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Journal of Neurosurgical Sciences 2021 Jan 22

DOI: 10.23736/S0390-5616.21.05226-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Turning tables: a war-like approach to neurosurgical emergencies in the Covid-19

Alberto BALESTRINO 1 , Chiara ROBBA 2, Marco CERAUDO 1, Pasquale ANANIA 1, Ilaria MELLONI 1, Simone NEGRINI 3, Paolo PELOSI 2, 4, Gianluigi ZONA 1, 5, Pietro FIASCHI 1, 5

1 Department of Neurosurgery, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; 2 Department. of Anesthesiology and Intensive Care, IRCCS for Oncology and Neurosciences, Genoa, Italy; 3 Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy; 4 Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy; 5 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy


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BACKGROUND: During the Coronavirus-disease-2019 (COVID-19) pandemic emergency, neurosurgeons may have to decide to prioritize treatments to patients with the best chance of survival, as in a war setting triage. We discuss factors that should be taken into account in the perioperative period and neurocritical care management of neurosurgical patients during a pandemic emergency; in particular, we will focus on the decision on whether to operate or not a patient during the COVID-19 pandemic and where and how to provide neurointensive care treatment.
METHODS: A multidisciplinary expert panel composed by specialists with direct experience in COVID-19 management discussed and reviewed the criteria that should be taken into account in the decision to operate or not a patient during the COVID-19 pandemic.
RESULTS: Disease-related factors should be first taken into account in order to precisely know the enemy we are facing. Patient-related factors should be then evaluated to understand the battleground on which we are facing the enemy. After these considerations, we must ascertain costs and expected outcomes of our surgical intervention by evaluation of surgery-related factors. Finally, the last factor that need to be evaluated before surgery is the availability of resources, staff and ward availability for perioperative care in particular. All these considerations will lead to the optimal organization and management of neurosurgical emergencies during pandemic times, taking into account the community and not only the single patient.
CONCLUSIONS: We provided schematic preoperative considerations that we hope will help neurosurgeons to guide their decisions in these challenging times.


KEY WORDS: Covid-19; Neurosurgical emergency; Resources management; Neuroanesthesia; Neuro-ICU

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