TABLE 1.
Surgical Timing Recommendations Based on Brain Tumor Surgical Indications
| Category/procedure | Recommendation |
|---|---|
| Emergent (performed as soon as possible) • Impending herniation, hydrocephalus |
• Assume patient is COVID-19 positive • Use enhanced PPEa |
| Urgent (performed as soon as possible, 2 to 7 d) • Suspicion for high-grade malignancy • Rapidly progressive neurological deficits |
• Stabilize patient medically • If COVID-19 testing available: – proceed with surgery – preoperative testing as close as possible to surgery – quarantine until testing returns negative – rapid testing the day of surgery if available • If testing unavailable: – assume patient is COVID-19 positive – use enhanced PPEa – only a minimum number of required staff permitted in the operating room |
| Semiurgent (performed within 1 to 4 wk) • Mild or asymptomatic brain lesions • Benign or stable imaging (absence of edema, mass effect, midline shift, etc) • Delay in surgery may cause progression of neurological deficit or disease |
• Stabilize patient medically • If testing not widely available: – preoperative testing as close as possible to surgery if the patient screens negative and has been self-quarantined for 14 d • If testing available: – proceed with surgery following preoperative testing as close as possible to surgery and quarantine until testing returns negative – rapid testing the day of surgery if available • Consider stereotactic radiosurgery as an alternative to open surgery and traditional fractionated radiotherapy in equivocal cases to preserve hospital resources and minimize risk of staff exposure |
PPE, personal protective equipment; PAPR, powered air-purifying respirator.
a
Enhanced PPE defined as an N95 respirator with facial protection or PAPR, surgical bouffant/cap, gloves, and gown.