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To the Editor: In anticipation of a surge in patients with the coronavirus disease of 2019 (COVID-19), neurosurgical patients across the majority of the United States with nonemergent conditions had their elective surgery postponed indefinitely. In preparation for the reopening of the surgical system and trying to prioritize which cases should go first, we produced a system by using the Delphi method to achieve general consensus. Neurosurgeons actively practicing in 2 separate geographic regions of the United States where "black level" COVID-19 surges occurred (the New York Metropolitan Area and Detroit, Michigan) participated in the process. We categorized a total of 86 unique neurosurgical scenarios into 6 tiers of priority and reached a consensus (>75% agreement) or majority opinion (>50%) on the timing of surgery on all except 1 case type (central cord syndrome). Here we present a guide that can assist neurosurgical departments prioritize the relative urgency of cases, whether it be due to a pandemic or any other scenario where the normal workflow has been severely disrupted.

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