Table 1.

Summary of Measures Applied in Our Neurosurgical Practice

Measures to avoid the risk of hospital congestion	Stop all elective clinical and surgical activities to redeploy wards to COVID-19 outbreak Triage case by phone and implementation of telemedicine
Outpatient management	Use telemedicine for consulting and screening
Clinical scheduling	Online preoperative visits Elective clinic visits canceled
Surgical scheduling	Only emergent and semiurgency were scheduled Elective surgeries canceled
Inpatient measures	Separate neurosurgical units (clean areas) and COVID units Avoid all crossing between patients infected and noninfected
Emergency	Cerebral hemorrhages (subarachnoid and intracerebral hemorrhages) Acute hydrocephalus Tumors at risk of intracranial hypertension Spinal cord compressions with neurologic deficit Cranial and spinal trauma emergencies Spine oncology, epidural abscess, cauda equina or severe root compression
Screening related with COVID-19	Reviews list of symptoms and exposure history Throat swab and chest computed tomography for all admission if testing available. Two swabs at a distance of 2–4 days (to minimize false-negatives possibility) Diagnosis confirmed by 1) positive nucleic acid test of SARS-CoV-2 detected reverse transcription-quantitative polymerase chain reaction, 2) highly homologous genome sequencing to SARS-CoV-2, and 3) positive serologic testing of SARS-CoV-2-specific immunoglobulin G and immunoglobulin M antibodies
Intraoperative measures if COVID-19-positive patient	Patient transportation on a closed circuit to a small negative-pressure suction room Respect airway management protocols for intubation/extubation (minimal personnel in the room, using contained air purifying respirators, out-of-room waiting time) Limit unnecessary personnel Avoid endonasal surgeries Decrease speed of bone drilling to reduce spread of bone dust Optimize surgical team to shorten duration of surgeries
Appropriate PPE	Disposable FFP2/N95 mask, water-resistant gown, gloves, goggles, cap, and full-face visor shield For COVID-19 positive patients, FFP3 mask and/or powered air purifying respirators
Specific surgical management	Endonasal surgery: manage patient as suspected case - nasal irrigation with povidone-iodine solution, caution with dural handling, minimize drilling and prefer osteotomes Spine surgery: favor prone position, minimally invasive approach, reduce suction and splatter Brain surgery: avoid awake strategies and biopsy rather than surgical resection if possible
ICU	Manage positive patients with COVID-19 to a separated COVID ICU unit Postoperative care for uncomplicated surgery includes craniotomies cases in a medium care unit rather than ICU
Postoperative management	Emphasize rapid discharge with close telemedicine follow-up
Measures for clinical team	Follow universal precautions and PPE guidelines Social distancing for all group-based activities Reduce the number of health care staff on clinical duty Clinical team-bases rotations to reduce virus exposure Social distancing for all group-based activities
Conference and education	All in-person conferences were canceled and replaced by seminars or webinars through video teleconferences

SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; PPE, personal protection equipment, ICU, intensive care unit.