Letter: Safety Considerations for Neurosurgical Procedures During the COVID-19 Pandemic

Daci, Rrita; Natarajan, Sabareesh K.; Johnson, Mark D.

doi:10.1093/neuros/nyaa196

Cited by 8 publications

(7 citation statements)

References 4 publications

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“…Neurosurgeons remain at the front line of patient care. 1 It is important for neurosurgeons to protect themselves and their families. We remember, commemorate, appreciate and celebrate those who have succumbed, and, no less, those who continue to risk the exposure incumbent on providing patient care generously, bravely, and at the level to which the neurosurgical community is accustomed.…”

mentioning

confidence: 99%

In Memoriam: A Memoir for Our Fallen “Heroes”

et al. 2020

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Even though neurosurgeons exercise these enormous and versatile skills, the COVID-19 pandemic has shaken the fabrics of the global neurosurgical family, jeopardizing human lives, and forcing the entire world to be locked down. We stand on the shoulders of the giants and will not forget their examples and their teachings. We will work to the best of our ability to honor their memory. Professor Harvey Cushing said: “When to take great risks; when to withdraw in the face of unexpected difficulties; whether to force an attempted enucleation of a pathologically favorable tumor to its completion with the prospect of an operative fatality, or to abandon the procedure short of completeness with the certainty that after months or years even greater risks may have to be faced at a subsequent session—all these require surgical judgment which is a matter of long experience.” It is up to us, therefore, to keep on the noble path that we have decided to undertake, to accumulate the surgical experience that these icons have shown us, the fruit of sacrifice and obstinacy. Our tribute goes to them; we will always remember their excellent work and their brilliant careers that will continue to enlighten all of us.

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confidence: 99%

In Memoriam: A Memoir for Our Fallen “Heroes”

et al. 2020

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“…All published expert recommendations and guidelines identified in our review support delaying surgery whenever feasible. 3 5 12 13 14 15 16 17 18 19 20 21 22 23 24 Alternatives to surgery (radiation therapy or systemic therapy) should be considered when possible. 15 25 Patients who require surgery should ideally be tested preoperatively to assess COVID-19 status.…”

Section: Resultsmentioning

confidence: 99%

“…13 Finally, in a correspondence on neurosurgical procedures in the current pandemic, Daci et al suggest wearing an N95 under PAPRs during long procedures to allow the battery to be changed safely if it is depleted. 21 Additional coverings such as the plastic drape suspension recommended by David et al are currently not included in most recommendations; however, the preliminary guidelines from the SFORL state these can be "discussed with the local operational hygiene team to minimize aerosolization of contaminated tissue microfragments." 16…”

Section: Personal Protective Equipmentmentioning

confidence: 99%

Aerosolization in Endoscopic Sinus Surgery and Risk Mitigation in the COVID-19 Era: A Scoping Review

Roy

Kay‐Rivest

Nguyen

et al. 2020

J Neurol Surg B Skull Base

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Background The continually evolving coronavirus disease 2019 (COVID-19) pandemic has created a dire need for rapid reorganization of health care delivery within surgical services. Ensuing initial reports of high infection rates following endoscopic sinus and skull base surgery, various expert and societal guidelines have emerged. We hereby provide a scoping review of the available literature on endoscopic sinus and skull base surgery, exploring both the risk of aerosolization and expert recommendations on surgical management during the pandemic. Methods A literature search of the PubMed database was performed up until May 9th, 2020. Additionally, websites and published statements from otolaryngology associations were searched for recommendations. This scoping review followed the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta Analyses Extension for Scoping Reviews. Results A total of 29 peer-reviewed publications and statements from expert recommendations or professional associations were included. Current expert guidance relies mainly on scarce, anecdotal evidence, and two cadaveric studies, which have demonstrated potential aerosolization during transnasal surgery. General consensus exists for delaying surgery when possible, ascertaining COVID-19 status preoperatively and donning of adequate personal protective equipment by all operating room staff (including at minimum an N95 mask). Cold, nonpowered surgical instruments are deemed the safest, while thermal instruments (electrocautery and laser) and high-speed drills should be minimized. Conflicting recommendations emerge for use of microdebriders. Conclusion Endoscopic sinus and skull base surgery impart a potential risk of aerosolization. Hence, surgical indications, protective measures for health care workers, and surgical instrumentation must be adapted accordingly in the COVID-19 context.

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“…Although such guidelines will most likely vary between different institutions, the common themes that have been consistently described in reported studies have included ensuring the availability of personal protective equipment for healthcare workers, continuing the use of telemedicine within neurosurgical workflows, and working to balance the increased surgical demand with the available hospital resources. 4 , 5 , 6 , 7 , 8 , 9 As pandemic restrictions are eased and surgical volumes increase, it will also be important to identify those patients requiring urgent neurosurgical intervention. Guides for prioritizing neurosurgery cases, such as that proposed by Thomas et al., 10 using the Delphi method, will likely become increasingly important as surgeons aim to clear the case backlogs that have accumulated during the height of the pandemic.…”

mentioning

confidence: 99%