Neurosurgical Practice During Coronavirus Disease 2019 (COVID-19) Pandemic

Lessons learned during COVID-19 pandemic, a worldwide survey: evolution of global neurosurgical practice

BACKGROUND

During the COVID-19 pandemic, a multitude of surveys have analyzed the impact virus spreading on the everyday medical practice, including neurosurgery. However, none have examined the perceptions of neurosurgeons towards the pandemic, their life changes, and the strategies they implemented to be able to deal with their patients in such a difficult time.

METHODS

From April 2021 to May 2021 a modified Delphi method was used to construct, pilot, and refine the questionnaire focused on the evolution of global neurosurgical practice during the pandemic. This survey was distributed among 1000 neurosurgeons; the responses were then collected and critically analyzed.

RESULTS

Outpatient department practices changed with a rapid rise in teleservices. 63.9% of respondents reported that they have changed their OT practices to emergency cases with occasional elective cases. 40.0% of respondents and 47.9% of their family members reported to have suffered from COVID-19. 56.2% of the respondents reported having felt depressed in the last 1 year. 40.9% of respondents reported having faced financial difficulties. 80.6% of the respondents found online webinars to be a good source of learning. 47.8% of respondents tried to improve their neurosurgical knowledge while 31.6% spent the extra time in research activities.

CONCLUSIONS

Progressive increase in operative waiting lists, preferential use of telemedicine, reduction in tendency to complete stoppage of physical clinic services and drop in the use of PPE kits were evident. Respondents' age had an impact on how the clinical services and operative practices have evolved. Financial concerns overshadow mental health.

COVID-19- Experiences and support needs of children and young people with Hydrocephalus and parents in the United Kingdom

PURPOSE

Little is known about the impact of COVID-19 on children and young people (CYP) with hydrocephalus and their families. This study explored the experiences and support needs of CYP with hydrocephalus and parents who have a child with hydrocephalus during the COVID-19 pandemic.

METHODS

CYP with hydrocephalus and parents of CYP with hydrocephalus in the United Kingdom completed an online survey with open and closed questions exploring experiences, information, support needs and decision making processes. Qualitative thematic content analysis and descriptive quantitative analyses were undertaken.

RESULTS

CYP aged 12-32 years (n=25) and parents of CYP aged 0-20 years (n=69) responded. Parents (63.5%) and CYP (40.9%) worried about the virus, and both were vigilant for virus symptoms (86.5% and 57.1%). Parents (71.2%) and CYP (59.1%) worried about their child/feeling more isolated during the virus outbreak. Parents felt concerned about having to take their child to hospital with a suspected shunt problem during the virus outbreak (64.0%). Qualitative findings reported the following themes: (1) Healthcare and treatment provision: delays and challenges to access and availability of care (2) Impact of COVID-19/lockdown on daily lives and routines, and (3) Provision of information and support for parents and CYP with hydrocephalus.

CONCLUSION

The impact of COVID-19 and national measures to control the spread of the virus- no contact with anyone outside the household significantly impacted the daily lives and routines of CYP with hydrocephalus and parents. Social engagements were missed, families faced challenges to their work life, education and access to health care and support, which subsequently contributed negatively to their mental wellbeing. CYP and parents highlighted a need for clear, timely and targeted information to address their concerns.

COVID-19 and Surgical Practice in Slovenia: Managing the Crisis in Neurosurgery during the COVID-19 Pandemic

Worldwide, the novel coronavirus disease 2019 (COVID-19) has become a significant threat to global health. Worldwide, COVID-19 has affected the health service also in Slovenia. During this time, neurosurgery is facing difficulties in its service, both in emergency and elective surgeries. In the article, we describe the anti-COVID-19 measures taken at our neurosurgical department in a medical centre in Ljubljana, Slovenia, and analysed and compared the number of emergency and elective neurosurgical procedures during the time of the pandemic.

Telemedicine Utilization in an Outpatient Pediatric Neurosurgical Clinic: A Prospective Survey of Patient and Family Preferences

OBJECTIVE

After becoming widespread during the COVID-19 pandemic, telemedicine continues to play an important role in outpatient neurosurgical care. Nevertheless, the factors that influence individual decisions to choose telemedicine versus in-person appointments remain understudied. Here, we performed a prospective survey of pediatric neurosurgical patients and caregivers presenting for telemedicine or in-person outpatient visits, to identify factors associated with appointment choice.

METHODS

All patients and caregivers with an outpatient pediatric neurosurgical encounter at Connecticut Children's between January 31st and May 20th, 2022, were invited to participate in this survey. Data related to demographics, socioeconomics, technological access, COVID-19 vaccination status, and appointment preferences were collected.

RESULTS

During the study period, there were 858 unique pediatric neurosurgical outpatient encounters (86.1% in-person and 13.9% telemedicine). A total of 212 (24.7%) respondents completed the survey. Those with a telemedicine appointment were more likely to be white (P = 0.005), not Hispanic or Latino (P = 0.020), have private insurance (P = 0.003), be established patients (P < 0.001), have a household income >$80,000 (P = 0.005), and have caregivers who completed a 4-year college degree (P < 0.001). Those who were seen in-person cited the patient's condition, quality of care, and communication as important factors, whereas those who were seen via telemedicine cited time, travel, and convenience.

CONCLUSIONS

While convenience influences some to choose telemedicine, concerns regarding the quality of care persist among those who prefer in-person encounters. Recognizing these factors will minimize barriers to care, better define the appropriate populations/contexts for each encounter type, and improve the integration of telemedicine within an outpatient neurosurgical setting.

The effect of COVID-19 process on patients with endocrinological disease in a pandemic hospital: What happened to the others?

Objective

To evaluate the effects of the pandemic process on those with an endocrinological disease that will require close follow-up from the last visit before the pandemic.

Materials and Methods

Patients of 3,903 with thyroid, calcium-bone metabolism, adrenal gland, pituitary diseases, and neuroendocrine tumor (NET) were retrospectively scanned. The remaining 855 (656 females and 199 males) patients with active disease or who still needed multidisciplinary approaches were included. The number of patients who continued the disease-related medical procedures and could complete these procedures on time in the pandemic period was determined, and medical deprivation rate (MDR) was calculated.

Results

The prepandemic period of our patients with thyroid disease (n = 594), calcium-bone metabolism disorder (n = 130), adrenal disease (n = 85), pituitary disease, and NET (n = 46) had MDRs of 85%, 56%, 81%, and 89%, respectively. For each subgroup of patients, the lowest MDR (67%) was in medullary thyroid carcinoma, the highest MDR (89%) was in differentiated thyroid carcinoma; the lowest MDR (6%) was in osteoporosis, the highest MDR (100%) was in the active Paget's disease; the lowest MDR (0%) was in primary adrenocortical insufficiency, the highest MDR (100%) was in hyperfunctional adrenal adenomas; the lowest MDR (81%) was in pituitary nonfunctional adenomas, and the highest MDR (100%) was in Cushing's disease, active prolactinoma, TSHoma, and NET, respectively.

Conclusion

This study showed that not only those who had COVID-19 but also those who had medical deprivation due to their current endocrinological disease were not to be underestimated during the pandemic period.

Problematics of neurosurgical service during the COVID-19 pandemic in Slovenia

The novel coronavirus disease 2019 (COVID-19) is an ongoing disease caused by severe acute respiratory syndrome coronavirus-2 that still poses an important and urgent threat to global health. In Slovenia, the epidemic was declared on March 12th, 2020, and since then COVID-19 has had a great impact on our health system. The field of neurosurgery in particular has been experiencing difficulties in both elective and emergency service. In this article, we described epidemiologic protocols and the effect that the COVID-19 pandemic had on the surgical practice and workflow of the Department of Neurosurgery at the University Medical Centre Ljubljana. We analyzed and compared the number of elective and emergency neurosurgical procedures in a 2-year period before and during the pandemic. We recorded a drop in cases mostly on account of elective procedures whilst emergency service remained relatively unaffected.

The Increased Mortality Rate with Lower Incidence of Traumatic Brain Injury during the COVID-19 Pandemic: A National Study

BACKGROUND

the COVID-19 pandemic with the following lockdown strategies have affected virtually all aspects of everyday life. Health services all over the world faced the crisis on an unprecedented scale, hampering timely care delivery. The present study was designed to assess the impact of the COVID-19 outbreak on the incidence and treatment of traumatic brain injuries in Poland.

METHODS

the data on hospital admissions with traumatic brain injuries as the primary diagnosis were extracted from the National Health Fund of Poland. For the purpose of this study, the search was limited to four relevant diagnosis-related groups. The overall in-house mortality was calculated.

RESULTS

there were 115,200 hospitalizations due to traumatic brain injury identified in the database. Overall, in comparison with the average of six prior years, in 2020 the volume of patients with traumatic brain injury dropped by 24.68% while the in-house mortality rate was increased by 26.75%.

CONCLUSIONS

the COVID-19 pandemic with the resulting lockdown caused a radical reduction in human mobility. It had a profound impact on the incidence of traumatic brain injury, which dropped significantly. At the same time, the mortality rate increased drastically.

Evaluation of a Role for Virtual Neurosurgical Education for Medical Students Over 2 Years of a Global Pandemic

BACKGROUND

Subinternships are critical experiences for medical students applying into neurosurgery to acquire knowledge of the field and network with colleagues. During the coronavirus disease 2019 pandemic, in-person rotations were suspended for 2020 and reduced for 2021. In 2020, our department developed a neurosurgical course to address this need. The course was continued in 2021, enabling assessment of student perceptions as the pandemic progresses.

METHODS

The virtual course consisted of weekly 1-hour seminars over a 3- to 4-month period. Prior to starting, participants were sent a comprehensive survey assessing their backgrounds, experiences, and confidences in core concepts across neurosurgical subdisciplines. Participants also completed postcourse surveys assessing the course's value and their confidence in the same topics. Responses from students completing both precourse and postcourse surveys were included, analyzed in pairwise fashion, and compared across course years.

RESULTS

Students shared similar baseline characteristics in terms of demographics, educational background, and exposure to neurosurgery prior to the course. In the 2020 and 2021 cohorts, quality ratings for presentations were favorable for all seminars, and participants reported significantly increased confidence in core topics across all neurosurgical disciplines after the course (2020: 3.36 ± 0.26, P < 0.0001; 2021: 3.56 ± 0.93, P = 0.005). Most participants felt the course would remain useful following the pandemic in both the 2020 (96.9%) and 2021 (100.0%) cohorts.

CONCLUSIONS

Survey results suggest that the course adds value for students seeking a basic didactic curriculum to supplement their education, and perhaps, an online curriculum for medical students would still be beneficial going forward as in-person rotations resume.

How has the COVID-19 pandemic impacted clinical care and research in Neuro-Oncology?

The COVID-19 pandemic has challenged the continued delivery of healthcare globally. Due to disease risk, clinicians were forced to re-evaluate the safety and priorities of pre-pandemic care. Neuro-oncology presents unique challenges, as patients can deteriorate rapidly without intervention. These challenges were also observed in countries with reduced COVID-19 burden with centres required to rapidly develop strategies to maintain efficient and equitable care. This review aims to summarise the impact of the pandemic on clinical care and research within the practice of Neuro-oncology. A narrative review of the literature was performed using MEDLINE and EMBASS and results screened using PRISMA guidelines with relevant inclusion and exclusion criteria. Search strategies included variations of ‘Neuro-oncology’ combined with COVID-19 and other clinical-related terms. Most adult and paediatric neurosurgical centres experienced reductions in new referrals and operations for brain malignancies, and those who did present for treatment frequently had operations cancelled or delayed. Many radiation therapy and medical oncology centres altered treatment plans to mitigate COVID-19 risk for patients and staff. New protocols were developed that aimed to reduce in-person visits and reduce the risk of developing severe complications from COVID-19. The COVID-19 pandemic has presented many challenges to the provision of safe and accessible healthcare. Despite these challenges, some benefits to healthcare provision such as the use of telemedicine are likely to remain in future practice. Neuro-oncology staff must remain vigilant to ensure patient and staff safety.

Resources for Operative Neurosurgical Education Among Trainees in the Philippines

BACKGROUND

Operative neurosurgical skills education is a vital part of neurosurgical training, and these skills are usually obtained through operating room experience and supplemented by textbooks and other resources. We aimed to determine the resources used by trainees in the Philippines, both prior to and after the onset of the coronavirus disease 2019 pandemic.

METHODS

An online survey was sent to neurosurgical trainees in the Philippines from January to March 2021. Data on demographics, educational resources used, and weekly hours spent on each were collected, for both the pre- and post-coronavirus disease 2019 periods.

RESULTS

A total of 37 neurosurgical trainees (60% response rate) participated in the survey. Most respondents were female (70%), in their senior levels (58%), and undergoing training in a public institution (65%). The main resources for operative neurosurgical education were operative experience, online academic resources, and neurosurgical textbooks. After the onset of the pandemic, the overall time spent decreased to 61.2 hours/week from 67.7 hours/week, with a significant reduction in the hours spent on operative experience (27.3 vs. 21.3 hours/week, P < 0.0001) and a significant increase in the time spent on webinars (0 vs. 3.2 hours/week, P < 0.0001) and online resources as a whole (14.9 vs. 16.4 hours/week, P = 0.0003).

CONCLUSIONS

Operative experience, online academic resources, and neurosurgical textbooks were the main resources for operative neurosurgical education among trainees in the Philippines. After the onset of the pandemic, the hours spent on operative experience decreased and online academic resources increased significantly. New avenues of neurosurgical education, particularly webinars, also became available locally.

A Nationwide Study on the Impact of COVID-19 Pandemic on Volume of Spine Surgery in South Korea

OBJECTIVE

In March 2020, World Health Organization declared a global pandemic caused by a novel coronavirus (SARS-CoV-2). The disease caused by this virus is called COVID-19. Due to its high contagiousness, many changes have occurred in overall areas of our daily life including hospital use by patients. The aim of this study was to investigate the impact of COVID-19 on volume of spine surgery in South Korea using the National Health Insurance database and compare it with the volume of a homologous period before the pandemic.

METHODS

Data of related to spine surgery from January 2019 to April 2021 were obtained from the National Health Insurance and Health Insurance Review and Assessment Service database. Primary outcomes were total number of patients, rate of patients per 100000 population, and total number of procedures. The number of patients by hospital size was also analyzed.

RESULTS

COVID-19 outbreaks occurred in South Korea in March, August, and December of 2020. Compared to the previous year, the total number of patients who underwent spinal surgery showed a decrease for 2-3 months after the first and second outbreaks. However, it showed an increasing trend after the third outbreak. The same pattern was observed in terms of the ratio of the number of patients per 100000 population. Between 2019 and 2021, the mean number of spine surgeries per month tended to increase. Mean annual medical expenses increased over the years (p=0.001). When the number of spine surgeries was analyzed by hospital size, proportion of tertiary general hospital in 2021 increased compared to those in 2019 and 2020 (vs. 2019, p=0.012; vs. 2020, p=0.016). The proportion of general hospital was significantly decreased in 2020 compared to that in 2019 (p=0.037).

CONCLUSION

After the COVID-19 outbreak, patients tended to postpone spinal surgery temporarily. The number of spinal surgeries decreased for 2-3 months after the first and second outbreaks. However, as the ability to respond to the COVID-19 pandemic at the hospital and society-wide level gradually increased, the number of spine surgeries did not decrease after the third outbreak in December 2020. In addition, the annual number of spine surgeries continued to increase. However, it should be noted that patients tend to be increasingly concentrated in tertiary hospitals for spinal surgery.

Control of airborne particles in surgical procedures during the Covid-19 pandemic: scoping review

OBJECTIVE

To map the technical and managerial strategies for the management and reduction of airborne particles production in surgical procedures settings during the Covid-19 pandemic.

METHOD

Scoping review, according to the Joana Briggs Institute methodology, based on documents indexed in MEDLINE, VHL, CINAHL Cochrane, Embase, Scopus, Web of Science, and gray literature, published in Portuguese, English, or Spanish. All studies from indexed scientific journals and recommendations published by international agencies or academic associations from 2019 to January 2022 were considered. Findings were summarized and analyzed using descriptive statistics and narrative synthesis.

RESULTS

Twenty-two studies were selected, 19 of which were published in English, two in Spanish, one in Portuguese, with a predominance of literature reviews. Findings were categorized into recommendations for the environment, the team, and the surgical technique.

CONCLUSION

The review mapped the technical and managerial strategies for the management and reduction of the airborne particles production in surgical procedures settings. They involve from the use of personal protective equipment, training, anesthetic modality, airway manipulation, to the execution of the surgical technique.

Immuno-Thrombotic Complications of COVID-19: Implications for Timing of Surgery and Anticoagulation

Early in the coronavirus disease 2019 (COVID-19) pandemic, global governing bodies prioritized transmissibility-based precautions and hospital capacity as the foundation for delay of elective procedures. As elective surgical volumes increased, convalescent COVID-19 patients faced increased postoperative morbidity and mortality and clinicians had limited evidence for stratifying individual risk in this population. Clear evidence now demonstrates that those recovering from COVID-19 have increased postoperative morbidity and mortality. These data-in conjunction with the recent American Society of Anesthesiologists guidelines-offer the evidence necessary to expand the early pandemic guidelines and guide the surgeon's preoperative risk assessment. Here, we argue elective surgeries should still be delayed on a personalized basis to maximize postoperative outcomes. We outline a framework for stratifying the individual COVID-19 patient's fitness for surgery based on the symptoms and severity of acute or convalescent COVID-19 illness, coagulopathy assessment, and acuity of the surgical procedure. Although the most common manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is COVID-19 pneumonitis, every system in the body is potentially afflicted by an endotheliitis. This endothelial derangement most often manifests as a hypercoagulable state on admission with associated occult and symptomatic venous and arterial thromboembolisms. The delicate balance between hyper and hypocoagulable states is defined by the local immune-thrombotic crosstalk that results commonly in a hemostatic derangement known as fibrinolytic shutdown. In tandem, the hemostatic derangements that occur during acute COVID-19 infection affect not only the timing of surgical procedures, but also the incidence of postoperative hemostatic complications related to COVID-19-associated coagulopathy (CAC). Traditional methods of thromboprophylaxis and treatment of thromboses after surgery require a tailored approach guided by an understanding of the pathophysiologic underpinnings of the COVID-19 patient. Likewise, a prolonged period of risk for developing hemostatic complications following hospitalization due to COVID-19 has resulted in guidelines from differing societies that recommend varying periods of delay following SARS-CoV-2 infection. In conclusion, we propose the perioperative, personalized assessment of COVID-19 patients' CAC using viscoelastic hemostatic assays and fluorescent microclot analysis.

Impact of COVID-19 to Neurosurgical Education: A Systematic Review

BACKGROUND: Coronavirus disease (COVID-19) has disrupted many aspects of healthcare and health education including medical education. Given that neurosurgical training requires direct patient contact, the social distancing policy due to COVID has impacted global neurosurgical education. AIM: We are conducting a systematic review to determine the impact of COVID-19 on global neurosurgical education. METHODS: This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The literature search was conducted on three repositories (PubMed, MedRxiv, and bioRxiv) which subsequently screened by two independent reviewers. RESULTS: Thirteen articles were processed for the systematic review. The impact of COVID-19 has been mainly negative to academic activity due to reduced case number and physical contact hours. Residents were also deployed to provide care for COVID-19-related workload. However, several studies reported a positive impact of COVID-19 on residents’ well-being such as increased personal time. Besides current residents, prospective medical students were also affected by COVID-19. CONCLUSION: Neurosurgical program directors should initiate the introduction of a flexible policy to accommodate case reduction to meet the board standard and guard residents’ safety and well-being are required to ensure the sustainability of high-quality neurosurgical education.

WhatsApp-Based virtual consultation in clinical practice during COVID times: A prospective institutional study

Background:

As the novel coronavirus disease 2019 (COVID-19) continues its pandemic surge globally, the attention toward the treatment of non-COVID diseases has become difficult. Software-based systems and social media platforms could provide alternatives for ensuring regular health-care non-COVID diseases. In this context, we evaluated our own experience with virtual consultation (VC) for the management of endocrine surgical patients during the current COVID pandemic.

Materials and Methods:

This prospective study was conducted in the endocrine surgery department spanning 4 months from April to July 2020. We employed WhatsApp-based group video conferencing for VC with both new and follow-up outpatients. We evaluated the satisfaction quotient of patients, regarding the three types of consultations (no consultation, VC, and direct consultation) on an ordinal scale of three modes of consultation.

Results:

Virtual consultation was performed with 102 new and 285 follow-up patients. Goiters, clinical findings, and wounds/scars (in post-operative cases) were evaluated virtually. Dosage of thyroxine replacement, calcium supplementation, and other medications was prescribed based on findings and history. Patients who needed surgery (25/102 cases) were given appropriate appointment. More than 82% of the patients in both groups preferred VC during this COVID pandemic.

Conclusions:

More than 82% of both new and follow-up patients preferred VC over direct or no consultation during this COVID pandemic. Our findings suggest that VC through social media platforms is capable of ensuring appropriate treatment and follow-up for endocrine diseases.

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

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.

Immune Response Is Key to Genetic Mechanisms of SARS-CoV-2 Infection With Psychiatric Disorders Based on Differential Gene Expression Pattern Analysis

Existing evidence demonstrates that coronavirus disease 2019 (COVID-19) leads to psychiatric illness, despite its main clinical manifestations affecting the respiratory system. People with mental disorders are more susceptible to COVID-19 than individuals without coexisting mental health disorders, with significantly higher rates of severe illness and mortality in this population. The incidence of new psychiatric diagnoses after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is also remarkably high. SARS-CoV-2 has been reported to use angiotensin-converting enzyme-2 (ACE2) as a receptor for infecting susceptible cells and is expressed in various tissues, including brain tissue. Thus, there is an urgent need to investigate the mechanism linking psychiatric disorders to COVID-19. Using a data set of peripheral blood cells from patients with COVID-19, we compared this to data sets of whole blood collected from patients with psychiatric disorders and used bioinformatics and systems biology approaches to identify genetic links. We found a large number of overlapping immune-related genes between patients infected with SARS-CoV-2 and differentially expressed genes of bipolar disorder (BD), schizophrenia (SZ), and late-onset major depressive disorder (LOD). Many pathways closely related to inflammatory responses, such as MAPK, PPAR, and TGF-β signaling pathways, were observed by enrichment analysis of common differentially expressed genes (DEGs). We also performed a comprehensive analysis of protein-protein interaction network and gene regulation networks. Chemical-protein interaction networks and drug prediction were used to screen potential pharmacologic therapies. We hope that by elucidating the relationship between the pathogenetic processes and genetic mechanisms of infection with SARS-CoV-2 with psychiatric disorders, it will lead to innovative strategies for future research and treatment of psychiatric disorders linked to COVID-19.

Controle de partículas aéreas nos procedimentos cirúrgicos durante a pandemia da Covid-19: revisão de escopo

RESUMO Objetivo: Mapear as estratégias técnicas e gerenciais para o manejo e a redução da produção de partículas aéreas em ambientes de procedimentos cirúrgicos durante a pandemia da Covid-19. Método: Revisão de escopo, de acordo com metodologia do Joana Briggs Institute, a partir de documentos indexados nas bases MEDLINE, BVS, CINAHL Cochrane, Embase, Scopus, Web of Science e literatura cinza, publicados em português, inglês ou espanhol. Foram considerados todos os estudos provenientes de periódicos científicos indexados e recomendações publicadas por órgãos internacionais ou associações acadêmicas, de 2019 a janeiro de 2022. Os achados foram sumarizados e analisados por estatística descritiva e síntese narrativa. Resultados: Foram selecionados 22 estudos, sendo 19 publicados em inglês, dois em espanhol, um em português, com predominância de revisões da literatura. Os achados foram categorizados em recomendações para o ambiente, a equipe e a técnica cirúrgica. Conclusão: a revisão mapeou as estratégias técnicas e gerenciais para o manejo e a redução da produção de partículas aéreas nos ambientes de procedimentos cirúrgicos. Envolvem desde o uso de equipamentos de proteção individual, treinamentos, modalidade anestésica, manipulação de vias aéreas, até a execução da técnica cirúrgica.

High-quality neurosurgeon communication and visualization during telemedicine encounters improves patient satisfaction

INTRODUCTION

While recent studies have focused on confirming satisfaction with telemedicine during the coronavirus disease 2019 (COVID-19) era, we leveraged a novel survey instrument to identify associations between patient experience and telemedicine-specific factors such as device selection, audio/visual resolution, and connection stability.

METHODS

Telemedicine visit data were gathered from our institution between June 22, 2020 and February 14, 2021. Each patient indicated their overall visit score, likelihood-to-recommend (LTR) score, and device used for the encounter. Remaining questions were randomly distributed to patients to ensure equal distribution across respondents.

RESULTS

Over 34 weeks, there were 901 unique neurosurgical telemedicine visits linked to a post-visit survey at our institution. The LTR top box score percentage showed no significant change across 34 weeks (p = 0.218). After adjusting across available covariates, patients who experienced wait times exceeding 20 min were significantly less likely to report high overall scores (aOR: 0.12; 95% CI: 0.03-0.41; p = 0.001). Patients who indicated they were less able to understand the provider (aOR: 0.22; 95% CI: 0.07-0.66; p = 0.007), or who indicated the provider was not able to properly see them (aOR: 0.11; 95% CI: 0.03-0.43; p = 0.002) were associated with substantially lower overall scores. Visits with interrupted connectivity or those forced to move to a regular phone call were not important predictors of overall score.

CONCLUSIONS

In the largest description of patient satisfaction with telemedicine in the neurosurgical setting during the COVID-19 era, we identified timely and high-quality physician-patient visualization and communication as among the most important predictors of patient satisfaction in virtual settings.

Impact of COVID-19 on Neurosurgery in Brazil's Health System: The Reality of a Developing Country Affected by the Pandemic

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.

Impact of COVID-19 on Saudi Neurosurgery Residency: Trainers' and Trainees' Perspectives

Introduction

After the official announcement of the coronavirus disease-19 pandemic on March 11, 2020, the disease impacted most aspects of health care delivery, especially postgraduate education and training.

Method

A cross-sectional, online questionnaire-based assessment was performed. The study participants involved neurosurgery residents and program directors (PDs) across the country between May 16 and May 27, 2020.

Results

Approximately 74 of 95 (77.9%) of the residents experienced an impact on their training calendar. Before the pandemic, 51 residents (53.3%) were involved in 2–3 surgeries per week, but during the pandemic, 66 (69.5%) were attending 0–1 case per week. Fifty-three residents (55.8%) agreed that academic sessions were affected despite the helpful effort of online teaching sessions. Thirty-four (35.8%) residents graded their anxiety during coronavirus disease-19 times as high. Ten PDs (58.8%) confirmed spending 3–5 hours per week on educational activities normally, whereas during the pandemic, 15 PDs (88.2%) reduced their educational hours to 0–2 hours per week.

Conclusion

Our study showed that educational activities significantly decreased and shifted toward virtual teaching methods. Operative volume showed a substantial reduction for both junior and senior residents. Academic and clinical teaching was the main concern for PDs, and they faced challenges interviewing newly matched residents.

The Impact of the Coronavirus Disease 2019 Pandemic on Neurosurgical Practice and Feasibility of Safe Resumption of Elective Procedures During this Era in a Large Referral Center in Tehran, Iran: An Unmatched Case-Control Study

Objective

The coronavirus disease 2019 (COVID-19) pandemic has considerably affected surgical practice. The present study aimed to investigate the effects of the pandemic on neurosurgical practice and the safety of the resumption of elective procedures through implementing screening protocols in a high-volume academic public center in Iran, as one of the countries severely affected by the pandemic.

Methods

This unmatched case-control study compared 2 populations of patients who underwent neurosurgical procedures between June 1, 2019 and September 1, 2019 and the same period in 2020. In the prospective part of the study, patients who underwent elective procedures were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection postoperatively to evaluate the viability of our screening protocol.

Results

Elective and emergency procedures showed significant reduction during the pandemic (59.4%, n = 168 vs. 71.3%, n = 380) and increase (28.7%, n = 153 vs. 40.6%, n = 115, respectively; P = 0.003). The proportional distribution of neurosurgical categories remained unchanged during the pandemic. Poisson regression showed that the reduction in total daily admissions and some categories, including spine, trauma, oncology, and infection were significantly correlated with the pandemic. Among patients who underwent elective procedures, 0 (0.0%) and 26 (16.25%) had positive test results on days 30 and 60 postoperatively, respectively. Overall mortality was comparable between the pre–COVID-19 and COVID-19 periods, yet patients with concurrent SARS-CoV-2 infection showed substantially higher mortality (65%).

Conclusions

By implementing safety and screening protocols with proper resource allocation, the emergency care capacity can be maintained and the risk minimized of hospital-acquired SARS-CoV-2 infection, complications, and mortality among neurosurgical patients during the pandemic. Similarly, for elective procedures, according to available resources, hospital beds can be allocated for patients with a higher risk of delayed hospitalization and those who are concerned about the risk of hospital-acquired infection can be reassured.

A Tale of Two Cities: Residents' Operative Experience in the United Kingdom and Germany During the Coronavirus Disease 2019 Pandemic

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.

Predictors of Telemedicine Utilization in a Pediatric Neurosurgical Population During the COVID-19 Pandemic

OBJECTIVE

In the wake of the COVID-19 pandemic, telemedicine has become rapidly adopted by the neurosurgical community; however, few studies have examined predictors of telemedicine utilization. Here, we analyze patient variables associated with the acceptance of a telemedicine encounter by a pediatric neurosurgical population during the early phases of the COVID-19 pandemic.

METHODS

All patients seen in a single institution's outpatient pediatric neurosurgery clinic between April 1, 2020 and July 31, 2020 were retrospectively reviewed. Demographic variables were collected for each patient's first completed encounter. Patients participating in telemedicine were compared with those seen in person. Univariate analysis was performed using the Wilcoxon rank sum test for continuous variables and Fischer exact test for categorical variables. A logistic regression multivariable analysis was then performed.

RESULTS

We included 682 patients (374 telemedicine and 308 in person). Univariate analysis demonstrated that telemedicine visits were more likely to occur at earlier study dates (P < 0.001) and that patients participating in telemedicine visits were more likely to be established rather than new patients (P < 0.001), White or Caucasian (P < 0.001), not Hispanic or Latino (P < 0.001), English-speaking (P < 0.001), non-Medicare/Medicaid recipients (P < 0.001), have lower no-show rates (P = 0.006), and live farther from the hospital (P = 0.005). Multivariable analysis demonstrated older age (P = 0.031), earlier appointment date (P < 0.01), established patient status (P < 0.001), English-speaking (P < 0.02), and non-Medicare/Medicaid insurance (P < 0.05) were significant predictors of telemedicine utilization.

CONCLUSIONS

Significant demographic differences exist among pediatric patients who participated in telemedicine versus those who requested an in-person visit at our institution. Addressing barriers to access will be crucial for promoting health equity in continued utilization of telemedicine.

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

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.

Student Survey Results of a Virtual Medical Student Course Developed as a Platform for Neurosurgical Education During the Coronavirus Disease 2019 Pandemic

Background

Before the coronavirus disease 2019 (COVID-19) pandemic, medical students training in neurosurgery relied on external subinternships at institutions nationwide for immersive educational experiences and to increase their odds of matching. However, external rotations for the 2020–2021 cycle were suspended given concerns of spreading COVID-19. Our objective was to provide foundational neurosurgical knowledge expected of interns, bootcamp-style instruction in basic procedures, and preinterview networking opportunities for students in an accessible, virtual format.

Methods

The virtual neurosurgery course consisted of 16 biweekly 1-hour seminars over a 2-month period. Participants completed comprehensive precourse and postcourse surveys assessing their backgrounds, confidence in diverse neurosurgical concepts, and opinions of the qualities of the seminars. Responses from students completing both precourse and postcourse surveys were included.

Results

An average of 82 students participated live in each weekly lecture (range, 41–150). Thirty-two participants completed both surveys. On a 1–10 scale self-assessing baseline confidence in neurosurgical concepts, participants were most confident in neuroendocrinology (6.79 ± 0.31) and least confident in spine oncology (4.24 ± 0.44), with an average of 5.05 ± 0.32 across all topics. Quality ratings for all seminars were favorable. The mean postcourse confidence was 7.79 ± 0.19, representing an improvement of 3.13 ± 0.38 (P < 0.0001).

Conclusions

Feedback on seminar quality and improvements in confidence in neurosurgical topics suggest that an interactive virtual course may be an effective means of improving students' foundational neurosurgical knowledge and providing networking opportunities before application cycles. Comparison with in-person rotations when these are reestablished may help define roles for these tools.

Getting Neurosurgery Services Back on Its Feet: "Learning to Live" with COVID-19

Background:

Cancellation/postponement of ”non-emergent” surgeries during coronavirus disease of 2019 (COVID-19) pandemic has created a huge backlog of patients waiting for surgery and has put them at risk of disease progression. We share our institute's policy and our department's attempt to resume ”non-emergent” surgeries.

Materials and Methods:

We collected details of all patients operated under department of neurosurgery since the onset of COVID-19 pandemic in India and categorized them into ”lockdown” and ”unlock” groups for comparison. COVID-19 tests done in these patients were also analyzed. We also compared our surgical volume with the number of COVID-19 cases in the state.

Results:

One hundred and forty-eight patients (97 males, 51 females) with mean age of 37.8 years (range-2 months-82 years) underwent surgery in our department during the study period. The operative volume per week increased by 37% during the ”unlock” period as compared to ”lockdown” period. The proportion of elective/”non-emergent” surgeries increased from 11.3% during ”lockdown” to 34.7% during the ”unlock” period (P = 0.0037). During ”lockdown” period, number of surgeries declined steadily as the number of COVID-19 cases rose in the state (rs(8) = −0.914, P = 0.000). Whereas there was a trend toward increased number of cases done per week despite increase in the number of cases in the state during the “unlock” period. During the ”unlocking” process, in-patient department admissions and surgeries performed per month increased (P = 0.0000) and this increase was uniform across all specialties. COVID-19 test was done (preoperatively or postoperatively) for all surgeries during ”unlock” period compared to 12 (22.6%) surgeries during ”lockdown” period. Three neurosurgery patients who underwent surgery during the ”unlock” period tested positive for COVID-19.

Conclusions:

Our experience shows that proper evidence-based protocols, setting up of adequate COVID-19 testing facilities and provision of ample personal protective equipments are instrumental in re-starting “nonemergent” surgeries.

Stroke and neurointervention in the COVID-19 pandemic: a narrative review

Introduction: In this review, we will summarize the impact of the COVID-19 pandemic on neurointerventional care for patients with cerebrovascular disease, with a particular emphasis on epidemiology, neurointerventional processes, and lessons learned from paradigm shifts in endovascular care.Areas covered: Peer-reviewed research is summarized regarding the complications of COVID-19 as related to the pandemic's impact on hospital admissions, imaging capabilities, treatment times, and outcomes of neurointerventional cases.Expert opinion: In the first wave of the COVID-19 pandemic, there was a global decline in neuroimaging, use of intravenous thrombolysis, thrombectomy, and coil embolization for ruptured intracranial aneurysms. An early recommendation to utilize general anesthesia and intubate all patients undergoing intervention to avoid an emergent aerosolizing procedure was found to have worse outcomes. The decline in new stroke and subarachnoid hemorrhage diagnoses may be related to patient and/or family fear of seeking acute medical care. A true shift in stroke epidemiology is also possible. As several vaccines become more readily available and the world rebounds from this pandemic, we hope to transform the neurointerventional experiences discussed in this paper into strategies that may improve care delivery of neurologically ill patients during a global crisis.

Is Elective Neurosurgery Justified During COVID-19 Pandemic?

Background

As the world faces a new viral pandemic, which has spread very rapidly, initial response from most countries was to suspend nonemergent health services so that available resources can be diverted to handle the large numbers of patients with COVID-19 infection. Many societies issued guidelines to suspend or postpone nonemergent surgeries.

Methods

We reviewed the emerging evidence regarding the impact of COVID-19 infection in neurosurgery and the postponement of elective surgeries.

Results and Observations

COVID-19 infection poses serious threat in hospitals in the form of cross-infection, hospital staff falling sick, with potential risk to overwhelm or paralyze the healthcare. In addition, we have come to realize the significant perioperative morbidity and mortality secondary to active COVID-19 infection. All these strongly favor suspension of elective neurosurgical services. However, these have to be weighed against the fallout due to prolonged postponement of neurosurgical treatment for conditions, which can progress and cause neurological deterioration.

Conclusion

This article discusses the contemporary published literature regarding the perioperative risk of COVID-19 infection, impact of postponed surgeries, challenges, risk assessment and guidelines for elective neurosurgery at this point of time.

The impact of coronavirus 2019 (COVID-19) on neurosurgical practice and training: a review article

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.

Effect of the COVID-19 Pandemic on Patient Presentation and Perception to a Neurosurgical Outpatient Clinic

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.

The Biosafety and Risk Management in Preparation and Processing of Cerebrospinal Fluid and Other Neurological Specimens With Potential Coronavirus Infection

The recent outbreak of coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2, has become a global threat. Due to neurological manifestations presented throughout the coronavirus disease process, the potential involvement of COVID-19 in central nervous system has attracted considerable attention. Notably, the neurologic system could be widely affected, with various complications such as acute cerebrovascular events, encephalitis, Guillain-Barré syndrome, and acute necrotizing hemorrhagic encephalopathy. However, the risk assessment of exposure to potential biohazards in the context of the COVID-19 pandemic has not been clearly clarified regarding the sampling, preparation, and processing neurological specimens. Further risk managements and implantations are seldom discussed either. This article aims to provide current recommendations and evidence-based reviews on biosafety issues of preparation and processing of cerebrospinal fluid and neurological specimens with potential coronavirus infection from the bedside to the laboratory.

Awake craniotomy in a Covid-19 positive patient: The challenges and outcome

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.

Pediatric neurosurgery during the COVID-19 pandemic: update and recommendations from the Brazilian Society of Pediatric Neurosurgery

OBJECTIVES

Coronavirus disease (COVID-19) is a potentially severe respiratory illness that has threatened humanity globally. The pediatric neurosurgery practice differs from that of adults in that it treats children in various stages of physical and psychological development and contemplates diseases that do not exist in other areas. The aim of this study was to identify the level of knowledge and readiness of the healthcare providers, as well as to evaluate new preventive practices that have been introduced, psychological concerns, and the impact of the COVID-19 pandemic on pediatric neurosurgical units in Brazil.

METHODS

Pediatric neurosurgeons were given an online questionnaire developed by the Brazilian Society of Pediatric Neurosurgery to evaluate the impact of the COVID-19 pandemic on their clinical practice.

RESULTS

Of a cohort of 110 active members of the Brazilian Society of Pediatric Neurosurgery, 76 completed the survey (69%). Ninety-six percent were aware of the correct use of and indication for the types of personal protective equipment in clinical and surgical practices, but only 73.7% of them had unrestricted access to this equipment. Ninety-eight percent of participants agreed or strongly agreed that the pandemic had affected their pediatric neurosurgical practice. The COVID-19 pandemic interfered with outpatient care in 88% of the centers, it affected neurosurgical activity in 90.7%, and it led to the cancellation of elective neurosurgical procedures in 57.3%. Concerning the impact of COVID-19 on surgical activity, 9.2% of the centers had less than 25% of the clinical practice affected, 46.1% had 26%-50% of their activity reduced, 35.5% had a 51%-75% reduction, and 9.2% had more than 75% of their surgical work cancelled or postponed. Sixty-three percent affirmed that patients had been tested for COVID-19 before surgery. Regarding the impact of the COVID-19 pandemic on the mental health of those interviewed, 3.9% reported fear and anxiety with panic episodes, 7.9% had worsening of previous anxiety symptoms, 60.5% reported occasional fear, 10.5% had sadness and some depressive symptoms, and 2.6% reported depressive symptoms.

CONCLUSIONS

The COVID-19 pandemic has posed unprecedented challenges to healthcare services worldwide, including neurosurgical units. Medical workers, pediatric neurosurgeons included, should be aware of safety measures and follow the recommendations of local healthcare organizations, preventing and controlling the disease. Attention should be given to the psychological burden of exposure to SARS-CoV-2 in healthcare workers, which carries a high risk of anxiety and depression.

Challenges posed by COVID-19 and neurosurgical nursing strategies in developing countries

Background:

Neurosurgical patients with stroke, trauma, and brain tumors can be among the victims of the COVID-19 pandemic in developing countries, which need to be managed efficiently.

Methods:

This is an overview of neurosurgical nurses’ challenges and strategies in the current COVID-19 pandemic environment in developing countries.

Results:

Here, we reviewed the unique challenges of providing neurosurgical nursing services during the COVID-19 pandemic in developing countries. We address specific issues such as transferring neurosurgical patients, allocating medical supplies, prioritizing neurosurgical services, COVID-19 testing protocols, and patient triage (emergent vs. urgent vs. delayed surgery). Teleconsultation, telenursing services for outpatient treatment, follow-up and virtual teaching strategies associated with neurosurgical nursing are discussed.

Conclusion:

Neurosurgical nursing during the COVID-19 pandemic in developing countries requires transparent planning, implementation, and careful consideration of various telemedicine strategies.

Democratizing Access to Neurosurgical Medical Education: National Efforts in a Medical Student Training Camp During Coronavirus Disease 2019

BACKGROUND

National medical student surveys amidst the coronavirus disease 2019 (COVID-19)-driven subinternship cancellations have demonstrated the need for supplemental, standardized subspecialty medical education, mentorship, and career planning nationally. We have presented the first live, cross-institutional virtual medical student subspecialty training camp to deliver standardized neurosurgical educational content to medical students during the COVID-19 pandemic, and its results on medical student anxiety and perceptions of neurosurgery.

METHODS

The online training camp used a video conferencing platform that was open to all medical students. A post-training camp survey was administered.

RESULTS

A total of 305 medical students registered for the event from 107 unique U.S. medical schools. Of the 305 medical students, 108 reported intending to apply to neurosurgery residency in 2021. The top medical student objectives for the training camp were program networking and mentorship. Of the 305 participants, 121 (39.7%) completed the post-training survey. Of the respondents, 65.0% reported improved neurosurgical knowledge, 79.8% reported decreased anxiety about subinternships and interviews, 82.5% reported increased enthusiasm about neurosurgery, and 100% desired a future annual virtual training camp because of the increased accessibility and decreased cost. This was especially important for students at institutions without home subspecialty programs and those with financial burdens.

CONCLUSIONS

COVID-19-driven innovations in medical education have accelerated changes that may have long been necessary. This virtual structure improved resource usage and scalability compared with in-person training, maintained social distancing, and democratized access to standardized, specialized content not often available through traditional medical curricula. Even as a supplement to in-person events, the virtual training camp model could be implemented by national medical societies, which might significantly increase medical students' preparedness for, and education in, neurosurgery and other subspecialties.

A Continental Survey on the Impact of COVID-19 on Neurosurgical Training in Africa

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.

Case Volumes and Perioperative Coronavirus Disease 2019 Incidence in Neurosurgical Patients During a Pandemic: Experiences at Two Tertiary Care Centers in Washington, DC

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.

Early Changes to Neurosurgery Resident Training During the COVID-19 Pandemic at a Large U.S. Academic Medical Center

BACKGROUND

The coronavirus disease 2019 pandemic has led to sweeping changes in residency programs across the world, including cancellation of elective cases. The effects of safety measures on neurosurgical training remain unclear. To understand how neurosurgical residents have been affected, we analyzed the operative experience in the months leading up to and during the pandemic.

METHODS

The resident and institutional case totals were tallied for a single residency program in Miami-Dade County from January 1, 2019 to June 30, 2020. A matched cohort analysis was performed before and during the pandemic to assess the effects on resident surgical training.

RESULTS

The case totals for all levels of training were lower when restrictions were placed on elective surgeries. An average of 11 cases was logged in April 2020, a decrease from 26 cases in April 2019 (95% confidence interval, 8.7-22; P < 0.01). An average of 20 cases was logged in May 2020, a decrease from 25 cases in May 2019 (95% confidence interval, 1.2-8.8; P = 0.01). In April and May 2020, 299 (66%) and 148 (50%) fewer cases had been performed at our institution compared with April and May 2109.

CONCLUSIONS

Operative experience was reduced for residents during the months when the performance of elective cases was restricted. Our data suggest experience in some areas of neurosurgery were more affected than were others, and residents at different levels of training were also affected differently. However, the extent of the coronavirus disease 2019 pandemic on neurosurgical training is unlikely to be understood in the short term.