Letter to the Editor: Awake Craniotomy for Intracranial Gliomas During Coronavirus Disease 2019 Pandemic

Núñez-Velasco, Santiago; Mercado-Pimentel, Rodrigo; Rodríguez-Arias, Regina

doi:10.1016/j.wneu.2020.05.219

Cited by 6 publications

(7 citation statements)

References 16 publications

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“…This concern is heightened especially when performing surgery on a patient with COVID-19, leading to the appropriate recommendation to delay surgery or use other diagnostic methods. 10,15,16,33 Additional difficulties in providing neurosurgical care arise from the encumbrance of PPE during use of the operating microscope. The use of bulky safety goggles and/or voluminous N95 respirators crowds the space, increasing the distance between the surgeon and the eyepieces by >5 mm.…”

Section: Discussionmentioning

confidence: 99%

Awake craniotomy for glioblastoma in COVID-19–positive patients and delivering the standard of care: illustrative case

Alvarez

Kotecha

McDermott

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Providing the standard of care to patients with glioblastoma (GBM) during the novel coronavirus of 2019 (COVID-19) pandemic is a challenge, particularly if a patient tests positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Further difficulties occur in eloquent cortex tumors because awake speech mapping can theoretically aerosolize viral particles and expose staff. Moreover, microscopic neurosurgery has become difficult because the use of airborne-level personal protective equipment (PPE) crowds the space between the surgeon and the eyepiece. However, delivering substandard care will inevitably lead to disease progression and poor outcomes. OBSERVATIONS A 60-year-old man with a left insular and frontal operculum GBM was found to be COVID-19 positive. Treatment was postponed pending a negative SARS-CoV-2 result, but in the interim, he developed intratumoral hemorrhage with progressive expressive aphasia. Because the tumor was causing dominant hemisphere language symptomatology, an awake craniotomy was the recommended surgical approach. With the use of airborne-level PPE and a surgical drape to protect the surgeon from the direction of potential aerosolization, near-total gross resection was achieved. LESSONS Delaying the treatment of patients with GBM who test positive for COVID-19 will lead to further neurological deterioration. Optimal and timely treatment such as awake speech mapping for COVID-19–positive patients with GBM can be provided safely.

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Section: Discussionmentioning

confidence: 99%

Awake craniotomy for glioblastoma in COVID-19–positive patients and delivering the standard of care: illustrative case

Alvarez

Kotecha

McDermott

et al. 2021

Journal of Neurosurgery: Case Lessons

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“…The preference during SARS-CoV-2 pandemic would be for the patient to be awake throughout however some patients cannot tolerate it and certain situations (e.g. generalized seizures) necessitate securing the airway [1] , [4] .…”

Section: Discussionmentioning

confidence: 99%

Awake craniotomy in the COVID-19 era - technical tips and feasibility

Razak

Sloan

Sebastian

et al. 2020

Journal of Clinical Neuroscience

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“…Patients require very close and direct contact between the neurophysiologist during stimulation and a lot of technical personnel. Patients infected with SARS-CoV-2 should not be referred to awake craniotomy, and the infection should be treated first 11 .…”

Section: Neurosurgerymentioning

confidence: 99%

Approaching glioblastoma during COVID-19 pandemic: current recommendations and considerations in Brazil

Batistella

Santos

Neto

et al. 2021

Arq. Neuro-Psiquiatr.

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Background: Cancer patients in general and glioblastoma patients, in particular, have an increased risk of developing complications from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and reaching a balance between the risk of exposure to infection and the clinical benefit of their treatment is ideal. The aggressive behavior of this group of tumors justifies the need for a multidisciplinary team to assist in clinical decisions during the current pandemic. Brazil is now ranked #2 in the number of cases and deaths from COVID-19 pandemic, and existing disparities in the treatment of neuro-oncology patients in Brazil will challenge the clinical and surgical decisions of this population, possibly affecting global survival. Objective: To search the literature about the management of glioblastomas during COVID-19 pandemic to guide surgical and clinical decisions in this population of patients in Brazil. Methods: We performed a systematic search on the PubMed electronic database targeting consensus statements concerning glioblastoma approaches during COVID-19 pandemic up to July 18, 2020. Results: When approaching glioblastoma during the COVID-19 pandemic, important parameters that help in the decision-making process are age, performance status, tumor molecular profile, and patient consent. Younger patients should follow the standard protocol after maximal safe resection, mainly those with MGMT methylated tumors. Aged and underperforming patients should be carefully evaluated, and probably a monotherapy scheme is to be considered. Centers are advised to engage in telemedicine and to elaborate means to reduce local infection. Conclusion: Approaching glioblastoma during the COVID-19 pandemic will be challenging worldwide, but particularly in Brazil, where a significant inequality of healthcare exists.

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Letter to the Editor: Awake Craniotomy for Intracranial Gliomas During Coronavirus Disease 2019 Pandemic

Cited by 6 publications

References 16 publications

Awake craniotomy for glioblastoma in COVID-19–positive patients and delivering the standard of care: illustrative case

Awake craniotomy for glioblastoma in COVID-19–positive patients and delivering the standard of care: illustrative case

Awake craniotomy in the COVID-19 era - technical tips and feasibility

Approaching glioblastoma during COVID-19 pandemic: current recommendations and considerations in Brazil

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