Neurosurgery and coronavirus: impact and challenges—lessons learnt from the first wave of a global pandemic

Abstract

Introduction and objectives The novel severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has had drastic effects on global healthcare with the UK amongst the countries most severely impacted. The aim of this study was to examine how COVID-19 challenged the neurosurgical delivery of care in a busy tertiary unit serving a socio-economically diverse population. Methods A prospective single-centre cohort study including all patients referred to the acute neurosurgical service or the subspecialty multidisciplinary teams (MDT) as well as all emergency and elective admissions during COVID-19 (18th March 2020–15th May 2020) compared to pre-COVID-19 (18th of January 2020–17th March 2020). Data on demographics, diagnosis, operation, and treatment recommendation/outcome were collected and analysed. Results Overall, there was a reduction in neurosurgical emergency referrals by 33.6% and operations by 55.6% during the course of COVID-19. There was a significant increase in the proportion of emergency operations performed during COVID-19 (75.2% of total, n=155) when compared to pre-COVID-19 (n = 198, 43.7% of total, p < 0.00001). In contrast to other published series, the 30-day perioperative mortality remained low (2.0%) with the majority of post-operative COVID-19-infected patients (n = 13) having underlying medical co-morbidities and/or suffering from post-operative complications. Conclusion The capacity to safely treat patients requiring urgent or emergency neurosurgical care was maintained at all times. Strategies adopted to enable this included proactively approaching the referrers to maintain lines of communications, incorporating modern technology to run clinics and MDTs, restructuring patient pathways/facilities, and initiating the delivery of NHS care within private sector hospitals. Through this multi-modal approach we were able to minimize service disruptions, the complications, and mortality.

Perioperative Complications of Patients with SARS-CoV-2 Infection in Neurosurgery

“…We present and analyze a series of ten patients undergoing neurosurgical procedures, while suffering from a concomitant COVID-19 infection. To our knowledge, this is one of a few case series specifically focusing on COVID-19-positive patients undergoing neurosurgical operations [12,13]. In this series, we observed thrombotic and hemorrhagic complication rates of 30% and 20%, respectively; however, none of these studies focused on neurosurgical patients [12].…”

“…It has been shown that patients undergoing general surgery with a concomitant COVID-19 infection are prone to developing postoperative complications [12]. To our knowledge, several studies have focused on the changes in referrals and organization of neurosurgical units during the SARS-CoV-2 pandemic but only few studies have investigated the incidence of perioperative complications in patients undergoing cranial neurosurgical procedures with concomitant COVID-19 infection [13][14][15][16]. This study aimed to investigate the rate of perioperative hemorrhagic or thrombotic complications in SARS-CoV-2-positive patients undergoing neurosurgical procedures.…”

Infection of a sylvian Galassi II arachnoid cyst after craniotomy for resection of a parasagittal meningioma

“…This was indeed one of the negative consequences the first wave of the COVID-19 pandemic instigated, with mandatory delays and cancellations in elective surgeries, that translated into a 3-month unnecessary corticosteroid therapy in this patient. 13 As a consequence, this patient developed opportunistic infections which eventually led to septicaemia and despite the initially excellent neurological recovery, the patient’s death.…”

The Impact of COVID-19 on the Functioning of a Neurosurgical Service at a Tertiary Institute in a Low-Resource Setting

“…The COVID-19 pandemic has affected the running of neurosurgical services worldwide, with varying effects seen. Some services have noted no change in their volume [2], or an increase in emergency procedures performed [3]. Other centres have seen a reduction in procedures and admissions [4][5][6].…”