Introduction: It has been 17 years since the severe acute respiratory syndrome outbreak and Singapore
is facing yet another daunting pandemic – the novel coronavirus (COVID-19). To date,
there are 57,607 cases and 27 casualties. This deadly pandemic requires significant
changes especially in the field of awake surgeries for intra-axial tumors that routinely
involve long clinic consults, significant interactions between patient and multiple
other team members pre, intra, and postoperatively. Materials and Methods: A retrospective review of all awake cases done during the COVID-19 pandemic from
February to June 2020 was done. In this article, we outline the rigorous measures
adopted during the COVID-19 pandemic that has allowed us to proceed with awake surgeries
and intraoperative mapping at our institution. Results and Discussion: We have divided the protocol into various phases of care of patients planned for
an awake craniotomy. Preoperatively, teleconsults have been used where possible thereby
limiting multiple hospital visits and interaction. Intraoperatively, safety nets have
been established during asleep-awake-asleep phases of awake craniotomy for all the
team members. Postoperatively, early discharge and teleconsult are being employed
for rehabilitation and follow-ups. Conclusions: Multiple studies have shown that with intraoperative mapping, we can improve neurological
outcomes. As the future of the pandemic remains unknown, the authors believe that
surgical treatment should not be delayed for intracranial tumors. Awake craniotomies
and intraoperative mapping can be safely carried out by adopting the described protocols
with combination of multiple checkpoints and usage of telecommunication.
Key-words:
Awake surgeries - COVID-19 - glioma - protocols
