Objective The objective was to determine the impact of the COVID-19 pandemic on operative case volume in 8 US neurosurgical residency training programs in early 2020 and to survey these programs regarding training activities during this period. Methods A retrospective review was conducted of monthly operative case volumes and types for 8 residency programs for 2019 and January-April 2020. Cases were grouped as elective cranial, elective spine, and non-elective emergent cases. Programs were surveyed regarding residents’ perceptions of the impact of COVID-19 on surgical training, didactics, and research participation. Data was analyzed for individual programs and pooled across programs. Results Across programs, the 2019 monthly case average was 211 (SD ± 82); 2020 average case volumes for January, February, March, and April were 228±93, 214±84, 180±73, and 107±45, respectively. Compared with 2019, March and April 2020 average cases declined 15% (p=0.003) and 49% (p=0.002), respectively. COVID-19 affected surgical case volume for all programs; 75% reported didactics negatively affected, and 90% reported COVID-19 resulted in increased research time. Several neurosurgery residents have required COVID-19 testing, however, to our knowledge, only one resident from the participating programs tested positive. Conclusions This study documents a significant reduction in operative volume in 8 neurosurgery residency training programs in early 2020. During this time, neurosurgery residents engaged in online didactics and research-related activities, reporting increased research productivity. Residency programs should collect data to determine the educational impact of the pandemic on resident operative case volumes, identify deficiencies, and develop plans to mitigate any effects.

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Neurological disorders are major contributors to death and disability worldwide. The pathology of injuries and disease processes includes a cascade of events that often involve molecular and cellular components of the immune system and their interaction with cells and structures within the central nervous system. Because of this, there has been great interest in developing neuroprotective therapeutic approaches that target neuroinflammatory pathways. Several neuroprotective anti-inflammatory agents have been investigated in clinical trials for a variety of neurological diseases and injuries, but to date the results from the great majority of these trials has been disappointing. There nevertheless remains great interest in the development of neuroprotective strategies in this arena. With this in mind, the complement system is being increasingly discussed as an attractive therapeutic target for treating brain injury and neurodegenerative conditions, due to emerging data supporting a pivotal role for complement in promoting multiple downstream activities that promote neuroinflammation and degeneration. As we move forward in testing additional neuroprotective and immune-modulating agents, we believe it will be useful to review past trials and discuss potential factors that may have contributed to failure, which will assist with future agent selection and trial design, including for complement inhibitors. In this context, we also discuss inhibition of the complement system as a potential neuroprotective strategy for neuropathologies of the central nervous system.