key: cord-0971951-mpecmrjh authors: Germanò, Antonino; Raffa, Giovanni; Angileri, Filippo Flavio; Cardali, Salvatore Massimiliano; Tomasello, Francesco title: COVID-19 and Neurosurgery. Literature and Neurosurgical Societies Recommendations Update. date: 2020-04-30 journal: World Neurosurg DOI: 10.1016/j.wneu.2020.04.181 sha: d07e81d74780f2e12e82666f5b3fc8f942cc2810 doc_id: 971951 cord_uid: mpecmrjh Abstract Background Since January 2020, 3 months ago, when the pathogen causing the Coronavirus-disease was identified in humans, the literature on COVID-19 has grown exponentially to over 4000 publications. There is the need to provide an update for each single medical discipline, including neurosurgery, to be used by single professionals or to be distributed through the neurosurgical community and to be used by governments in designing new scenario of care. Methods A review of the MEDLINE database was performed on April 13th, 2020. Search terms included “COVID-19”, “neurosurgery,” and “surgery”. A review of documents published on the web-page of the WFNS and of the 5 continental associations of neurosurgical societies AANS, AASNS, CAANS, EANS, and FLANC representing the 119 national Neurosurgical Societies around the world was performed. Results The literature search yielded 38 results that were manually reviewed. Fourteen manuscripts were considered eligible. They described suggestions and considerations to optimize care of neurosurgical patients, editorials on operational models, perspectives from neurosurgical departments, letters to the editor describing experiences on how to help medical staff to be prepared in advance for pandemic situations, description of regional or departmental models and/or organizational schemes. The webpages of the searched societies reported a total of 57 documents. Conclusions The neurosurgical scientific community has promptly reacted to the COVID-19 outbreak by producing a growing number of documents that could serve as guidance for neurosurgeons all over the world. Neurosurgical Societies will represent the key-institutions for guiding the neurosurgical community to overcome the COVID-19 crisis. Since January 2020, 3 months ago, when the pathogen causing the Coronavirus- disease pneumonia was identified as the cause of disease in humans, the literature on COVID-19 has grown exponentially, from no manuscripts to over 4000 publications at the time of this reporting. Moreover, as it is evidently a pandemic, it has diffused throughout the entire worldwide human community at different levels, and, in the medical fields, it has involved numerous disciplines, not limited to virology, epidemiology, infectious disease, critical care medicine, pediatrics, and medical education, but also psychiatry and surgery, including neurosurgery. As the number of scientific reports increases daily, there is a need to provide an update for each medical discipline, including neurosurgery, in order to provide updates and recommendations, if available. This information should be used not only by individual professionals on how to treat a single case and disseminated through the neurosurgical community, including neurosurgical societies, but also should be helpful for governments in planning and implementing new management strategies for future medical epidemics and other disasters, and for reorganizing neurosurgical care. A review of the MEDLINE database (PubMed -National Library of Medicine) was performed on Monday, April 13, 2020 for articles published in the English language from October 1952 to-date. Search terms included "COVID-19", "neurosurgery" and "surgery". We reviewed search results to assess the relevance of publications on this topic, including case reports. References from eligible articles were reviewed to locate other articles of interest. The literature yielded an initial set of 38 results that were reviewed for relevance to neurosurgery and COVID-19. We included only articles published in the English language. Only one article in Chinese language was found and excluded (http://rs.yiigle.com/yufabiao/1187863.htm) 3 Others were excluded despite their PubMed citation, which did not specifically Fourteen reports were considered eligible for inclusion in the present report, which included suggestions and considerations to optimize care of neurosurgical patients 4-6 , editorial commentaries on operational models 7-12 , perspectives from neurosurgical departments 13 , letters to the editor describing experiences with medical staff preparations in advance of pandemic situations 14, 15 , and description of regional or departmental models and/or organizational scheme 7, 16, 17 . Three main topics were discussed in these papers: The search of neurosurgical societies webpages resulted in a total of 57 documents (Table 1) , dealing with 7 main topics: "General Information regarding COVID-19", "General Messages from Neurosurgical Societies", "Triage and Management of Neurosurgical Patients / Practice Recommendations", "Reorganization Models for Neurosurgical Departments", "Neurosurgery Residents Education", "Surveys on Neurosurgical Practice in Most Affected Countries", and "Personal Protective Equipment (PPE)" ( Table 2 ). These documents include three presidential addresses; one presidential message, one administrative committee message; one document in support of a position paper from a national general surgery society, one audio interview; one weekly webinar series discussing a variety of COVID-19 topics of interest to neurosurgeons; two webinars, two links to national neurosurgical societies where a specific COVID-19 section was present; one article offering advice on triaging non-emergent neurosurgical procedures; one regional update from departments of neurosurgery located in a region severely affected by COVID-19; eight links to scientific manuscripts or letters to journal editors reporting neurosurgically-relevant aspects of COVID-19; two surveys designed to understand how neurosurgical departments are facing the epidemic; one handbook describing methods to prevent and treat COVID-19 according to clinical experience; one statement from a national neurosurgical society; two recommendations on elective surgery; one neurosurgeon's guide to pulmonary critical care of COVID-19; eleven documents reporting government information and resources; one telemedicine services coding white paper; three links to major international scientific journals' COVID-19 information for continuing medical education and clinical information; ten advocacy efforts dedicated to a number of political recommendations, including how to support and sustain physicians and their practices during this unprecedented national emergency through tax relief, no interest loans, direct payments, payment for virtual visits including telephone calls and other measures; and 3 obituaries dedicated to neurosurgeons and doctors that have been lost due to the disease. Since the FLANC webpage is in Spanish, only the link to a webinar in English and to a bulletin on COVID-19 in Spanish were included. In addition, the CAANS had both Arabic and English versions, but no document on COVID-19 was found. The EANS webpage included two scientific manuscripts addressing, respectively, the CT and MR features of COVID-19 associated with hemorrhagic necrotizing encephalopathy and the neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China, that were not found in the PubMed search 18, 19 . Therefore, the number of manuscript relevant to COVID-19 and neurosurgery to-date found is of a total 16. Despite a total number of 1.9 million reported cases of individuals to-date worldwide, with only 441,000 recovered, and most importantly, 119,000 deaths, and a total number of 4000 scientific manuscripts published in the medical literature in 3 months, only 0.4% of published reports are relevant to neurosurgery. It may be hypothesized that, despite a long tradition of neurosurgical contribution to basic and translational science and research, little awareness exists in the neurosurgical community of the COVID-19 pandemic. Therefore, there is a need not only to increase awareness of the disease per se, but also, and more importantly, to establish new concepts of organization of neurosurgical practice and education. The PubMed and web search performed yielded only seven scientific manuscripts addressing the topic of neurosurgery and COVID-19 [4] [5] [6] 11, [18] [19] [20] , the remaining four being letters to the editor 7, 14, 15, 17 or editorials [8] [9] [10] 12, 16 . Within these reports some recommendations can be found that may be useful for neurosurgical practice in this pandemic. Globally, there has been a broad call to reduce "elective" neurosurgical operations with the aim to minimize potential exposure of fragile neurosurgical patients with diseases other than COVID-19. Consequently, neurosurgeons are expected to devise alternative plans of how and when to treat non-emergent neurosurgical patients. Nonetheless, apart from clear-cut emergent cases, the timing of neurosurgery may be crucial, even in some elective procedures, such as intracranial tumors or cervical myelopathy. These situations often In fact, although some surgeries could be delayed for a significant period of time, others need to be scheduled more promptly, despite the pandemic, because of the risk of illness progression by delay (i.e., malignant brain tumors and vascular disease). With this in view, it must be understood that the choice to postpone an operation must be made with consideration of medical and logistical factors, as no one can anticipate the influence of COVID-19 in the near or more distant future, and individual cases might be deemed emergencies that cannot be safely delayed. The recent COVID-19 outbreak has strongly impacted neurosurgical practice all over the world, often confusing both patients and neurosurgeons. The neurosurgical scientific community, especially led by the 5 continental associations of neurosurgical societies, has promptly reacted by producing a growing number of documents that could serve as guidance for neurosurgeons all over the world. Nevertheless, the drafting of recommendations and guidelines for the best neurosurgical practices in the COVID-19 era is still on-going. We strongly believe that, during these difficult times, a daily referral to the Neurosurgical Societies' webpages will represent a key tool to spread information, suggestions, considerations and models to optimize care of neurosurgical patients all over the world, as well as to maintain high standards of surgical education, thus guiding the neurosurgical community through the COVID-19 crisis. Neurosurgery on the web: an analysis of the webvisibility of the European Neurosurgical Societies Website-visibility of Neurosurgical Centers in Europe. A necessary tool for enhancing scientific network cooperation and information distribution: letter to the editor Urgent Considerations for the Neurooncologic Treatment of Patients with Gliomas During the COVID-19 Pandemic. Neuro Oncol Inpatient and outpatient case prioritization for patients with neuro-oncologic disease amid the COVID-19 pandemic: general guidance for neuro-oncology practitioners from the AANS/CNS Tumor Section and Society for Neuro-Oncology Preliminary Recommendations for Surgical Practice of Neurosurgery Department in the Central Epidemic Area Letter: The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm Neurosurgery in the storm of COVID-19: suggestions from the Lombardy region, Italy (ex malo bonum) Response to COVID-19 in Chinese neurosurgery and beyond Early lessons in the management of COVID-19 for the pediatric neurosurgical community from the leadership of the American Society of Pediatric Neurosurgeons Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy On pandemics: the impact of COVID-19 on the practice of neurosurgery Effects of the COVID-19 Outbreak in Northern Italy: Perspectives from the Bergamo Neurosurgery Department Academic Neurosurgery Department Response to COVID-19 Pandemic: The University of Miami/Jackson Memorial Hospital Model Strategies for Prevention and Control of 2019 Novel Coronavirus Infection Among Medical Staff Experiences of practicing surgical neuro-oncology during the COVID-19 pandemic May we deliver neuro-oncology in difficult times (e.g. COVID-19)? Neurological manifestations of COVID-19 COVID-19-associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features A novel coronavirus from patients with pneumonia in China Telemedicine-assisted treatment of patients with intracerebral hemorrhage COVID-19 and Telemedicine: Immediate action required for maintaining healthcare providers well-being Table 1: Summary of the COVID-19 documents presented in the webpages of the neurosurgical societies Society Title of the documents Web address WFNS Presidential address Resources Neurosurgeon's guide to pulmonary critical care for Non-elective surgical interventions by German Neurosurgeons DGNC -BDNC COVID-19-associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features Audio interview: New Research on Possible Treatments for Covid-19 Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan Demyelinating encephalomyelitis induced by a long-term corona virus infection in rats Early and late CNS-effects of corona virus infection in rats The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm Impact of COVID-19 on Neurosurgery -International Webinar Symposium Abbreviation list AANS: American Association of Neurological Surgeon AASNS: Asian Australasian Society of Neurological Surgeons CAANS: Continental Association of African Neurosurgical Societies COVID-19: Coronavirus Disease 2019 CT: Computed Tomography EANS: European Association of Neurosurgical Societies ERP: Evidence Review Panel ESAS: Elective Surgery Acuity Scale FLANC: Latin American Federation of Neurosurgical Societies MR: Magnetic Resonance Imaging WFNS: World Federation of Neurosurgical Societies