M. COVID-19 pandemic: An update on the reaction attitude of the spine societies and their members worldwide. World J Orthop 2022; 13:193-200. [PMID: 35317407 PMCID: PMC8891658 DOI: 10.5312/wjo.v13.i2.193] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/01/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND All surgical specialties have been influenced by the coronavirus disease 2019 (COVID-19) pandemic, and substantial changes have been determined in medical assistance, especially in elective surgery. Several spine societies have published recommendations to provide optimal care during this unique situation.
AIM To discuss the recommendations by many spine societies for the management of spinal diseases during the COVID-19 pandemic.
METHODS The present study was performed according to the PRISMA guidelines. A review of the MEDLINE database (PubMed – National Library of Medicine), Google, and Google Scholar was performed from March 2020 to date for articles published in the English Language.
RESULTS Spine associations and societies worldwide were divided into three groups: Continental, specialty and country-based societies. A total of 27 spine associations were included in this review. There were eight major continental associations, but only one-third of these had published guidelines and recommendations on this topic. On the other hand, the specialty-based societies have not addressed the topic, except in two cases.
CONCLUSION The national spine societies showed the deepest concern on this topic with several publications in scientific journals influenced by the local epidemiological severity. Contrarily, continental and specialty-based societies showed less interest in this topic.
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Apostolopoulou K, Elmoursi O, deLacy P, Zaki H, McMullan J, Ushewokunze S. The impact of telephone consultations due to COVID-19 on paediatric neurosurgical health services. Childs Nerv Syst 2022; 38:2133-9. [PMID: 35978198 DOI: 10.1007/s00381-022-05651-z] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/13/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The aim of the study was to evaluate the role of telephone consultations due to the pandemic in the management of paediatric neurosurgical patients and, furthermore, to examine the proportion of patients who eventually needed a face-to-face appointment and assess the underline reasons for that. METHODS This retrospective study included all the paediatric neurosurgical patients who had a telephone appointment during a 3-month lockdown period. Overall, 319 patients (186 males and 133 females) aged 8.36 ± 4.88 (mean ± SD) had a consultation via telephone. Two hundred fifty-one (78.7%) patients had a follow-up assessment and 68 (21.3%) were new appointments. RESULTS Patients were divided between two main groups. Group A included 263 patients (82.4%) whose consultation was adequate via telephone, and Group B included 56 patients (17.6%) who required a complementary face-to-face appointment. Patients who were more likely to require a supplementary appointment were patients with either dysraphism or ventriculomegaly and benign enlarged subarachnoid spaces (BESS) (43.3% and 36.4%, respectively). Interestingly, most children with hydrocephalus who underwent a cerebrospinal fluid (CSF) diversion procedure and children with Chiari I malformation were appropriately assessed via telephone (85.1% and 83.3%, respectively). Finally, children aged < 2 years (55.2%) were better managed with face-to-face appointments. No difference was noticed regarding follow-up and new appointments. CONCLUSION Although telemedicine was not unknown to neurosurgical services, the actual application of telephone or video consultations remained quite limited. It was COVID-19 pandemic who reinforced the use of telemedicine, and taking into consideration its promising results, we can safely assume that it can be incorporated into neurosurgical health care even once the pandemic crisis has resolved.
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Azab MA, Azzam AY, Salem AE. Impact of COVID-19 on neurosurgical service: A one-year experience from a provincial countryside hospital in a rural area in north Egypt. Interdiscip Neurosurg 2021; 27:101416. [PMID: 34729362 PMCID: PMC8553372 DOI: 10.1016/j.inat.2021.101416] [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] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/18/2021] [Accepted: 10/23/2021] [Indexed: 11/28/2022]
Abstract
Background Globally, there is a shooting pandemic that affected many healthcare systems. Healthcare facilities had to set up strategies to avoid exhaustion while facing a catastrophic health problem. Vaccines or perfect therapies were not available over a long pandemic time and also no certified immunity against that disease is guaranteed. Therefore, it is probable that healthcare systems will face it for an exceptionally long period. That already had a grave effect on the strategy of daily practice of different specialties’ services at healthcare centers. Methods We tried simply to share a countryside hospital’s expertise in managing neurosurgical cases amid a dreadful health crisis. Healthcare workers’ safety and patient safety were typical priorities for neurosurgical service at Damietta Specialized Hospital. We expose the lines of management, triaging cases, the methods of handling confirmed and suspected neurosurgical patients, and strategies for discharging and following up patients. We identified hospital admission and discharge records starting from February 2020 till February 2021 to track the neurosurgical case burden, the state of service offered and the rate of infection among healthcare workers who participated in surgeries. Results At the peak time of the COVID‑19 pandemic in Egypt starting from February 2020 till February 2021, we have admitted about 500 neurosurgical patients. About 400 (80%) of them did surgeries according to the triaging protocol of the hospital. About 150 (30%) of those who did surgeries were urgent and the rest were borderline or semi‑urgent. About 20 (4%) were tested COVID-19 positive and six of them died due to acute respiratory distress syndrome. Only two mortality cases were reported due to post-operative complications and not related to SARS‑CoV‑2 infection. The rest of the cases (97.6%) were discharged for follow‑up without complications. No neurosurgeons but three anesthesia staff were infected with SARS‑CoV‑2. A successful undisturbed neurosurgical care was available for patients during COVID-19 time. Conclusions Following the suggested strategies, a rural area-serving hospital managed to provide uninterrupted neurosurgical care amid COVID-19 pandemic in Egypt. Rural areas in developing countries are in need of strategies to deal with pandemics in the future without dismantling the normal health system, especially for life‑saving cases in a critical specialty as neurosurgery.
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Affiliation(s)
- Mohammed A Azab
- Department of Neurosurgery, Cairo University Faculty of Medicine, Cairo, Egypt
| | - Ahmed Y Azzam
- October 6 University Faculty of Medicine, Giza, Egypt
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Sudhan MD, Singh RK, Yadav R, Sivasankar R, Mathai SS, Shankaran R, Kulkarni SN, Shanthanu CP, Sandhya LM, Shaikh A. Neurosurgical Outcomes, Protocols, and Resource Management During Lockdown: Early Institutional Experience from One of the World's Largest COVID 19 Hotspots. World Neurosurg 2021; 155:e34-e40. [PMID: 34325030 PMCID: PMC8312048 DOI: 10.1016/j.wneu.2021.07.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 02/23/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND As the COVID-19 pandemic surpasses 1 year, it is prudent to reflect on the challenges faced and the management strategies employed to tackle this overwhelming health care crisis. We undertook this study to validate our institutional protocols, which were formulated to cater to the change in volume and pattern of neurosurgical cases during the raging pandemic. METHODS All admitted patients scheduled to undergo major neurosurgical intervention during the lockdown period (15 March 2020 to 15 September 2020) were included in the study. The data involving surgery outcomes, disease pattern, anesthesia techniques, patient demographics, as well as COVID-19 status, were analyzed and compared with similar retrospective data of neurosurgical patients operated during the same time period in the previous year (15 March 2019 to 15 September 2019). RESULTS Barring significant increase in surgery for stroke (P = 0.008) and hydrocephalus (P <0.001), the overall case load of neurosurgery during the study period in 2020 was 42.75% of that in 2019 (P < 0.001), attributable to a significant reduction in elective spine surgeries (P < 0.001). However, no significant difference was observed in the overall incidence of emergency and essential surgeries undertaken during the 2 time periods (P = 0.482). There was an increased incidence in the use of monitored anesthesia care techniques during emergency and essential neurosurgical procedures by the anesthesia team in 2020 (P < 0.001). COVID-19 patients had overall poor outcomes (P = 0.003), with significant increase in mortality among those subjected to general anesthesia vis-a-vis monitored anesthesia care (P = 0.014). CONCLUSIONS Despite a significant decrease in neurosurgical workload during the COVID-19 lockdown period in 2020, the volume of emergency and essential surgeries did not change much compared with the previous year. Surgery in COVID-19 patients is best avoided, unless critical, as the outcome in these patients is not favorable. The employment of monitored anesthesia care techniques like awake craniotomy and regional anesthesia facilitate a better outcome in the ongoing COVID-19 era.
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Affiliation(s)
| | | | - Rahul Yadav
- Department of Neuroanaesthesiology, INHS Asvini, Colaba, Mumbai, India,To whom correspondence should be addressed: Rahul Yadav, D.M
| | - Rajeev Sivasankar
- Department of Radiodiagnosis and Interventional Radiology, INHS Asvini, Colaba, Mumbai, India
| | - Sheila Samanta Mathai
- Commanding Officer and Chairperson, COVID-19 Protocol Committee, INHS Asvini, Colaba, Mumbai, India
| | - Ramakrishnan Shankaran
- Department of Surgery and Senior Member, COVID-19 Protocol Committee, INHS Asvini, Colaba, Mumbai, India
| | | | | | | | - Azimuddin Shaikh
- Department of Neuroanaesthesiology, INHS Asvini, Colaba, Mumbai, India
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de Macêdo Filho LJ, Aragão ACA, dos Santos VTD, Galvão LB, Shlobin NA, De Biase G, Suarez-Meade P, Almeida JPC, Quinones-Hinojosa A, de Albuquerque LA. Impact of COVID-19 on Neurosurgery in Brazil's Health System: The Reality of a Developing Country Affected by the Pandemic. World Neurosurg 2021; 155:e142-e149. [PMID: 34400327 PMCID: PMC8548285 DOI: 10.1016/j.wneu.2021.08.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/12/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The coronavirus disease identified in 2019 (COVID-19) pandemic changed neurosurgery protocols to provide ongoing care for patients while ensuring the safety of health care workers. In Brazil, the rapid spread of the disease led to new challenges in the health system. Neurooncology practice was one of the most affected by the pandemic due to restricted elective procedures and new triage protocols. We aim to characterize the impact of the pandemic on neurosurgery in Brazil. METHODS We analyzed 112 different types of neurosurgical procedures, with special detail in 11 neurooncology procedures, listed in the Brazilian Hospital Information System records in the DATASUS database between February and July 2019 and the same period in 2020. Linear regression and paired t-test analyses were performed and considered statistically significant at P < 0.05. RESULTS There was an overall decrease of 21.5% (28,858 cases) in all neurosurgical procedures, impacting patients needing elective procedures (-42.46%) more than emergency surgery (-5.93%). Neurooncology procedures decreased by 14.89%. Nonetheless, the mortality rate during hospitalization increased by 21.26%. Linear regression analysis in hospitalizations (Slope = 0.9912 ± 0.07431; CI [95%] = 0.8231-1.159) and total cost (Slope = 1.03 ± 0.03501; CI [95%] = 0.9511-1.109) in the 11 different types of neurooncology procedures showed a P < 0.0001. The mean cost per type of procedure showed an 11.59% increase (P = 0.0172) between 2019 and 2020. CONCLUSIONS The COVID-19 pandemic has increased mortality, decreased hospitalizations, and therefore decreased overall costs, despite increased costs per procedure for a variety of neurosurgical procedures. Our study serves as a stark example of the effect of the pandemic on neurosurgical care in settings of limited resources and access to care.
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Affiliation(s)
- Leonardo J.M. de Macêdo Filho
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA,Health Science Center, University of Fortaleza, Fortaleza, Ceará, Brazil,To whom correspondence should be addressed: Leonardo J.M. de Macêdo Filho, M.D
| | | | | | - Lívia B.A. Galvão
- Health Science Center, University of Fortaleza, Fortaleza, Ceará, Brazil
| | - Nathan A. Shlobin
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Gaetano De Biase
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Paola Suarez-Meade
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Joao Paulo C. Almeida
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Ridwan S, Ganau M, Zoia C, Broekman M, Grote A, Clusmann H. Unequal Impact of COVID-19 on Private and Academic Neurosurgical Workforce: Results of an International Survey. Front Surg 2021; 8:749399. [PMID: 34660687 PMCID: PMC8517237 DOI: 10.3389/fsurg.2021.749399] [Citation(s) in RCA: 3] [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: 07/29/2021] [Accepted: 09/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Since the COVID-19 outbreak several manuscripts regarding neurosurgical practice during this pandemic have been published. Qualitative studies on how the pandemic affected neurosurgeons, with additional focus on their practice, are still scarce. This study's objective was to investigate the impact of COVID-19 on various aspects of the professional and private life of a homogeneous group of international neurosurgeons affiliated to the European Association of Neurosurgical Societies (EANS). Methods: Neurosurgeons from Europe and abroad were invited to participate in an online survey endorsed by the Individual Membership Committee of the EANS. The survey captured a subjective snapshot of the impact of the first wave of the COVID-19 pandemic on EANS members and was advertised through its Institutional website. In addition to departmental data, personal feeling of safety, financial security, local precautions, number of surgeries performed, changes in daily routine, and other practice-related information were inquired. Differences among practice types were closely reviewed. Results: The survey was distributed between April and May 2020: 204 neurosurgeons participated. Participants were typically active EANS members (73%), consultants (57.9%), from university hospitals (64.5%). Elective surgical practice was still ongoing only for 15% of responders, whereas 18.7% of them had already transitioned to COVID-19 and emergency medical services. While 65.7% of participants thought their institutions were adequately prepared, lack of testing for SARS-CoV-2, and scarcity of personal protective equipment were still a matter of concern for most of them. Overall surgical activity dropped by 68% (cranial by 54%, spine by 71%), and even emergencies decreased by 35%. COVID-19 prompted changes in communication in 74% of departments, 44% increased telemedicine by >50%. While most neurosurgeons had concerns about personal and families' health, financial outlook appeared to be gloomy only for private practitioners. Conclusion: The lockdown imposed in many countries by the COVID-19 outbreak called for immediate modification of working routine and resulted in a dramatic decrease of elective surgical procedures. Neurosurgeons share common concerns but were not equally exposed to the personal health and financial dangers of the ongoing pandemic.
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Affiliation(s)
- Sami Ridwan
- Department of Neurosurgery, Klinikum Ibbenbueren, Ibbenbueren, Germany
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marike Broekman
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, Leiden University Medical Center, Leiden, Netherlands.,Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Alexander Grote
- Department of Neurosurgery, Bethel Clinic, Bielefeld, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
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14
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Azab MA, Azzam AY, Salem AE, Reda A, Hassanein SF, Sabra M, Gadelmoula IS. Neurological problems in the context of COVID-19 infection in Egypt. A multicenter retrospective analysis. Interdiscip Neurosurg 2021; 26:101345. [PMID: 34426783 PMCID: PMC8372485 DOI: 10.1016/j.inat.2021.101345] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/25/2021] [Accepted: 08/15/2021] [Indexed: 12/11/2022]
Abstract
Background COVID–19 infection has spread so fast in both low– and high–income countries. In December 2019, an outbreak of a respiratory disease occurred in China, and later, it involved different countries. Acute neurological insults are more likely to occur in severely infected patients. Methods We tried to evaluate patients with selective criteria including, the age of participants 18 and older with a confirmed diagnosis of SARS-CoV-2, and developed neurological complications post COVID-19 infection. An overall data of 1500 patients were collected from neurological and primary health care departments. About 970 of them had neurological problems. Patients-related data were gathered and assembled from the patients’ records at participating hospitals from the Ministry of Health and university hospitals. Results We presented the results according to several variables including, regional distribution, reasons of presentation, neurological complications, follow-ups, and survival outcome. Conclusions To our knowledge, we conducted the first retrospective analysis for neurological problems related to COVID-19 infection in Egypt. COVID-19 patients present with a variety of central and peripheral neurological symptoms, the pathogenic mechanisms of which have not been explained. Robust investigations of the neurological presentations of COVID-19 infection should be recruited for better understanding of the possible association. Moreover, further explaining the pathophysiologic mechanisms will help in designing proper treatment plans.
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Affiliation(s)
- Mohammed A Azab
- Department of Neurosurgery, Cairo University Faculty of Medicine, Cairo, Egypt
- Department of Biochemistry and Molecular Biology, Boise State University, Idaho, USA
| | - Ahmed Y Azzam
- October 6 University Faculty of Medicine, Giza, Egypt
| | | | - Ahmed Reda
- Cairo University Faculty of Medicine, Cairo, Egypt
| | | | - Mohamed Sabra
- Cardiovascular Research Center, Rhode Island Hospital, Providence, RI 02903, USA
| | - Islam S Gadelmoula
- Department of Neurology, Egyptian Ministry of Health and Population Hospitals, Cairo, Egypt
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15
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Kovoor JG, Tivey DR, Ovenden CD, Babidge WJ, Maddern GJ. Evidence, not eminence, for surgical management during COVID-19: a multifaceted systematic review and a model for rapid clinical change. BJS Open 2021; 5:6342605. [PMID: 34355242 PMCID: PMC8342932 DOI: 10.1093/bjsopen/zrab048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus (COVID-19) forced surgical evolution worldwide. The extent to which national evidence-based recommendations, produced by the current authors early in 2020, remain valid, is unclear. To inform global surgical management and a model for rapid clinical change, this study aimed to characterize surgical evolution following COVID-19 through a multifaceted systematic review. METHODS Rapid reviews were conducted targeting intraoperative safety, personal protective equipment and triage, alongside a conventional systematic review identifying evidence-based guidance for surgical management. Targeted searches of PubMed and Embase from 31 December 2019 were repeated weekly until 7 August 2020, and systematic searches repeated monthly until 30 June 2020. Literature was stratified using Evans' hierarchy of evidence. Narrative data were analysed for consistency with earlier recommendations. The systematic review rated quality using the AGREE II and AMSTAR tools, was registered with PROSPERO, CRD42020205845. Meta-analysis was not conducted. RESULTS From 174 targeted searches and six systematic searches, 1256 studies were identified for the rapid reviews and 21 for the conventional systematic review. Of studies within the rapid reviews, 903 (71.9 per cent) had lower-quality design, with 402 (32.0 per cent) being opinion-based. Quality of studies in the systematic review ranged from low to moderate. Consistency with recommendations made previously by the present authors was observed despite 1017 relevant subsequent publications. CONCLUSION The evidence-based recommendations produced early in 2020 remained valid despite many subsequent publications. Weaker studies predominated and few guidelines were evidence-based. Extracted clinical solutions were globally implementable. An evidence-based model for rapid clinical change is provided that may benefit surgical management during this pandemic and future times of urgency.
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Affiliation(s)
- J G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia.,Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - D R Tivey
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - C D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
| | - W J Babidge
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - G J Maddern
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
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16
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Dhillon RS, Nguyen LV, Rowin WA, Humphries RS, Kevin K, Ward JD, Yule A, Phan TD, Zhao YC, Wynne D, McNeill PM, Hutchins N, Scott DA. Aerosolisation in endonasal endoscopic pituitary surgery. Pituitary 2021; 24:499-506. [PMID: 33469830 PMCID: PMC7814858 DOI: 10.1007/s11102-021-01125-8] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 12/03/2022]
Abstract
PURPOSE To determine the particle size, concentration, airborne duration and spread during endoscopic endonasal pituitary surgery in actual patients in a theatre setting. METHODS This observational study recruited a convenience sample of three patients. Procedures were performed in a positive pressure operating room. Particle image velocimetry and spectrometry with air sampling were used for aerosol detection. RESULTS Intubation and extubation generated small particles (< 5 µm) in mean concentrations 12 times greater than background noise (p < 0.001). The mean particle concentrations during endonasal access were 4.5 times greater than background (p = 0.01). Particles were typically large (> 75 µm), remained airborne for up to 10 s and travelled up to 1.1 m. Use of a microdebrider generated mean aerosol concentrations 18 times above baseline (p = 0.005). High-speed drilling did not produce aerosols greater than baseline. Pituitary tumour resection generated mean aerosol concentrations less than background (p = 0.18). Surgical drape removal generated small and large particles in mean concentrations 6.4 times greater than background (p < 0.001). CONCLUSION Intubation and extubation generate large amounts of small particles that remain suspended in air for long durations and disperse through theatre. Endonasal access and pituitary tumour resection generate smaller concentrations of larger particles which are airborne for shorter periods and travel shorter distances.
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Affiliation(s)
- Rana S Dhillon
- Department of Neurosurgery, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Lana V Nguyen
- Department of Neurosurgery, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Wagih Abu Rowin
- Department of Mechanical Engineering, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Ruhi S Humphries
- Climate Science Centre, CSIRO Oceans and Atmosphere, 107 Station Street, Aspendale, VIC, 3195, Australia
| | - Kevin Kevin
- Department of Mechanical Engineering, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Jason D Ward
- Climate Science Centre, CSIRO Oceans and Atmosphere, 107 Station Street, Aspendale, VIC, 3195, Australia
| | - Andrew Yule
- ARPANSA (Australian Radiation Protection and Nuclear Safety Agency), 619 Lower Plenty Road, Yallambie, VIC, 3085, Australia
| | - Tuong D Phan
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
- University of Melbourne, Parkville, Australia
| | - Yi Chen Zhao
- Department of Ear, Nose and Throat Surgery, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - David Wynne
- Department of Neurosurgery, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Peter M McNeill
- Department of Neurosurgery, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Nicholas Hutchins
- Department of Mechanical Engineering, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - David A Scott
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
- University of Melbourne, Parkville, Australia
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Jayakumar N, Hellwig S, Allison C, Stummer W, Holling M, Surash S. A Tale of Two Cities: Residents' Operative Experience in the United Kingdom and Germany During the Coronavirus Disease 2019 Pandemic. World Neurosurg 2021; 154:e428-e436. [PMID: 34280539 PMCID: PMC8285217 DOI: 10.1016/j.wneu.2021.07.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 12/23/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has had a detrimental effect on residents’ operative training. Our aim was to identify the proportion of procedures performed by residents across 2 neurosurgical centers (1 in the United Kingdom and 1 in Germany) during the pandemic-affected months of March 2020–May 2020, inclusive, compared with March 2019–May 2019, inclusive. Methods All neurosurgical procedures performed at the United Kingdom and German institutions, between March 1, 2019 and May 31, 2019 (pre-COVID months) and March 1, 2020 and May 31, 2020 (COVID months), were extracted and operative notes evaluated. Statistical analysis was performed on SPSS version 22. Results There was a statistically significant reduction in operative volume in the United Kingdom center from the pre-COVID months to the COVID months (χ2(5) = 84.917; P < 0.001) but no significant difference in the operative volume in the German center (P = 0.61). A Mann-Whitney U test showed a statistically significant difference in the volume of residents operating in the COVID months compared with pre-COVID months in both United Kingdom and German centers (P < 0.001). The average number of procedures performed by residents in the United Kingdom center as the primary surgeon decreased from 82 to 72 per month (pre-COVID vs. COVID months), whereas German residents’ operating volume increased from 68 to 89 per month (pre-COVID vs. COVID months). Conclusions The COVID-19 pandemic has significantly reduced the volume of operating by neurosurgical residents in the United Kingdom center, whereas residents in the German center performed more procedures compared with 2019. This finding may reflect variations in national practice on maintaining surgical activities and provision of critical care beds during the first wave of the pandemic.
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Affiliation(s)
- Nithish Jayakumar
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom.
| | - Sönke Hellwig
- Department of Neurosurgery, University Hospital Münster, Münster, North Rhine-Westphalia, Germany
| | - Callum Allison
- Medical School, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, North Rhine-Westphalia, Germany
| | - Markus Holling
- Department of Neurosurgery, University Hospital Münster, Münster, North Rhine-Westphalia, Germany
| | - Surash Surash
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
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Alvarez R, Kotecha R, McDermott MW, Siomin V. Awake craniotomy for glioblastoma in COVID-19–positive patients and delivering the standard of care: illustrative case. Journal of Neurosurgery: Case Lessons 2021; 2:CASE21246. [PMID: 35854955 PMCID: PMC9272361 DOI: 10.3171/case21246] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/05/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Providing the standard of care to patients with glioblastoma (GBM) during the novel coronavirus of 2019 (COVID-19) pandemic is a challenge, particularly if a patient tests positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Further difficulties occur in eloquent cortex tumors because awake speech mapping can theoretically aerosolize viral particles and expose staff. Moreover, microscopic neurosurgery has become difficult because the use of airborne-level personal protective equipment (PPE) crowds the space between the surgeon and the eyepiece. However, delivering substandard care will inevitably lead to disease progression and poor outcomes. OBSERVATIONS A 60-year-old man with a left insular and frontal operculum GBM was found to be COVID-19 positive. Treatment was postponed pending a negative SARS-CoV-2 result, but in the interim, he developed intratumoral hemorrhage with progressive expressive aphasia. Because the tumor was causing dominant hemisphere language symptomatology, an awake craniotomy was the recommended surgical approach. With the use of airborne-level PPE and a surgical drape to protect the surgeon from the direction of potential aerosolization, near-total gross resection was achieved. LESSONS Delaying the treatment of patients with GBM who test positive for COVID-19 will lead to further neurological deterioration. Optimal and timely treatment such as awake speech mapping for COVID-19–positive patients with GBM can be provided safely.
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Affiliation(s)
- Reinier Alvarez
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Rupesh Kotecha
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; and
| | - Michael W. McDermott
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
- Department of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida
| | - Vitaly Siomin
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; and
- Department of Neurosurgery, Miami Neuroscience Institute, Baptist Health South Florida, Miami, Florida
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Fiore G, Remore LG, Tariciotti L, Carrabba GG, Schisano L, Pluderi M, Bertani GA, Borsa S, Locatelli M. Does COVID-19 Affect Survival and Functional Outcome in Emergency and Urgent Neurosurgical Procedures? A Single-Center Prospective Experience During the Pandemic. World Neurosurg 2021; 153:e187-94. [PMID: 34166828 DOI: 10.1016/j.wneu.2021.06.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/16/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/21/2022]
Abstract
Objective To assess organizational and technical difficulties of neurosurgical procedures during the coronavirus disease 2019 (COVID-19) pandemic and their possible impact on survival and functional outcome and to evaluate virological exposure risk of medical personnel. Methods Data for all urgent surgical procedures performed in the COVID-19 operating room were prospectively collected. Preoperative and postoperative variables included demographics, pathology, Karnofsky performance status (KPS) and neurological status at admission, type and duration of surgical procedures, length of stay, postoperative KPS and functional outcome comparison, and destination at discharge. We defined 5 classes of pathologies (traumatic, oncological, vascular, infection, hydrocephalus) and 4 surgical categories (burr hole, craniotomy, cerebrospinal fluid shunting, spine surgery). Postoperative SARS-CoV-2 infection was checked in all the operators. Results We identified 11 traumatic cases (44%), 4 infections (16%), 6 vascular events (24%), 2 hydrocephalus conditions (8%), and 2 oncological cases (8%). Surgical procedures included 11 burr holes (44%), 7 craniotomies (28%), 6 cerebrospinal fluid shunts (24%), and 1 spine surgery (4%). Mean patient age was 57.8 years. The most frequent clinical presentation was coma (44 cases). Mean KPS score at admission was 20 ± 10, mean surgery duration was 85 ± 63 minutes, and mean length of stay was 27 ± 12 days. Mean KPS score at discharge was 35 ± 25. Outcome comparison showed improvement in 16 patients. Four patients died. Mean follow-up was 6 ± 3 months. None of the operators developed postoperative SARS-CoV-2 infection. Conclusions Standardized protocols are mandatory to guarantee a high standard of care for emergency and urgent surgeries during the COVID-19 pandemic. Personal protective equipment affects maneuverability, dexterity, and duration of interventions without affecting survival and functional outcome.
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Azab MA. Strategies to Offer Uninterrupted Neurosurgical Care at a Tertiary Center in Makka amid COVID-19 Pandemic. Asian J Neurosurg 2021; 16:271-275. [PMID: 34268150 PMCID: PMC8244686 DOI: 10.4103/ajns.ajns_324_20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/14/2020] [Accepted: 02/15/2021] [Indexed: 11/04/2022] Open
Abstract
Background Globally, there is a shooting pandemic that affected many healthcare systems. Healthcare facilities had to set up logistics to avoid being drained while facing a catastrophic health problem. There are currently no available vaccines or perfect therapies and also no certified immunity against that disease. Therefore, it is probable that healthcare systems will face it for an exceptionally long period. That will have a grave effect on the strategy of daily practice of different specialties' services at healthcare centers. Impossible decisions in usual workdays are now forcibly adopted for the sake of patients, care providers, and health resources. Methods We try in a simple way to share tertiary center expertise in managing neurosurgical cases amid a dreadful healthcare crisis. Healthcare workers' safety and patient safety were typical priorities for neurosurgical service at King Abdullah Medical City. We expose the lines of management, triaging cases, the methods of handling confirmed and suspected neurosurgical patients, and strategies for discharging and following up patients. We identified hospital admission and discharge records starting from March 2020 till July to track the neurosurgical case burden and the state of service offered and the rate of infection among healthcare workers who participated in surgeries. Results At the peak time of the COVID-19 pandemic in Makka starting from March till July, we have admitted 250 neurosurgical patients. About 210 (84%) of them did surgeries according to the triaging protocol described in the article. About 155 (62%) of those who did surgeries were urgent and the rest were borderline or semi-urgent. About 10 (4%) were severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and three of them died due to acute respiratory distress syndrome. Only two mortality cases were reported due to a neurological complication and not related to SARS-CoV-2 infection. The rest of the cases (98%) were discharged for follow-up without grave complications after they were offered the service. No neurosurgeons or anesthesia staff involved in offering the service were infected with SARS-CoV-2. Successful uninterrupted neurosurgical care was available for patients during that health crisis without any healthcare worker being infected. Conclusion Following the suggested strategies, any center can provide the healthcare service amid any pandemic happening now or in the future without dismantling the normal health system, especially for life-saving cases in a critical specialty as neurosurgery.
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Affiliation(s)
- Mohammed A Azab
- Department of Neurosurgery, King Abdullah Medical City, Makka, KSA
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21
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Azab MA, Azzam AY. Impact of COVID-19 pandemic on the management of glioma patients around the world. An evidence-based review. Brain Disord 2021; 2:100012. [PMID: 33997826 PMCID: PMC8106822 DOI: 10.1016/j.dscb.2021.100012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 04/09/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
Background The coronavirus pandemic has affected many health care services worldwide since the emergence of the first case in Wuhan. Surgical neuro-oncology care is a fundamental part of hospital services, making it susceptible to strategic changes amid the COVID-19 pandemic. Methods An electronic search on several databases (PubMed/Medline, Scopus, and Google Scholar) from the beginning of the pandemic to the end of 2020, each paper was reviewed independently. The publication inclusion and exclusion criteria were done using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Results Eight studies were found to be eligible for our meta-analysis. Most of the studies were on a retrospective basis, except one which was retrospective and prospective. An overall of 951 glioma patients’ were included for surgical admission from the beginning of the pandemic until 2020. Seventy-four patients' had mortality outcomes, and 250 patients had complications for both surgical admitted and non-surgical admitted purposes. Conclusions To our knowledge, we made the first systematic review and meta-analysis regarding the management of glioma patients’ during the pandemic of COVID-19. Our main findings are that the number of surgical admissions for glioma patients’ did not significantly differ between COVID-19 negative and COVD-19 positive cases; however, surprisingly, we found that both overall complications and mortality outcomes were more significant COVID-19 negative patients’ from the reported studies.
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Affiliation(s)
- Mohammed A Azab
- Department of Neurosurgery, Cairo University Faculty of Medicine, Cairo, Egypt
| | - Ahmed Y Azzam
- October 6 University Faculty of Medicine, Giza, Egypt
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Sahin B, Hanalioglu S. The Continuing Impact of Coronavirus Disease 2019 on Neurosurgical Training at the 1-Year Mark: Results of a Nationwide Survey of Neurosurgery Residents in Turkey. World Neurosurg 2021; 151:e857-e870. [PMID: 33974985 DOI: 10.1016/j.wneu.2021.04.137] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The impact of the coronavirus disease 2019 (COVID-19) pandemic has led to a significant transformation in medical practice and training. This nationwide survey study aims to evaluate the 1-year impact of the pandemic on training of neurosurgical residents. METHODS A 38-question Web-based survey was sent to 356 neurosurgery residents. Two hundred and thirty-five participated in the study (66% response rate), representing more than half of all neurosurgical residents in the country. RESULTS Assignment to direct COVID-19 medical care was common (85.5%). Many of the neurosurgery residents (37.9%) were tested positive for COVID-19. Almost half of the respondents reported a decrease in work hours. Most participants (84.3%) reported a decline in total operative case volume (mean change, -29.1% ± 1.6%), largely as a result of a decrease in elective (-33.2% ± 1.6%) as opposed to emergency cases (-5.1% ± 1.8%). For theoretic education, most respondents (54.9%) indicated a negative impact, whereas 25.1% reported a positive impact. For practical training, most respondents (78.7%) reported an adverse effect. A decrease in elective surgical case volume predicted a positive impact on theoretic training but a negative impact on practical training. Research productivity was reported by 33.2% to have decreased and by 23% to have increased. Forty-two percent indicated an increase in concerns about their training and career, with a negative impact on practical training being the most important predictor. Most (57.4%) had considered extending residency training to overcome negative effects of the pandemic. CONCLUSIONS COVID-19 has had a significant impact on neurosurgical practice and training. Effective measures should be used to mitigate these effects and better prepare for the future challenges.
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Affiliation(s)
- Balkan Sahin
- Department of Neurosurgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Sisli, Istanbul, Turkey
| | - Sahin Hanalioglu
- Department of Neurosurgery, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.
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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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Lyson T, Kisluk J, Alifier M, Politynska-Lewko B, Sieskiewicz A, Kochanowicz J, Reszec J, Niklinski J, Rogowski M, Konopinska J, Mariak Z, Carrau RL. Transnasal endoscopic skull base surgery in the COVID-19 era: Recommendations for increasing the safety of the method. Adv Med Sci 2021; 66:221-230. [PMID: 33744516 PMCID: PMC7931688 DOI: 10.1016/j.advms.2021.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/07/2020] [Revised: 02/03/2021] [Accepted: 03/01/2021] [Indexed: 12/18/2022]
Abstract
Transnasal endoscopic skull base surgery (eSBS) has been adopted in recent years, in great part to replace the extended procedures required by external approaches. Though sometimes perceived as “minimally invasive”, eSBS still necessitates extensive manipulations within the nose/paranasal sinuses. Furthermore, exposure of susceptible cerebral structures to light and heat emanated by the telescope should be considered to comprehensively evaluate the safety of the method. While the number of studies specifically targeting eSBS safety still remains scarce, the problem has recently expanded with the SARS-CoV-2 pandemic, which also has implications for the safety of the surgical personnel. It must be stressed that eSBS may directly expose the surgeon to potentially high volumes of virus-contaminated aerosol. Thus, the anxiety of both the patient and the surgeon must be taken into account. Consequently, safety requirements must follow the highest standards. This paper summarizes current knowledge on SARS-CoV-2 biology and the peculiarities of human immunology in respect of the host-virus relationship, taking into account the latest information concerning the SARS-CoV-2 worrisome affinity for the nervous system. Based on this information, a workflow proposal is offered for consideration. This could be useful not only for the duration of the pandemic, but also during the unpredictable timeline involving our coexistence with the virus. Recommendations include technical modifications to the operating theatre, personal protective equipment, standards of testing for SARS-CoV-2 infection, prophylactic pretreatment with interferon, anti-IL6 treatment and, last but not least, psychological support for the patient.
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25
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Alimohammadi E, Eden SV, Anand SK, Ahadi P, Bostani A, Bagheri SR. The impact of coronavirus 2019 (COVID-19) on neurosurgical practice and training: a review article. Br J Neurosurg 2021; 36:569-573. [PMID: 33612023 DOI: 10.1080/02688697.2021.1888874] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The 2019 coronavirus pandemic (COVID-19) has affected all of society at different levels. Similarly, COVID-19 has significantly impacted every medical field, including neurosurgery. By exposing scarcities in the healthcare industry and requiring the reallocation of available resources towards the priority setting and away from elective surgeries and outpatient visits, the pandemic posed new, unprecedented challenges to the medical community. Despite the redistribution of resources towards COVID-19 patients and away from elective surgeries, urgent and emergent surgeries for life-threatening conditions needed to be continued. The neurosurgical community, like other specialties not directly involved in the care of COVID-19 patients, initially struggled to balance the needs of COVID-19 patients with those of neurosurgical patients, residents, and researchers. Several articles describing the effect of COVID-19 on neurosurgical practice and training have been published throughout the COVID-19 pandemic. This article aims to provide a focused review of the impact COVID-19 has had on neurosurgical practice and training as well as describe neurological manifestations of the disease.
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Affiliation(s)
- Ehsan Alimohammadi
- Neurosurgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sonia V Eden
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Paniz Ahadi
- Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arash Bostani
- Neurology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Reza Bagheri
- Neurosurgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Pinggera D, Kerschbaumer J, Grassner L, Demetz M, Hartmann S, Thomé C. Effect of the COVID-19 Pandemic on Patient Presentation and Perception to a Neurosurgical Outpatient Clinic. World Neurosurg 2021; 149:e274-80. [PMID: 33610862 DOI: 10.1016/j.wneu.2021.02.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/29/2020] [Accepted: 02/09/2021] [Indexed: 12/23/2022]
Abstract
Background The world currently faces the novel COVID-19 pandemic, with cutbacks in patient care. Little is known about the effects of a pandemic on the presentation and admission to an outpatient clinic. Our aim was to gain a better understanding of the effects of reduced neurosurgical care access from the patient perspective, especially in terms of anxiety and urgency of treatment, and to improve outpatient management in case of a potential second wave and potential restrictions on health care. Methods We performed a questionnaire study over a period of 4 weeks following the COVID-19 lockdown at our academic neurosurgical department. A 15-item questionnaire was distributed to the patients with 3 additional questions to be answered by the treating neurosurgeon. Results A total of 437 questionnaires were analyzed. Overall anxiety to visit a general practitioner or the outpatient facility within the hospital was very low among patients. A quarter of all appointments had to be postponed due to COVID-19, in 0.6% postponement was perceived as incorrect by the treating neurosurgeon. We noted that 43% did not get an appointment due to the restrictions, 20% did not want to bother the medical system, and only 4% were afraid to get infected in the hospital. Conclusions Despite COVID-19, patients in need of neurosurgical service were hardly afraid to visit doctors and/or hospitals. Nonetheless, because legal requirements, access has been restricted, causing potential collateral damage in a small subset of neurosurgical patients.
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Ashkan K, Jung J, Velicu AM, Raslan A, Faruque M, Kulkarni P, Bleil C, Hasegawa H, Kailaya-Vasan A, Maratos E, Grahovac G, Vergani F, Zebian B, Barazi S, Malik I, Bell D, Walsh D, Bhangoo R, Tolias C, Bassi S, Selway R, Thomas N, Chandler C, Gullan R. Neurosurgery and coronavirus: impact and challenges-lessons learnt from the first wave of a global pandemic. Acta Neurochir (Wien) 2021; 163:317-29. [PMID: 33222008 DOI: 10.1007/s00701-020-04652-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 09/22/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022]
Abstract
Introduction and objectives The novel severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has had drastic effects on global healthcare with the UK amongst the countries most severely impacted. The aim of this study was to examine how COVID-19 challenged the neurosurgical delivery of care in a busy tertiary unit serving a socio-economically diverse population. Methods A prospective single-centre cohort study including all patients referred to the acute neurosurgical service or the subspecialty multidisciplinary teams (MDT) as well as all emergency and elective admissions during COVID-19 (18th March 2020–15th May 2020) compared to pre-COVID-19 (18th of January 2020–17th March 2020). Data on demographics, diagnosis, operation, and treatment recommendation/outcome were collected and analysed. Results Overall, there was a reduction in neurosurgical emergency referrals by 33.6% and operations by 55.6% during the course of COVID-19. There was a significant increase in the proportion of emergency operations performed during COVID-19 (75.2% of total, n=155) when compared to pre-COVID-19 (n = 198, 43.7% of total, p < 0.00001). In contrast to other published series, the 30-day perioperative mortality remained low (2.0%) with the majority of post-operative COVID-19-infected patients (n = 13) having underlying medical co-morbidities and/or suffering from post-operative complications. Conclusion The capacity to safely treat patients requiring urgent or emergency neurosurgical care was maintained at all times. Strategies adopted to enable this included proactively approaching the referrers to maintain lines of communications, incorporating modern technology to run clinics and MDTs, restructuring patient pathways/facilities, and initiating the delivery of NHS care within private sector hospitals. Through this multi-modal approach we were able to minimize service disruptions, the complications, and mortality.
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Dannhoff G, Cebula H, Chibbaro S, Ganau M, Todeschi J, Mallereau CH, Pottecher J, Proust F, Ollivier I. Investigating the real impact of COVID-19 pandemic on the daily neurosurgical practice? Neurochirurgie 2021; 67:99-103. [PMID: 33493541 PMCID: PMC7826024 DOI: 10.1016/j.neuchi.2021.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/15/2020] [Revised: 11/27/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to relate the neurosurgical activity during a time of sanitary crisis such as experienced during the SARS-CoV-2 pandemic. METHODS A monocentric retrospective analysis was made based on a prospectively gathered cohort of all patients requiring neurosurgical care between March 15th and May 12th, 2020. Local impact of SARS-CoV-2 was analysed regarding number of patients admitted in ICU. RESULTS One hundred and sixty patients could benefit from neurosurgical care with a wide-ranging profile of clinical and surgical activities performed during the study that seemed similar to last year profile activity. Surgical indications were restricted to non-deferrable surgeries, leading to a drop in operative volume of 50%. Only 1.3% of patients required transfer to other units due to the impossibility of providing gold standard neurosurgical care in our centre. CONCLUSION Despite the challenges represented by the SARS-CoV-2 pandemic, it was proven possible to ensure the routine neurosurgical continuity and provide high standards of neurosurgical care without compromising patients' access to the required treatments.
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Affiliation(s)
- G Dannhoff
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France.
| | - H Cebula
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - S Chibbaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - M Ganau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - J Todeschi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - C-H Mallereau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - J Pottecher
- ICU, Strasbourg University Hospital, Strasbourg, France
| | - F Proust
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - I Ollivier
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
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Salomão JFM. Presidential address-the Black Swan: ISPN and pediatric neurosurgery in times of COVID-19. Childs Nerv Syst 2021; 37:3293-301. [PMID: 34357426 DOI: 10.1007/s00381-021-05306-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 07/21/2021] [Indexed: 10/28/2022]
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Agrawal M, Tripathi M, Samala R, Doddamani R, Ramanujan B, Chandra PS. Epilepsy surgery in COVID times-a unique conundrum. Childs Nerv Syst 2021; 37:3219-3224. [PMID: 33839899 PMCID: PMC8036014 DOI: 10.1007/s00381-021-05048-4] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/14/2021] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic has forced hospitals to prioritize admissions. Epilepsy surgeries have been postponed at most centers. As the pandemic continues with no definite end in sight in the near future, the question arises until when such patients should be denied appropriate treatment. A 12-year-old child with left-sided Rasmussen's encephalitis with drug refractory epilepsy (DRE) presented at the height of the pandemic, with worsening of seizure frequency from 4-5/day to 20/day, with new-onset epilepsia partialis continua. She demonstrated features of progressive cognitive decline. The pros and cons of operating during the pandemic were discussed with the parents by a multidisciplinary team. She underwent endoscopic left hemispherotomy. Postoperatively she became seizure free but developed hospital-acquired mild COVID infection for which she was treated accordingly. Chosen cases of severe DRE, as the one illustrated above, who are deemed to benefit from surgery by a multidisciplinary team of physicians, should be re-categorized into the most severe class of patients and scheduled for surgery as soon as possible. The risk benefit ratio of the seizures being mitigated by surgery on one hand and possibility of acquiring COVID infection during hospital stay has to be balanced and a decision made accordingly.
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Affiliation(s)
- Mohit Agrawal
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, Room No. 607, New Delhi, 110029, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Raghu Samala
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, Room No. 607, New Delhi, 110029, India
| | - Ramesh Doddamani
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, Room No. 607, New Delhi, 110029, India
| | - Bhargavi Ramanujan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, Room No. 607, New Delhi, 110029, India.
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Alhaj AK, Al-Saadi T. Letter to the Editor: "Neurosurgery Practice during the Second Wave of COVID-19 Pandemic-Are We Prepared for the Upcoming Challenges?". World Neurosurg 2020; 145:521-522. [PMID: 33348498 DOI: 10.1016/j.wneu.2020.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Ahmad Kh Alhaj
- Neurosurgery Department, Ibn Sina Hospital, Ministry of Health, Kuwait, Kuwait
| | - Tariq Al-Saadi
- Department of Neurology & Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada.
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Okunlola AI. Awake craniotomy in a Covid-19 positive patient: The challenges and outcome. Interdiscip Neurosurg 2020; 24:101064. [PMID: 33520666 PMCID: PMC7834066 DOI: 10.1016/j.inat.2020.101064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/29/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
Background The SARS-COV-2 is a novel coronavirus which is the etiological agent of the COVID-19 infection. The neurosurgical practice is not exempted from the impact of the COVID-19 pandemic. Awake craniotomy in a COVID-19 positive patient pose a significant risk for theatre staff but intubation of a COVID-19 positive patient for surgery under general anesthesia also pose similar risk. Method Federal Teaching Hospital Ido Ekiti is a tertiary hospital in suburban community in Southwest Nigeria with 300-bed capacity. The hospital is a designated COVID-19 treatment centre. A 69-year-old female patient was referred from a nearby COVID-19 treatment hospital on account of left parieto-occipital high grade glioma. She had awake craniotomy and gross total tumor excision. Result There was no need to convert to general anesthesia and she had immediate post-operative neurological improvement. Repeat COVID-19 test on post-operative day 4 was negative and she was discharged home. Thirty-day post-operative review confirmed progressive motor gain. Conclusion Awake craniotomy in COVID-19 positive patient with appropriate use of necessary PPEs is achievable.
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Affiliation(s)
- Abiodun Idowu Okunlola
- Department of Surgery, Federal Teaching Hospital, Ido-Ekiti/Afe Babalola University, Ado-Ekiti, Nigeria
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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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Díaz-Bello S, Hernández-Hernández A, Guinto-Nishimura GY, Mondragón-Soto MG, Lem-Carrillo M, González-Aguilar A, Calleja-Castillo JM, Leyva-Rendón A, León-Ortiz P, Chávez-Piña CM, Pando-Tarín GA, Mejía-Pérez SI, Taboada-Barajas J, Zavala-Álvarez ED, Soto-Hernández JL, Cárdenas G, Gómez-Amador JL. Reconversion of neurosurgical practice in times of the SARS-CoV-2 pandemic: a narrative review of the literature and guideline implementation in a Mexican neurosurgical referral center. Neurosurg Focus 2020; 49:E4. [PMID: 33260129 DOI: 10.3171/2020.9.focus20553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/14/2020] [Accepted: 09/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has forced the modification of surgical practice worldwide. Medical centers have been adapted to provide an efficient arrangement of their economic and human resources. Although neurosurgeons are not in the first line of management and treatment of COVID-19 patients, they take care of patients with neurological pathology and potential severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, the authors describe their institutional actions against the pandemic and compare these actions with those in peer-reviewed publications. METHODS The authors conducted a search using the MEDLINE, PubMed, and Google Scholar databases from the beginning of the pandemic until July 11, 2020, using the following terms: "Neurosurgery," "COVID-19/SARS-CoV-2," "reconversion/modification," "practice," "academy," and "teaching." Then, they created operational guidelines tailored for their institution to maximize resource efficiency and minimize risk for the healthcare personnel. RESULTS According to the reviewed literature, the authors defined the following three changes that have had the greatest impact in neurosurgical practice during the COVID-19 pandemic: 1) changes in clinical practices; 2) changes in the medical care setting, including modifications of perioperative care; and 3) changes in the academic teaching methodology. CONCLUSIONS The Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez" is one of the major referral centers for treating highly complex neurosurgical pathologies in Mexico. Its clinical and neurosurgical practices have been modified with the implementation of specific interventions against the spread of COVID-19. These practical and simple actions are remarkably relevant in the context of the pandemic and can be adopted and suited by other healthcare centers according to their available resources to better prepare for the next event.
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Affiliation(s)
- Sergio Díaz-Bello
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Alan Hernández-Hernández
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Gerardo Y Guinto-Nishimura
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Michel G Mondragón-Soto
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Monica Lem-Carrillo
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Alberto González-Aguilar
- 2Neurological Emergencies.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Juan M Calleja-Castillo
- 2Neurological Emergencies.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Adolfo Leyva-Rendón
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Pablo León-Ortiz
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Carmen M Chávez-Piña
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,4Neuroanesthesiology
| | - Gustavo A Pando-Tarín
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,4Neuroanesthesiology
| | - Sonia I Mejía-Pérez
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,5Medical Education
| | - Jesús Taboada-Barajas
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,6Neuroradiology, and
| | - Elsa D Zavala-Álvarez
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - José L Soto-Hernández
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - Graciela Cárdenas
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - Juan L Gómez-Amador
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
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Pramusinto H, Tamba DA, Subagio Y, Numberi TJ, Pramujo B, Sinanu FL, Ariasthapuri G, Bismantara H, Meliala A. The adjustment of neurosurgical procedures during the COVID-19 pandemic: a case study at Dr. Sardjito General Hospital as a part of an academic health system. Neurosurg Focus 2020; 49:E8. [PMID: 33260132 DOI: 10.3171/2020.9.focus20699] [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: 08/01/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The recent COVID-19 outbreak has forced notable adjustments to surgical procedure preparation, including neurosurgical services. However, due to the uniqueness of the recent situation, neurosurgical centers, especially those located in low-resource settings, are facing several challenges such as a lack of coordination, poor equipment, and shortage of medical personnel. Therefore, several guidelines from local authorities and international neurosurgical bodies have been published to help clinicians manage their patients. In addition, the academic health system (AHS), which is an integrated system containing a medical institution, universities, and a teaching hospital, may play some role in the management of patients during COVID-19. The objective of this study was to describe how each hospital in the authors' network adjusted their neurosurgical practice and how the AHS of the Universitas Gadjah Mada (UGM) played its role in the adaptation process during the pandemic. METHODS The authors gathered both local and national data about the number of COVID-19 infections from the government's database. To assess the contribution of the AHS to the efforts of each hospital to address the pandemic, questionnaires were given to 6 neurosurgeons, 1 resident, and 2 general surgeons about the management of neurosurgical cases during the pandemic in their hospitals. RESULTS The data illustrate various strategies to manage neurosurgical cases by hospitals within the authors' networks. The hospitals were grouped into three categories based on the transmission risk in each region. Most of these hospitals stated that UGM AHS had a positive impact on the changes in their strategies. In the early phase of the outbreak, some hospitals faced a lack of coordination between hospitals and related stakeholders, inadequate amount of personal protective equipment (PPE), and unclear regulations. As the nation enters a new phase, almost all hospitals had performed routine screening tests, had a sufficient amount of PPE for the medical personnel, and followed both national and international guidelines in caring for their neurosurgical patients. CONCLUSIONS The management of neurosurgical procedures during the outbreak has been a challenging task and a role of the AHS in improving patient care has been experienced by most hospitals in the authors' network. In the future, the authors expect to develop a better collaboration for the next possible pandemic.
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Affiliation(s)
- Handoyo Pramusinto
- 1Division of Neurosurgery, Department of Surgery, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta
| | - Daniel Agriva Tamba
- 1Division of Neurosurgery, Department of Surgery, Universitas Gadjah Mada, Yogyakarta, Special Region of Yogyakarta
| | - Yoyok Subagio
- 2Division of Neurosurgery, Muhammadiyah University Hospital, Malang, East Java
| | - Tommy J Numberi
- 3Division of Neurosurgery, Jayapura General Hospital, Jayapura, Papua
| | - Bangun Pramujo
- 4Division of Neurosurgery, Dr. Midiyato Suratani Naval Hospital, Tanjung Pinang, Riau Islands
| | - Franklin L Sinanu
- 5Division of Neurosurgery, Undata General Hospital, Palu, Central Sulawesi; and
| | - Gheanita Ariasthapuri
- 6Department of Health Policy and Management, Universitas Gadjah Mada, Special Region of Yogyakarta, Indonesia
| | - Haryo Bismantara
- 6Department of Health Policy and Management, Universitas Gadjah Mada, Special Region of Yogyakarta, Indonesia
| | - Andreasta Meliala
- 6Department of Health Policy and Management, Universitas Gadjah Mada, Special Region of Yogyakarta, Indonesia
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Rahman M, Shrivastava A, Moscote-salazar LR, Kosgi S, Agrawal A. Letter to the Editor Regarding “COVID-19's Impact on Neurosurgical Training in Southeast Asia”. World Neurosurg 2020; 144:331. [DOI: 10.1016/j.wneu.2020.08.190] [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] [Received: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/18/2022]
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Sahoo SK, Dhandapani S, Singh A, Gendle C, Karthigeyan M, Salunke P, Aggarwal A, Singla N, Singla R, Tripathi M, Chhabra R, Mohindra S, Tewari MK, Mohanty M, Bhagat H, Chakrabarti A, Gupta SK. COVID-19: changing patterns among neurosurgical patients from North India, efficacy of repeat testing, and inpatient prevalence. Neurosurg Focus 2020; 49:E7. [PMID: 33260131 DOI: 10.3171/2020.9.focus20705] [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] [Received: 08/01/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVECOVID-19 has affected surgical practice globally. Treating neurosurgical patients with the restrictions imposed by the pandemic is challenging in institutions with shared patient areas. The present study was performed to assess the changing patterns of neurosurgical cases, the efficacy of repeated testing before surgery, and the prevalence of COVID-19 in asymptomatic neurosurgical inpatients.METHODSCases of non–trauma-related neurosurgical patients treated at the Postgraduate Institute of Medical Education and Research (PGIMER) before and during the COVID-19 pandemic were reviewed. During the pandemic, all patients underwent a nasopharyngeal swab reverse transcription–polymerase chain reaction test to detect COVID-19 at admission. Patients who needed immediate intervention were surgically treated following a single COVID-19 test, while stable patients who initially tested negative for COVID-19 were subjected to repeated testing at least 5 days after the first test and within 48 hours prior to the planned surgery. The COVID-19 positivity rate was compared with the local period prevalence. The number of patients who tested positive at the second test, following a negative first test, was used to determine the probable number of people who could have become infected during the surgical procedure without second testing.RESULTSOf the total 1769 non–trauma-related neurosurgical patients included in this study, a mean of 337.2 patients underwent surgery per month before COVID-19, while a mean of 184.2 patients (54.6% of pre–COVID-19 capacity) underwent surgery per month during the pandemic period, when COVID-19 cases were on the rise in India. There was a significant increase in the proportion of patients undergoing surgery for a ruptured aneurysm, stroke, hydrocephalus, and cerebellar tumors, while the number of patients seeking surgery for chronic benign diseases declined. At the first COVID-19 test, 4 patients (0.48%) tested were found to have the disease, a proportion 3.7 times greater than that found in the local community. An additional 5 patients tested positive at the time of the second COVID-19 test, resulting in an overall inpatient period prevalence of 1%, in contrast to a 0.2% national cumulative caseload. It is possible that COVID-19 was prevented in approximately 67.4 people every month by using double testing.CONCLUSIONSCOVID-19 has changed the pattern of neurosurgical procedures, with acute cases dominating the practice. Despite the fact that the pandemic has not yet reached its peak in India, COVID-19 has been detected 3.7 times more often in asymptomatic neurosurgical inpatients than in the local community, even with single testing. Double testing displays an incremental value by disclosing COVID-19 overall in 1 in 100 inpatients and thus averting its spread through neurosurgical services.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Arunaloke Chakrabarti
- 3Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Wittayanakorn N, Nga VDW, Sobana M, Bahuri NFA, Baticulon RE. Impact of COVID-19 on Neurosurgical Training in Southeast Asia. World Neurosurg 2020; 144:e164-e177. [PMID: 32805466 PMCID: PMC7428452 DOI: 10.1016/j.wneu.2020.08.073] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 07/20/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Neurosurgery departments worldwide have been forced to restructure their training programs because of the coronavirus disease 2019 (COVID-19) pandemic. In this study, we describe the impact of COVID-19 on neurosurgical training in Southeast Asia. METHODS We conducted an online survey among neurosurgery residents in Indonesia, Malaysia, Philippines, Singapore, and Thailand from May 22 to 31, 2020 using Google Forms. The 33-item questionnaire collected data on elective and emergency neurosurgical operations, ongoing learning activities, and health worker safety. RESULTS A total of 298 of 470 neurosurgery residents completed the survey, equivalent to a 63% response rate. The decrease in elective neurosurgical operations in Indonesia and in the Philippines (median, 100% for both) was significantly greater compared with other countries (P < 0.001). For emergency operations, trainees in Indonesia and Malaysia had a significantly greater reduction in their caseload (median, 80% and 70%, respectively) compared with trainees in Singapore and Thailand (median, 20% and 50%, respectively; P < 0.001). Neurosurgery residents were most concerned about the decrease in their hands-on surgical experience, uncertainty in their career advancement, and occupational safety in the workplace. Most of the residents (n = 221, 74%) believed that the COVID-19 crisis will have a negative impact on their neurosurgical training overall. CONCLUSIONS An effective national strategy to control COVID-19 is crucial to sustain neurosurgical training and to provide essential neurosurgical services. Training programs in Southeast Asia should consider developing online learning modules and setting up simulation laboratories to allow trainees to systematically acquire knowledge and develop practical skills during these challenging times.
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Affiliation(s)
- Nunthasiri Wittayanakorn
- Division of Neurosurgery, Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | | | - Mirna Sobana
- Division of Pediatric Neurosurgery, Hasan Sadikin Hospital/Padjadjaran University, Bandung, West Java, Indonesia
| | | | - Ronnie E Baticulon
- Division of Neurosurgery, Philippine General Hospital, and Department of Anatomy, College of Medicine, University of the Philippines Manila, Manila, Philippines.
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Hoz SS, Al-Sharshahi ZF, Dolachee AA, Matti WE. Letter to the Editor: "Beyond Containment: Tracking the Impact of Coronavirus Disease 2019 (COVID-19) on Neurosurgery Services in Iraq". World Neurosurg 2020; 143:619-620. [PMID: 33167145 PMCID: PMC7608015 DOI: 10.1016/j.wneu.2020.08.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Samer S Hoz
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | | | - Ali A Dolachee
- Department of Surgery, College of Medicine, University of Al-Qadisiyah, Diwaniyah, Iraq
| | - Wamedh E Matti
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
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Tata N, Dahdaleh NS. Letter to the Editor. Philosophical underpinnings of neurosurgical decision-making in the time of the coronavirus pandemic. J Neurosurg 2020; 134:1017-1018. [PMID: 33186912 DOI: 10.3171/2020.9.jns203459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Cheserem JB, Esene IN, Mahmud MR, Kalangu K, Sanoussi S, Musara A, El-Ghandour NMF, Fieggen G, Qureshi M. A Continental Survey on the Impact of COVID-19 on Neurosurgical Training in Africa. World Neurosurg 2020; 147:e8-e15. [PMID: 33186788 PMCID: PMC7834456 DOI: 10.1016/j.wneu.2020.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 08/13/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 12/21/2022]
Abstract
Background Containment measures for COVID-19 have affected surgical training globally. We sought to assess how neurosurgical training has been affected across Africa in April 2020. Methods A cross-sectional survey was distributed to African Neurosurgical trainees seeking to review demographics and effects of COVID on training. Results A total of 123 neurosurgery trainees responded from 23 African countries and a further 6 were abroad. A total of 91.80% were men, and 96.70% were training in public institutions. Only 41% had received training in COVID-19 with 61.79% worried that they would contract COVID-19 while performing their clinical duties. There was a marked reduction in clinical activities including a median reduction of elective surgery (−80%), clinics (−83%), and emergency surgery (−38.50%). A total of 23.58% of residents did not receive a formal salary, with 50% on less than $1000 USD gross per month. Conclusions This is the first continental survey of neurosurgery trainees in Africa. COVID-19 has significantly affected clinical and learning opportunities. There are concerns of the long-term effects on their training activities for an uncertain period of time during this pandemic. Although there has been a global increase in e-learning, there is need to evaluate if this is accessible to all trainees.
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Affiliation(s)
- Jebet Beverly Cheserem
- Department of Neurosurgery, Weill Cornell, New York, New York, USA; Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya.
| | - Ignatius N Esene
- Department of Neurosurgery, University of Bamenda, Bamenda, Cameroon
| | - Muhammad Raji Mahmud
- Neurosurgery Unit, Department of Surgery, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Kazadi Kalangu
- Department of Neurosurgery, University of Zimbabwe, Harare, Zimbabwe
| | - Samuila Sanoussi
- Department of Neurosurgery, Niamey National Hospital, Niamey, Niger Republic
| | - Aaron Musara
- Department of Neurosurgery, University of Zimbabwe, Harare, Zimbabwe
| | | | - Graham Fieggen
- Department of Neurosurgery, University of Cape Town, Cape Town, South Africa
| | - Mahmood Qureshi
- Department of Neurosurgery, Aga Khan University Hospital, Nairobi, Kenya
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Dowlati E, Zhou T, Sarpong K, Pivazyan G, Briscoe J, Fayed I, Mualem W, Black J, Kalhorn CG, Nair MN, Felbaum DR. Case Volumes and Perioperative Coronavirus Disease 2019 Incidence in Neurosurgical Patients During a Pandemic: Experiences at Two Tertiary Care Centers in Washington, DC. World Neurosurg 2020; 143:e550-e560. [PMID: 32777390 PMCID: PMC7834543 DOI: 10.1016/j.wneu.2020.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 07/14/2020] [Accepted: 08/02/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The true incidence of perioperative coronavirus disease 2019 (COVID-19) has not been well elucidated in neurosurgical studies. We reviewed the effects of the pandemic on the neurosurgical case volume to study the incidence of COVID-19 in patients undergoing these procedures during the perioperative period and compared the characteristics and outcomes of this group to those of patients without COVID-19. METHODS The neurosurgical and neurointerventional procedures at 2 tertiary care centers during the pandemic were reviewed. The case volume, type, and acuity were compared to those during the same period in 2019. The perioperative COVID-19 tests and results were evaluated to obtain the incidence. The baseline characteristics, including a modified Medically Necessary Time Sensitive (mMeNTS) score, and outcome measures were compared between those with and without COVID-19. RESULTS A total of 405 cases were reviewed, and a significant decrease was found in total spine, cervical spine, lumbar spine, and functional/pain cases. No significant differences were found in the number of cranial or neurointerventional cases. Of the 334 patients tested, 18 (5.4%) had tested positive for COVID-19. Five of these patients were diagnosed postoperatively. The mMeNTS score, complications, and case acuity were significantly different between the patients with and without COVID-19. CONCLUSION A small, but real, risk exists of perioperative COVID-19 in neurosurgical patients, and those patients have tended to have a greater complication rate. Use of the mMeNTS score might play a role in decision making for scheduling elective cases. Further studies are warranted to develop risk stratification and validate the incidence.
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Affiliation(s)
- Ehsan Dowlati
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
| | - Tianzan Zhou
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Kwadwo Sarpong
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Gnel Pivazyan
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Jessica Briscoe
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Islam Fayed
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - William Mualem
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Jordan Black
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Christopher G Kalhorn
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Mani N Nair
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Daniel R Felbaum
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA; Department of Neurosurgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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Marini A, Iacoangeli M, Dobran M. Letter to the Editor Regarding "Coronavirus Disease 2019 (COVID-19) and Neurosurgery: Literature and Neurosurgical Societies Recommendations Update". World Neurosurg 2020; 141:536-537. [PMID: 32470608 PMCID: PMC7255196 DOI: 10.1016/j.wneu.2020.05.160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Alessandra Marini
- Clinic of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, and Department of Neurosurgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy.
| | - Maurizio Iacoangeli
- Clinic of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, and Department of Neurosurgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
| | - Mauro Dobran
- Clinic of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, and Department of Neurosurgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy
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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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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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Al-Saadi T, Al-Kalbani H, Lam J. Letter to the Editor: Spinal and Neurosurgical Publications During the COVID-19 Era. World Neurosurg 2020; 141:562-563. [PMID: 32741738 PMCID: PMC7392593 DOI: 10.1016/j.wneu.2020.06.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Tariq Al-Saadi
- Department of Neurology & Neurosurgery, Montreal Neurological Institute-Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, Khoula Hospital, Muscat, Sultanate of Oman.
| | - Humaid Al-Kalbani
- Department of Ophthalmology, Al-Nahdha Hospital, Muscat, Sultanate of Oman
| | - Jack Lam
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Angileri FF, Sabatino G, Cavallo LM, Pessina F, Ius T, DE Divitiis O, Esposito F, Grimod G, Raffa G, Spena G, Cardali S, Esposito V, GermanÒ A, Maiuri F, Fontanella M, Cenzato M. Natura non facit saltus: a phase 2 proposal to manage brain tumors cases from the Neuro-oncology section of the Italian Society of Neurosurgery (SINch®). J Neurosurg Sci 2020; 65:1-7. [PMID: 32525292 DOI: 10.23736/s0390-5616.20.05054-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The Coronavirus (COVID-19) pandemic has fast spread throughout the world in more than 200 countries, resulting in the need for a de-prioritization of elective medical care to face the demands of the global health crisis. Although the acute and catastrophic phase of the pandemic seems to have been left behind, it is also clear that the virus will not disappear soon, and we must live with it for a period of unpredictable length, the COVID-19 era. In this setting, a common coordinated approach to treat patients harboring brain tumors is urgently required to guarantee the best updated oncological care and to reduce the risk of viral infection during hospitalization. The study group on Neuro-oncology of Italian Society of Neurosurgery, SINCh gathered pieces of evidence and data and would like to suggest a practice protocol of care for neurosurgical oncologic procedures in the COVID-19 era. The present document aimed at summarizing current evidence and expert opinions to help neurosurgeons in taking decisions on their patients harboring different brain tumors.
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Affiliation(s)
- Filippo F Angileri
- Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy -
| | - Giovanni Sabatino
- Unit of Neurosurgery, Department of Neurosciences, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Luigi M Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Federico II University, Naples, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
| | - Tamara Ius
- Unit of Neurosurgery, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Oreste DE Divitiis
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Federico II University, Naples, Italy
| | - Felice Esposito
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Federico II University, Naples, Italy
| | - Gianluca Grimod
- Unit of Neurosurgery, Department of Neurosciences, A. Manzoni Hospital, Lecco, Italy
| | - Giovanni Raffa
- Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giannantonio Spena
- Unit of Neurosurgery, Department of Neurosciences, A. Manzoni Hospital, Lecco, Italy
| | - Salvatore Cardali
- Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Vincenzo Esposito
- Sapienza University, Rome, Italy.,G. Cantore Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Antonino GermanÒ
- Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Francesco Maiuri
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Federico II University, Naples, Italy
| | - Marco Fontanella
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Cenzato
- Department of Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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