key: cord-258293-7q9zj8c2
authors: Marini, Alessandra; Iacoangeli, Maurizio; Dobran, Mauro
title: Letter to the Editor Regarding 'Coronavirus Disease 2019 (COVID-19) and Neurosurgery: Literature and Neurosurgical Societies Recommendations Update'
date: 2020-05-26
journal: World Neurosurg
DOI: 10.1016/j.wneu.2020.05.160
sha: 
doc_id: 258293
cord_uid: 7q9zj8c2

nan

Letter: Epidemiological variations in neuro-oncological patients' presentation during the Coronavirus 1 crisis in the Clinical Department of Neurosurgery of Ancona 2 3

Dear Editor, 4

we read with great interest the Original Article by Antonino Germanò et al. "COVID-19 and Neurosurgery. 5

Literature and Neurosurgical Societies Recommendations Update". This paper provides a relevant insight into 6 the management of neuro-oncological patients during the COVID-19 pandemic, which has fast spread 7

worldwide and critically impacted on the healthcare system. Italy resulted one of the most affected countries, 8

witnessing dramatic revolutions in the routine practice. In such intense atmosphere, neurosurgical departments 9

are balancing between the urgent and emergency cases, public-opinion concerns about transmission and the 0 safety of the staff and patients. 1

Regarding the neuro-oncological patients, as already reported by Zoia et al., a priority criteria were established, 2 in order to stratify the urgency of the cases: Class A ++ are the patients who require immediate treatments, 3

with intracranial or spinal oncological pathology (rapidly evolving intracranial hypertension with deteriorating 4 state of consciousness, acute hydrocephalus, spinal cord compression with rapid tetra or paraparesis); Class A + 5 are the patients who requirie treatment within a maximum of 7-10 days, with intracranial tumors with mass 6 effect or with progressive neurological deficit, without deterioration of consciousness and patients requiring 7 treatment within a month, namely Class A, with neurological alteration or suspected malignant lesion, related 8

to a oncological pathology. 9

We report a survey conducted by the neurosurgical team of the Emergency Regional Hospital of Ancona 0 (Italy) which serves approximately 1.5 million inhabitants. During the last three months, from February to 1

April 2020, despite the halving of the elective cases in the weekly schedule, due to the re-distribution of the 2 staff, the number of oncological patients who underwent a surgical treatment in our department was 3 approximately analogous to the same time-period in 2019 (February-April, 49 patients in 2020 and 45 patients 4 in 2019). Nonetheless, the amount of urgent or emergency cases, accessing from emergency room, substantially 5 rocketed, reaching the 57,1% compared to the 31,1 % in 2019, as reported in the Illustrative Table.  6 Interestingly, the patients with spinal lesions were the most affected, recording the 76,9 % with emergency 7 room access (10 patients out of 13), while the same feature in 2019 was slightly more than 45 % (5 patients out 8 of 11 ). As highlighted in the Illustrative Table, the most common symptom was a progressive paraparesis, and 9

all the patients reported a previous history of neglected upper or low back pain. This data, in our survey, 0 resulted to be related to a public health concern, in the patient point of view, about visiting hospitals during the 1 COVID-19 crisis, especially for not apparently alarming symptoms, usually related to degenerative spine 2 pathologies, such as back pain. In addition, the temporary difficult access to radiological exams may have 3

influenced, as well, the postponement in the diagnosis. This resulted in progression of the neurological 4 symptoms, without an early neurosurgical evaluation, until the onset of acute deficit which actually led to the 5 emergency room access. 6

The same patient's attitude, even if with minor impact, was registered in the patients affected by brain lesions, 7

in which the percentage of patients with acute onset, and subsequent via emergency room evaluation, 8

dramatically increased in the last three months, compared to 2019. As a matter of fact, the most common 9

symptoms were consciousness alteration and seizures; in our survey approximately 10,7 % of the acute-onset 0 patients reported to have previously refused the surgical treatment, in the weeks before, correlated to concerns 1 about the hospitalization during the Coronavirus emergency. Even if it is widely known that time is essential 2 for the clinical and neurological outcome, our survey did not have a sufficient follow-up to properly compared 3 the outcomes between the two time periods analyzed, so further evaluations would be indispensable to 4

appropriately investigated this aspect. 5

In conclusion, during the COVID-19 pandemic the neurosurgical urgent and emergency onset of neuro-6 oncological cases increased, in comparison to 2019. Our survey highlighted how this trend is minorly related to 7 a combination of difficult access to radiological exams and mostly to patients' concerning about hospitalization. 8

The consequent apprehension should be restoring the public health judgement, in order to re-balance this trend 9

and subsequently improve the clinical outcome of the patients. A reasonable respond in this contest can be the 0 intensification of telemedicine clinic visits, as well as ameliorating the clinic scheduling safety, concomitantly 1

to the mass media impact on the public health opinion, in order to reestablish the confidence in the healthcare 2 system, in such intense atmosphere of fear. 3 4

Alessandra Marini, MD 5

Prof Maurizio Iacoangeli, MD 6

Prof Mauro Dobran, MD 7

References 8 9 Patients who underestimated their symptoms 20/28 (71, 4%) 1/14 (7,1%) Patients who had difficult access to radiological exams 3/28 (10,7 %) none Patients who refused hospitalization due to the infection risk 10/28 (35,7%) none

Illustrative Table regarding the epidemiological variations in neuro-oncological patients' onset during the COVID-19 crisis