TABLE 2.

High-Risk COVID-19 Transmission Brain Tumor Surgical Approach Recommendations

Surgical approach	Recommendations
Endoscopic endonasal	• Consider transcranial approach if feasible
Awake craniotomy	• Consider asleep mapping with intraoperative electromyogram mapping • Consider biopsy only if near speech areas (Broca/Wernicke)
Approaches requiring mastoid air cell drilling (ie, retrosigmoid craniotomy, posterior petrosectomy)	• Enhanced PPE for all staff even if negative COVID-19 testing due to false-negative rate
Frontal craniotomies	• Avoid entering paranasal sinuses
Benign tumors that are at high risk for prolonged hospital stay causing obstructive hydrocephalus	• Consider CSF diversion with ETV or VPS and defer tumor resection
All high-risk surgical approaches	• Defer surgery if elective • Enhanced PPE for all staff even if negative COVID-19 testing due to false-negative rate • Minimal staff in operating room at all times

CSF, cerebrospinal fluid; ETV, endoscopic third ventriculostomy; PPE, personal protective equipment; VPS, ventriculoperitoneal shunt.