Letter: The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm

Abstract

To the Editor:The recent outbreak of a novel coronavirus illness (coronavirus disease 2019; COVID-19) has grown into a global pandemic. As a response, there have been several treatment recommendations published by international, federal, state, and local governing bodies. Here, we aim to help neurosurgeons synthesize these recommendations into an institutional policy that fits the unique demands of neurosurgical practice. We performed a comprehensive review of COVD-19 policies and aggregated multidisciplinary expertise at our institution to formulate recommendations for scheduling surgery, providing neurosurgical coverage, and engaging in neurosurgical research during the COVID-19 outbreak. Here, we present a neurosurgical algorithm for varying levels of COVID-19 community infection. This algorithm (with an accompanying checklist) is centered around a 3-tiered system of viral "surge" quantification, which we use to triage case scheduling, and a paired coverage model (PCM), which we use to provide inpatient services. COVID-19 represents a challenge to ongoing practice; however, with clear algorithms, checklists, and contingency planning, it is possible to provide focused neurosurgical care during this pandemic.

The impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations: a global neurosurgery study

“…To help define what constitutes a legitimate procedure that should be done despite the pandemic, several institutions have published categories of procedures to be considered "emergent." [16][17][18][19][20] But neurosurgeons are trained to recognize emergencies, and our data reflected that the strongest agreement among our respondents was on the 2 case scenarios with highest risk and urgency scores (i.e. giant aneurysm and cerebellar metastasis, Table 2 Q7, Q3).…”

Neurosurgical management of brain and spine tumors in the COVID-19 era: an institutional experience from the epicenter of the pandemic

“…One other institution, the University of California at San Francisco, has described their own protocols for the scheduling of neurosurgical cases and for neurosurgical coverage throughout the COVID-19 pandemic [17]. Of particular interest to the topic of this paper is the checklist they developed to determine what constitutes an emergent versus urgent versus elective neurosurgical procedure ( Fig.…”

Letter: Surgical Management of Brain Tumor Patients in the COVID-19 Era

“…Except in emergency cases, we advocate using multidisciplinary conferences to gather consensus regarding surgical urgency. [1][2][3][4] Table 1 outlines our stratification used to guide surgical timing.…”