Neurosurgical management of brain and spine tumors in the COVID-19 era: an institutional experience from the epicenter of the pandemic

Kessler, Remi A.; Zimering, Jeffrey H.; Gilligan, Jeffrey; Rothrock, Robert J.; McNeill, Ian T; Shrivastava, Raj; Caridi, John M.; Bederson, Joshua B.; Hadjipanayis, Costas G.

doi:10.1007/s11060-020-03523-7

Cited by 27 publications

(45 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It would seem that cancer patients may be more susceptible to infections because of their immunosuppressive status. [9][10][11] This is particularly the case in patients with a diagnosis of glioma, the most common primary brain tumor. Patients with glioma are considered one of the most fragile and vulnerable cancer populations due to several factors: 1) a tendency toward old age along with multiple age-related comorbidities; 2) increased risk of thromboembolic events related to the patient's loss of autonomy, the tumor, and/or chemotherapy treatments; and 3) the large use of steroid medications, which produce a further increase in the patient's immunosuppression status and, consequently, a greater susceptibility to infections.…”

mentioning

confidence: 99%

Treatment of patients with glioma during the COVID-19 pandemic: what we learned and what we take home for the future

Pessina

Navarria

Bellu

et al. 2020

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVECoronavirus disease 2019 (COVID-19) has changed the way in which cancer is treated. Patients with high-grade glioma (HGG) are believed to be in a vulnerable category. The aim of this study was to describe the experience of a hub cancer center and the measures that were put in place for treatment of patients with newly diagnosed and recurrent glioma.METHODSTo prevent in-hospital contagion and preserve the safety of health professionals and patients, specific protocols and strict regulations were introduced. Physical distancing, use of surgical masks, and diligent hand hygiene were adopted. Each case was discussed in a multidisciplinary board meeting before treatment. All patient candidates for surgical procedures were tested for SARS-CoV-2 with a nasopharyngeal swab and a chest CT scan. Indications for surgery were the radiological suspicion of HGG in patients with a good performance status and/or the rapid and progressive occurrence of neurological deficits. Adjuvant treatments were performed only in cases of HGG. This therapy consisted of conventional fractional radiotherapy (RT; 60 Gy/30 fractions) with concomitant and adjuvant temozolomide chemotherapy (TMZCHT) in younger patients; in elderly patients, a short course of RT was employed (40.5 Gy/15 fractions). For recurrent HGG, treatments were assessed after a careful evaluation of the patient’s general condition, neurological status, and risk of early impairment in neurological status if not treated. During simulation CT for the RT plan, each patient underwent a chest CT study. In cases in which an imaging study was suspicious for COVID-19 pneumonia, the patient was immediately isolated and rapidly underwent nasopharyngeal swab testing.RESULTSBetween March 1 and April 30, 2020, 23 HGGs were treated, and these cases are included in the present evaluation. Fifteen patients harboring newly diagnosed glioblastoma (GBM) underwent resection followed by a regimen of chemotherapy and RT, and 3 patients with newly diagnosed anaplastic oligodendroglioma underwent surgery followed by adjuvant RT. Five patients were treated for recurrent GBM, and they received surgery plus adjuvant RT. One patient in whom the simulation CT study was suspicious for COVID pneumonia was tested with a nasopharyngeal swab, which proved positive for SARS-CoV-2 infection. No patients contracted COVID-19 during hospitalization for surgery or during RT treatment. Corticosteroid therapy was administered to all patients beginning on the 1st day of RT.CONCLUSIONSThe authors’ experience during the COVID-19 pandemic showed that patients with HGG can be treated in the most effective manner without a compromise in safety. Careful selection criteria and a multidisciplinary evaluation are pivotal to assessing the optimal therapeutic strategy.

show abstract

mentioning

confidence: 99%

Treatment of patients with glioma during the COVID-19 pandemic: what we learned and what we take home for the future

Pessina

Navarria

Bellu

et al. 2020

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…Surgery was performed following pneumonia and COVID-19 testing under pandemic conditions and significantly improved outcomes. Upper extremity numbness was resolved in patients with a spinal tumor [10]. In contrast, the widespread recommendation to postpone elective operations in the US during the pandemic has produced a large population of patients with hip and knee osteoarthritis who are unable to receive their recommended surgical treatment [11].…”

Section: Discussionmentioning

confidence: 99%

Loop-Mediated Isothermal Amplification Screening for COVID-19 in Asymptomatic Preoperative Orthopedic Patients in a General Hospital in Kanagawa, Japan

Uchida¹,

Sekiguchi²,

Higashiyama

et al. 2020

Cureus

View full text Add to dashboard Cite

The global coronavirus disease 2019 (COVID-19) pandemic has caused several million infections and hundreds of thousands of deaths. A large number of healthcare workers have died as a result of infection with this virus. Therefore, elective surgery was markedly reduced or stopped in our hospital's orthopedic department. The detection of asymptomatic COVID-19positive patients became key to reducing the infection risk to physicians and staff to allow orthopedic surgery to be performed. A total of 21 patients were scheduled to undergo orthopedic surgery, including elective surgery, in Shonantobu General Hospital, Chigasaki City, Kanagawa, Japan. All 21 patients gave permission to undergo loop-mediated isothermal amplification (LAMP) screening the day before surgery. None of the 21 patients we tested was positive for COVID-19. All patients remained asymptomatic during the two to four weeks of postoperative follow-up. No physicians or medical staff developed COVID-19 symptoms. This was a very small study in a city with a relatively low incidence of COVID-19. We found that LAMP screening was accurate, in terms of its negative predictive value. Larger studies are needed.

show abstract

“…Emergency procedures were continued similar to most countries, however, there are some of these procedures require more precaution due to high viral load of the SARSCoV-2 in the upper airway with potential aerosolization during the procedure such as endoscopic endonasal surgeries. [ 24 ] Most of the sellar-suprasellar lesion patients present subacute or chronic symptoms and can wait, however, patients presenting with progressive neurological deficits, pituitary apoplexy, and high-flow cerebrospinal fluid (CSF) leak secondary to a sellar-suprasellar lesion which is considered urgent. It will be unforgivable to allow such patients to be blind or develop meningitis during this pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…Emergency procedures are likely continuing in most countries, however, some of them raises certain concerns to the surgeons such as the endoscopic endonasal skull base surgeries which carries an additional risk of the sinuses harboring a high COVID-19 viral load as well as potential aerosolization during endoscopic endonasal instrumentation. [ 24 ]…”

Section: Introductionmentioning

confidence: 99%

Endoscopic endonasal skull base surgery during the COVID-19 pandemic: A developing country perspective

Soliman

Elbaroody

Elsamman

et al. 2020

Surgical Neurology International

View full text Add to dashboard Cite

Background: Although primarily a respiratory disorder, the coronavirus pandemic has paralyzed almost all aspects of health-care delivery. Emergency procedures are likely continuing in most countries, however, some of them raises certain concerns to the surgeons such as the endoscopic endonasal skull base surgeries. The aim of this study is to present the current situation from a developing country perspective in dealing with such cases at the time of the COVID-19 pandemic. Methods: A cross-sectional analytical survey was distributed among neurosurgeons who performed emergency surgeries during the COVID-19 pandemic in Cairo, Egypt, between May 8, 2020, and June 7, 2020. The survey entailed patients’ information (demographics, preoperative screening, and postoperative COVID-19 symptoms), surgical team information (demographics and postoperative COVID-19 symptoms), and operative information (personal protective equipment [PPE] utilization and basal craniectomy). Results: Our survey was completed on June 7, 2020 (16 completed, 100% response rate). The patients were screened for COVID-19 preoperatively through complete blood cell (CBC) (100%), computed tomography (CT) chest (68.8%), chest examination (50%), C-reactive protein (CRP) (50%), and serological testing (6.3%). Only 18.8% of the surgical team utilized N95 mask and goggles, 12.5% utilized face shield, and none used PAPRs. Regarding the basal craniectomy, 81.3% used Kerrison Rongeur and chisel, 25% used a high-speed drill, and 6.3% used a mucosal shaver. None of the patients developed any COVID-19 symptoms during the first 3 weeks postsurgery and one of the surgeons developed high fever with negative nasopharyngeal swabs. Conclusion: In developing countries with limited resources, preoperative screening using chest examination, CBC, and CT chest might be sufficient to replace Reverse transcription polymerase chain reaction. Developing countries require adequate support with screening tests, PPE, and critical care equipment such as ventilators.

show abstract

Neurosurgical management of brain and spine tumors in the COVID-19 era: an institutional experience from the epicenter of the pandemic

Cited by 27 publications

References 16 publications

Treatment of patients with glioma during the COVID-19 pandemic: what we learned and what we take home for the future

Treatment of patients with glioma during the COVID-19 pandemic: what we learned and what we take home for the future

Loop-Mediated Isothermal Amplification Screening for COVID-19 in Asymptomatic Preoperative Orthopedic Patients in a General Hospital in Kanagawa, Japan

Endoscopic endonasal skull base surgery during the COVID-19 pandemic: A developing country perspective

Contact Info

Product

Resources

About