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Neurosurgery during Covid-19 Pandemic

Neurosurgery during Covid-19 Pandemic – Dr. Satish Rudrappa.

On March 11, 2020, the World Health Organization (WHO) declared the COVID-19 a global pandemic.

We all know (in fact in this IT era and with nonstop information bombardment, the knowledge difference between doctors and the non-medical public has narrowed significantly!) that Coronavirus is a respiratory virus. It is spread from person to person by three means.

  • Droplets
  • Fomites
  • Aerosols

Are Neurosurgery surgeries safe during this pandemic?

While this virus and the disease it causes, often referred to as COVID-19, does not appear to affect the brain, spinal cord or peripheral nerves.

Neurological patients are unique from other surgical patients. Most of them suffer from other related medical issues such as mental disorders, cardiovascular diseases, hypertension, diabetes, and certain respiratory diseases. Hence the outbreak of the COVID-19 has drastically changed the way Neurosurgeons work.

Risks to be aware of

Any surgery carries a risk of contamination and infection irrespective of the organ being operated upon. However, the risk across specialties is different. For instance, ENT, dental, facio-maxillary, and facial surgeries carry the highest risk for the surgeon as well as the patient because of the proximity of the doctor’s and patient’s faces.

“The nasal and oral passages have demonstrated high viral loads and as such non-emergent procedures that require transgression of the nasal/oral mucosa should be delayed” says Dr.Satish Rudrappa, a neurosurgeon based at Bangalore [Neurosurgery during Covid-19 Pandemic]

Some neurosurgical cases might place surgeons and staff at higher risk of contracting the virus. Specifically, there are concerns that transsphenoidal surgeries (surgery of the brain through the nose) on patients who have the virus have a higher risk of transmission to operating room staff than other surgeries.

Conclusion

Until there is enough data to verify that surgical exposure is safe, restraint is recommended.

In patients who are COVID-19 positive, unless they have a life-threatening emergency, we recommend delay of surgery until recovered. For patients with unknown COVID-19 status, it is recommended they be tested before surgery.

COVID-19, caused by the SARS-CoV-2, is currently believed to spread through respiratory droplets. Currently, antivirals for treatment and vaccines do not exist. Hence it is left to the health care professionals to protect vulnerable patients.

We recommend that elective neurosurgery to be postponed until the COVID-19 pandemic is over. Postoperative follow-up can be done through telemedicine. Patients in the pipeline can be counseled and advised remotely.

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