key: cord-1037044-fsuad52h
authors: Ajler, Pablo
title: Opinion piece: Microneurosurgery in COVID-19 positive patients
date: 2020-05-12
journal: World Neurosurg
DOI: 10.1016/j.wneu.2020.04.251
sha: 75a395fca35300dcfa5de7a5084fc322981d126a
doc_id: 1037044
cord_uid: fsuad52h

nan

Given the large-scale spreading of COVID-19 around the world, the priority is to identify infected cases and contain all possible spreading routes. Increased risk has narrowed the opportunity window to effectively restrain the disease 1 . The situation has also become much more complicated and challenging, as the demand for healthcare workers is growing (and so is their exposure), and the extreme pressures they face cause declining availability.

As an immediate consequence to the pandemic, many elective neurosurgery procedures have been discontinued, even though urgent life-threatening pathologies such as oncology or acute vascular disease continue to require treatment. In order to curtail the potential rise of hospital infections, it is critical to strengthen health workers' safety and trust in the system within which they work 2 .

As regards the increasing number of patients infected with covid-19 who may present pathologies which end up requiring surgery, scientific societies have suggested the implementation of level 3 protection for surgical procedures 3 .

In neurosurgery, as well as in other specialties, the use of the surgical microscope is essential for the implementation of lighting and magnification of the surgical field and its capability to dissect the microneurovascular structures 4 . On the contrary, the use of class 3 protection is not compatible with the use of this device since it is impossible to look through the eyepieces with protective goggles.

To obtain the opinion of experts in Latin America, we carried out a survey among 57 referring neurosurgeons, through the networks of the sections of neurooncology and skull base surgery of the Latin American Federation of Neurosurgery, and we used Google forms to carry this out.

We asked a single question: "Given the situation of having to urgently operate on a positive covid-19 patient, where is the use of a microscope required, what would you do?"

The response options were: "do not operate it", "use the microscope looking through the goggles", "remove the goggles and use the microscope as usual", "operate without a microscope", "use an exoscope", "use an endoscope", other option (please describe).

Of the participants, 96.5% leaned between two options, 77.2% answered that they use the microscope with the goggles in place, and 19.3% answered that they take off the goggles.

The use of goggles under the microscope is very complex, especially in prolonged surgeries, and not wearing them is a significant risk for the surgeon.

A possible solution is the use of an exoscope, whose main advantages include greater magnification, wider focal distance, and better surgeon ergonomics, whereas the main disadvantage is its nonstereoscopic vision 4,5 . However, this device is not available in all hospitals. How will patients undergo surgical procedures in these cases? This other side of the arising pandemic may be solved by the use of endoscopes like exoscopes, finding a solution for developing countries that do not have the necessary equipment.

We, in our hospital, have a simulation system to train residents, and we are adapting our system to these circumstance 6 .

Simulation programs of these events should be generated to minimize the risk, and will play a fundamental role in the preservation of healthcare workers' and patients' health.

Letter to editor: Role of masks/respirator protection against 2019-novel coronavirus (COVID-19)

Protecting Health Care Workers during the COVID-19

Coronavirus Outbreak-Lessons from Taiwan's SARS response

Preliminary Recommendations for Surgical Practice of Neurosurgery Department in the Central Epidemic Area of 2019 Coronavirus Infection

The exoscope in neurosurgery: an innovative "point of view". A systematic review of the technical, surgical, and educational aspects

Advances in Intraoperative Optics: A Brief Review of Current Exoscope Platforms

Programa de Simulación Neuroquirúrgica