The management and outcomes of coronavirus disease 2019 infection in a series of neurosurgical patients

Farzin Farahbakhsh; Mohsen Rostami; Alireza Khoshnevisan; Negin Naderian; Mohammad Ghorbani; Michael Fehlings; Vafa Rahimi-Movaghar

doi:10.4103/ajns.AJNS_187_20

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(01): 78-83
DOI: 10.4103/ajns.AJNS_187_20

Original Article

The management and outcomes of coronavirus disease 2019 infection in a series of neurosurgical patients

Autor*innen

Farzin Farahbakhsh

¹Sports Medicine Research Center, Neuroscience Institute

²Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran
Mohsen Rostami

¹Sports Medicine Research Center, Neuroscience Institute

²Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran
Alireza Khoshnevisan

²Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran
Negin Naderian

³Department of Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran
Mohammad Ghorbani

⁴Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran
Michael Fehlings

⁵Department of Surgery, Division of Neurosurgery, University of Toronto

⁶Krembil Research Institute, University Health Network, Toronto, Ontario
Vafa Rahimi-Movaghar

²Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran

⁷Sina Trauma and Surgery Research Center

⁸Brain and Spinal Cord Injury Research Center, Neurosciences Institute, Tehran University of Medical Sciences, Tehran

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted neurosurgical practice worldwide. In Iran, hospitals have halted their routine activities, and most hospital beds have been assigned to COVID-19 patients. Here, we share our experience with 10 neurosurgical cases with confirmed COVID-19. Materials and Methods: From February 24, 2020 to April 20, 2020, we were able to obtain clinical data on ten neurosurgical patients with COVID-19 through a predefined electronic form. Results: Of the 10 patients with COVID-19 on neurosurgical units, eight underwent surgical interventions. The age of the patients ranged from 21 to 75 years and 70% were males. The diagnosis of COVID-19 was based on chest imaging findings and reverse transcriptase-polymerase chain reaction for coronavirus and an infectious disease specialist and a pulmonologist confirmed the diagnoses. In two cases, there was a significant decrease in O2 saturation intraoperatively. Three patients in this series died during the assessment period. One death was due to respiratory failure induced by the coronavirus infection. The cause of death in other two patients was cardiovascular failure not related to COVID-19. Conclusions: We hope we can provide a reference for future studies and help develop a clearer understanding of neurosurgical practice and outcomes in patients with COVID-19. In the time of COVID-19 pandemic when dealing with neurosurgical emergencies, a conservative approach is recommended. Using committed personal protective equipment, short-time operating procedures or minimally invasive surgery must be considered in the management of emergent patients. Resuming elective surgeries need defining measures needed to ensure patients and health-care providers' safety. Reorganizing the health-care system for telemonitoring released patients can lessen hospital visits.

Key-words:

Coronavirus - coronavirus disease 2019 - neurosurgery

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References
1 Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet. 2020 Apr 11;395:1225-8. doi: 10.1016/S0140-6736(20)30627-9. Epub 2020 Mar 13. PMID: 32178769; PMCID: PMC7102589.
2 Coronavirus Disease 2019 (COVID-19) Cases in U.S; 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html. [Last Accessed on 2020 April 29].
3 Heymann DL, Shindo N. COVID-19: What is next for public health? Lancet 2020;395:542-5.
4 Fisher D, Wilder-Smith A. The global community needs to swiftly ramp up the response to contain COVID-19. Lancet. 2020 Apr 4;395:1109-10. doi: 10.1016/S0140-6736(20)30679-6. Epub 2020 Mar 19. PMID: 32199470; PMCID: PMC7138255.
5 Coronavirus Disease (COVID-19) Situation Dashboard; 2020. Available from: https://www.who.int/redirect-pages/page/novel-coronavirus-(covid-19)-situation-dashboard. [Last Accessed on 2020 April 29].
6 Instruction and Guidlines of Iran Ministry of Health and Medical Education on COVID-19; 2020. Available from: http://treatment.sbmu.ac.ir/index.jsp?siteid=62&fkeyid=&siteid=62&pageid=63989. [Last Accessed on 2020 April 29].
7 Johnson HC, Gossner CM, Colzani E, Kinsman J, Alexakis L, Beauté J, Würz A, Tsolova S, Bundle N, Ekdahl K. Potential scenarios for the progression of a COVID-19 epidemic in the European Union and the European Economic Area, March 2020. Euro Surveill. 2020 Mar;25(9):2000202. doi: 10.2807/1560-7917.ES.2020.25.9.2000202. PMID: 32156332; PMCID: PMC7068161.
8 Thompson R. Pandemic potential of 2019-nCoV. Lancet Infect Dis 2020;20:280.
9 Lee N, Sung JJ. Nosocomial transmission of SARS. Curr Infect Dis Rep 2003;5:473-6.
10 McDonald LC, Simor AE, Su IJ, Maloney S, Ofner M, Chen KT, et al. SARS in healthcare facilities. Toronto and Taiwan. Emerg Infect Dis 2004;10:777.
11 Gomersall CD, Joynt GM, Ho OM, Ip M, Yap F, Derrick JL, et al. Transmission of SARS to healthcare workers. The experience of a Hong Kong ICU. Intensive Care Med 2006;32:564-9.
12 Seto W, Tsang D, Yung R, Ching T, Ng T, Ho M, et al. Authority, Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet 2003;361:1519-20.
13 Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ 2003;168:1245-51.
14 Bai Y, Lin CC, Lin CY, Chen JY, Chue CM, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv 2004;55:1055-7.
15 Lee AM, Wong JG, McAlonan GM, Cheung V, Cheung C, Sham PC, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatry 2007;52:233-40.
16 Chua SE, Cheung V, Cheung C, McAlonan GM, Wong JW, Cheung EP, et al. Psychological effects of the SARS outbreak in Hong Kong on high-risk health care workers. Can J Psychiatry 2004;49:391-3.
17 Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3:e203976.
18 Peters A, Vetter P, Guitart C, Lotfinejad N, Pittet D. Understanding the emerging coronavirus: what it means for health security and infection prevention. J Hosp Infect. 2020;104:440-8. doi:10.1016/j.jhin.2020.02.023.
19 Aminian A, Safari S, Razeghian-Jahromi A, Ghorbani M, Delaney CP. COVID-19 Outbreak and Surgical Practice: Unexpected Fatality in Perioperative Period. Ann Surg. 2020 Jul;272:e27-e29. doi: 10.1097/SLA.3114723114723925. PMID: 32221117; PMCID: PMC7188030
20 Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, Zhan LY, Jia Y, Zhang L, Liu D, Xia ZY, Xia Z. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020 Apr 5;21:100331. doi: 10.1016/j.eclinm.2020.100331. PMID: 32292899; PMCID: PMC7128617.
21 Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, Xie C, Ma K, Shang K, Wang W, Tian DS. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020 Jul 28;71:762-8. doi: 10.1093/cid/ciaa248. PMID: 32161940; PMCID: PMC7108125.
22 Prompetchara E, Ketloy C, Palaga T. Immune responses in COVID-19 and potential vaccines: Lessons learned from SARS and MERS epidemic. Asian Pac J Allergy Immunol 2020;38:1-9.
23 Tan YT, Wang JW, Zhao K, et al. Preliminary Recommendations for Surgical Practice of Neurosurgery Department in the Central Epidemic Area of 2019 Coronavirus Infection. Current Medical Science. 2020 Apr;40:281-4. DOI: 10.1007/s11596-020-2173-5.
24 Bernucci C, Brembilla C, Veiceschi P. Effects of the COVID-19 Outbreak in Northern Italy: Perspectives from the Bergamo Neurosurgery Department. World Neurosurg. 2020 May;137:465-8.e1. doi: 10.1016/j.wneu.2020.03.179. Epub 2020 Apr 2. PMID: 32247797; PMCID: PMC7271324.
25 Burke JF, Chan AK, Mummaneni V, Chou D, Lobo EP, Berger MS, Theodosopoulos PV, Mummaneni PV. Letter: The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm. Neurosurgery. 2020 Jul 1;87:E50-E56. doi: 10.1093/neuros/nyaa116. PMID: 32242901; PMCID: PMC7184344.
26 Zoia C, Bongetta D, Veiceschi P, Cenzato M, Di Meco F, Locatelli D, et al. Neurosurgery During the COVID-19 Pandemic: Update from Lombardy. Northern Italy: Springer; 2020.
27 Givi B, Schiff BA, Chinn SB, Clayburgh D, Iyer NG, Jalisi S, Moore MG, Nathan CA, Orloff LA, O'Neill JP, Parker N, Zender C, Morris LGT, Davies L. Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic. JAMA Otolaryngol Head Neck Surg. 2020 Jun 1;146:579-84. doi: 10.1001/jamaoto.2020.0780. PMID: 32232423.
28 Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM, Zhang LJ. Coronavirus Disease 2019 (COVID-19): A Perspective from China. Radiology. 2020 Aug;296:E15-E25. doi: 10.1148/radiol.2020200490. Epub 2020 Feb 21. PMID: 32083985; PMCID: PMC7233368.
29 Kluge S, Janssens U, Welte T, Weber-Carstens S, Marx G, Karagiannidis C. Empfehlungen zur intensivmedizinischen Therapie von Patienten mit COVID-19 [Recommendations for critically ill patients with COVID-19]. Med Klin Intensivmed Notfmed. 2020 Apr;115:175-7. German. doi: 10.1007/s00063-020-00674-3. PMID: 32166350; PMCID: PMC7080004.
30 Di Saverio S, Pata F, Gallo G, Carrano F, Scorza A, Sileri P, Smart N, Spinelli A, Pellino G. Coronavirus pandemic and colorectal surgery: practical advice based on the Italian experience. Colorectal Dis. 2020 Jun;22:625-34. doi: 10.1111/codi.15056. Epub 2020 Jun 1. PMID: 32233064.
31 Simonato A, Giannarini G, Abrate A, Bartoletti R, Crestani A, De Nunzio C, Gregori A, Liguori G, Novara G, Pavan N, Trombetta C, Tubaro A, Porpiglia F, Ficarra V; Research Urology Network (RUN). Clinical pathways for urology patients during the COVID-19 pandemic. Minerva Urol Nefrol. 2020 Jun;72:376-83. doi: 10.23736/S0393-2249.20.03861-8. Epub 2020 Mar 30. PMID: 32225135.
32 Méjean A, Rouprêt M, Rozet F, Bensalah K, Murez T, Game X, Rebillard X, Mallet R, Faix A, Mongiat-Artus P, Fournier G, Neuzillet Y; le comité de cancérologie de l'Association française d'urologie (CCAFU). Recommandations CCAFU sur la prise en charge des cancers de l'appareil urogénital en période d'épidémie au Coronavirus COVID-19 [Recommendations CCAFU on the management of cancers of the urogenital system during an epidemic with Coronavirus COVID-19]. Prog Urol. 2020 Apr;30:221-31. French. doi: 10.1016/j.purol.2020.03.009. Epub 2020 Mar 30. PMID: 32224294; PMCID: PMC7146722.