Does COVID-19 affect survival and functional outcome in emergency and urgent neurosurgical procedures? A single center prospective experience during the pandemic

Fiore, G.; Remore, L. G.; Tariciotti, L.; Carrabba, G.; Schisano, L.; Pluderi, M.; Bertani, G.; Borsa, S.; Locatelli, M.

Objective To assess the organization and technical difficulties of neurosurgical procedures during the COVID-19 pandemic and their possible impact on survival and functional outcome; in addition, to evaluate the virological exposure risk of the medical personnel. Methods We prospectively collected data for all urgent surgical procedures performed in the COVID-19-dedicated theatre. Pre and postoperative variables were gathered: demographics, pathology, KPS and neurological status at admission, type of surgical procedures and their duration, length of in-ward stay(LOS), postoperative KPS and functional outcome comparison, destination at discharge. We defined five classes of pathologies - trauma, oncology, vascular, infection and hydrocephalus – and three surgical categories: burr hole(BH), craniotomy, CSF shunting and spine surgery. A postoperative Sars-Cov-2-infection was checked in all the operators. Results We identified 11 traumatic cases(44%), 4 infections(16%), 6 vascular events(24%), 2 hydrocephalus conditions(8%) and 2 oncological cases(8%). The surgical procedures were represented by 11 BHs(44%), 7 craniotomies(28%), 6 CSF shunts(24%) and one spine surgery(4%). The mean age was 57.8 years. The most frequent clinical presentation was coma(44). Mean KPS ad admission was 20±10, mean surgery duration was 85±63 minutes, mean LOS was 27±12 days. Mean KPS at discharge was 35±25. Outcome comparison resulted improved for sixteen patients. Four patients died. Mean follow-up was 6±3 months. None of the operators developed a post-operative Cov-Sars-2-infection. Conclusion Standardized protocols are mandatory to guarantee a high standard of care for emergency and urgent surgeries during the pandemic. Personal protective equipment affects maneuverability, dexterity and duration of interventions without affecting survival and functional outcome.