Characteristics and operation outcomes of neuro-oncology patients after COVID-19 pandemic — A case series

Abstract

BACKGROUND COVID-19 has been spreading worldwide at hitherto unknown speed, and the treatment of neuro-oncology patients without COVID-19 has been greatly affected. Methods To compare the medical records and surgical results of surgical patients before and after the pandemic. We collected a total of 80 patients form April 2020 to May 2020 after pandemic and from April 2019 to May 2019 before pandemic. The patient's demographics, past medical history, comorbidities, imaging, pathology, laboratory teat, and Karnofsky Performance Score (KPS) were analyzed. Results The most common presenting symptom was intracranial hypertension and neurological deficit. Hypertension and diabetes were the most common comorbid diseases. The pre-operation KPS were 83.21 ± 15.60, 80 ± 14.77, 78.57 ± 12.83 and 74.14 ± 12.72, respectively. The post-operation KPS were 94.64 ± 8.65, 95.45 ± 6.56, 91.43 ± 10.82 and 84.21 ± 22.55, respectively. The tumor volume was larger and the midline shift distance was greater after the pandemic than before. For pathological grade, meningiomas were mostly grade I, while gliomas were mainly grade III and IV. Conclusion Although affected by the COVID-19 pandemic, patients with glioma should be operated as soon as possible to obtain better surgical results, however, for patients with meningiomas, their operation can be postponed slightly when the patients are tolerable.

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

“…Included studies were from India ( n = 6), 21 , 22 , 23 , 24 , 25 , 26 China ( n = 2), 19 , 20 Brazil ( n = 1), 18 Iran ( n = 1), 27 Turkey ( n = 1), 28 and multiple Asian countries (most from China). 29 Study types were case-control ( n = 6), 20 , 21 , 22 , 25 , 26 , 27 expert opinion and review ( n = 3), 18 , 23 , 28 cross-sectional survey ( n = 1), 29 retrospective cohort ( n = 1), 24 and letter to the editor with case report ( n = 1). 19 …”

“…Of these studies, 66.7% (6/9) reported decreases in caseloads ranging from 11.2% to 79.3%. 20 , 21 , 22 , 24 , 25 , 27 Of the 6 studies, 5 (83.3%) reported on the proportion of surgical neuro-oncologic compared with other types of cases. The proportions remained similar, ranging from 16.1% to 44% before the pandemic and 17.1% to 51.2% during the pandemic.…”

“…Only 1 study from China reported on the tumor characteristics comparing prepandemic and postpandemic time frames, wherein larger tumors (mean, 8.7 vs. 4.6 cm 3 ) with greater midline shift (2 vs. 0 cm) were observed during the pandemic. 20 …”

“…All studies used a triaging system to classify patients requiring surgery according to urgency. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 In general, emergent or urgent surgical treatment was recommended for patients with brain tumors with significant size and mass effect, malignant tumors, or those in herniation. Patients with benign asymptomatic tumors were deemed non- elective and had the least priority.…”

“…All studies recommended COVID-19 screening with reverse transcriptase polymerase chain reaction (RT-PCR) for all patients undergoing surgical neuro-oncology procedures. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Two studies required a pulmonary high-resolution computed tomography (HRCT) scan in addition to the RT-PCR test. 18 , 27 One study recommended the use of a COVID-19 rapid antigen test in patients who needed acute and emergent treatment while waiting for the RT-PCR.…”