Acute hemorrhage after intra-cerebral biopsy in COVID-19 patients: a report of 3 cases

Degeneffe, Aurélie; Bruneau, Michaël; Spitaels, Julien; Gilis, Nathalie; De Witte, Olivier; Lubansu, Alphonse

Abstract Background When Belgium’s COVID-19 outbreak began in March of 2020, our neurosurgical department followed the protocol of most surgical departments in the world and postponed elective surgery. However, patients with tumor-like brain lesions requiring urgent surgery still received treatment as usual, in order to ensure ongoing neuro-oncological care. From a series of 31 patients admitted for brain surgery, three were confirmed as infected by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Case description We present the clinical outcomes of these three COVID-19 patients, who underwent an intra-cerebral biopsy in our department during April of 2020. All suffered from a diffuse intra-parenchymal hemorrhage post-operatively. Unfortunately, we were not able to identify a clear etiology of these post-operative complications. It could be hypothesized that an active COVID-19 infection status may be related to a higher bleeding risk. The remaining 28 neuro-oncological non-COVID patients underwent uneventful surgery during the same period. Conclusions This case series reports the previously unreported and unexpected outcomes of COVID-19 patients suffering from acute hemorrhage after intra-cerebral biopsy procedures. Although no direct relation can yet be established, we recommend the neurosurgical community be cautious in such cases.