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Germanò A, Raffa G, Angileri FF, Cardali SM, Tomasello F. Coronavirus Disease 2019 (COVID-19) and Neurosurgery: Literature and Neurosurgical Societies Recommendations Update. World Neurosurg 2020; 139:e812-e817. [PMID: 32360733 PMCID: PMC7192081 DOI: 10.1016/j.wneu.2020.04.181] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Since January 2020, when the pathogen causing the coronavirus disease was identified in humans, the literature on coronavirus disease 2019 (COVID-19) has grown exponentially to more than 4000 publications. There is the need to provide an update for each single medical discipline, including neurosurgery, to be used by single professionals or to be distributed through the neurosurgical community and to be used by governments in designing new scenario of care. METHODS A review of the MEDLINE database was performed on April 13, 2020. Search terms included "COVID-19," "neurosurgery," and "surgery." A review of documents published on the webpage of the WFNS (World Federation of Neurosurgical Societies) and of the 5 continental associations of neurosurgical societies, AANS (American Association of Neurological Surgeons), AASNS (Asian Australasian Society of Neurological Surgeons), CAANS (Continental Association of African Neurosurgical Societies), EANS (European Association of Neurosurgical Societies), and FLANC (Latin American Federation of Neurosurgical Societies), representing the 119 national neurosurgical societies around the world, was performed. RESULTS The literature search yielded 38 results that were manually reviewed. Fourteen manuscripts were considered eligible. They described suggestions and considerations to optimize care of neurosurgical patients, editorials on operational models, perspectives from neurosurgical departments, letters to the editor describing experiences on how to help medical staff to be prepared in advance for pandemic situations, and descriptions of regional or departmental models and/or organizational schemes. The webpages of the searched societies reported a total of 57 documents. CONCLUSIONS The neurosurgical scientific community has promptly reacted to the COVID-19 outbreak by producing a growing number of documents that could serve as guidance for neurosurgeons all over the world. Neurosurgical societies will represent the key institutions for guiding the neurosurgical community to overcome the COVID-19 crisis.
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Affiliation(s)
- Antonino Germanò
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
| | - Giovanni Raffa
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy.
| | | | | | - Francesco Tomasello
- Division of Neurosurgery, BIOMORF Department, University of Messina, Messina, Italy
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Schmidt FA, Kirnaz S, Wipplinger C, Kuzan-Fischer CM, Härtl R, Hoffman C. Review of the Highlights from the First Annual Global Neurosurgery 2019: A Practical Symposium. World Neurosurg 2020; 137:46-54. [PMID: 31996336 DOI: 10.1016/j.wneu.2020.01.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 01/16/2020] [Accepted: 01/18/2020] [Indexed: 11/28/2022]
Abstract
This paper provides a detailed report of Global Neurosurgery 2019: A Practical Symposium held January 18-19, 2019, at Weill Cornell Medical College, New York, New York, USA. The meeting convened an international faculty and audience, leaders in the world of global neurosurgery (GNS), and junior faculty and residents beginning their contribution to the field. Remote access for the symposium was provided to include faculty practicing in developing countries. The goal of the symposium was to present the state of the union of GNS initiatives worldwide, to use this forum as a means to centralize resources and converge parallel efforts, and to identify the largest areas of need and successful means of advancing training and care in these areas. The meeting also served as a conduit for the presentation of funding and training opportunities for junior faculty and trainees looking for avenues to gain support and mentorship in pursuing academic and clinical endeavors globally.
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Affiliation(s)
- Franziska A Schmidt
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Christoph Wipplinger
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Claudia M Kuzan-Fischer
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA
| | - Caitlin Hoffman
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, New York, USA.
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Lin CM, Wang AYC, Chen CC, Wu YM, Liu CH, Tsay PK, Chang CH. Warning headache correlates survival rate in aneurysmal subarachnoid hemorrhage. Biomed J 2019; 42:352-357. [PMID: 31783996 PMCID: PMC6889243 DOI: 10.1016/j.bj.2019.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 12/31/2018] [Accepted: 04/23/2019] [Indexed: 11/23/2022] Open
Abstract
Background Severe headaches, projectile vomiting, focal neurological deficits and early onset seizure are regarded as early warning symptoms of subarachnoid hemorrhage (SAH). Earlier diagnosis based on such warning symptoms theoretically would improve the clinical prognosis. However, it is still not clear whether the prognosis is correlated with early warning symptoms. Here, we reviewed warning symptoms and other predictive factors in the emergency room (ER) setting and examined their correlations with mortality. Methods Ninety saccular aneurysmal SAH cases were reviewed in a single medical center between January 2011 and December 2013. We examined differences in mortality rate related to warning symptoms, SAH scales, onset-to-ER time, hydrocephalus, and aneurysm size, location, and complexity. Logistic regression analyses were performed to determine the correlations of warning symptoms and other predictive factors with mortality. Receiver operating characteristic (ROC) curve analysis was used to calculate the area the under curve (AUC) of SAH mortality prediction tools. Results Warning headache, projectile vomiting, the Hunt and Hess scale, Fisher scale, World Federation of Neurological Surgeons (WFNS) grading scale, and modified WFNS (m-WFNS) scale, body mass index, aneurysm complexity and hydrocephalus were significantly different between the survivors and the decedents. The warning headache and WFNS grade were strongly correlated with mortality. The rate of prognostic prediction improved from 90.4% to 94.6% when warning headache was additionally evaluated. Conclusions With growing healthcare costs and recognition of the value of palliative care, early identification via warning headache and a detailed clinical history review is necessary for cases of aSAH.
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Affiliation(s)
- Chuan-Min Lin
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Alvin Yi-Chou Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Chang Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ming Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Hung Liu
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Kwei Tsay
- Department of Public Health and Center of Biostatistics, Chang Gung University, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Rosseau G, Johnson WD, Park KB, Arráez Sánchez M, Servadei F, Vaughan KA. Global neurosurgery: current and potential impact of neurosurgeons at the World Health Organization and the World Health Assembly. Executive summary of the World Federation of Neurosurgical Societies-World Health Organization Liaison Committee at the 71st World Health Assembly. Neurosurg Focus 2019; 45:E18. [PMID: 30269578 DOI: 10.3171/2018.7.focus18295] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Since the creation of the World Health Organization (WHO) in 1948, the annual World Health Assembly (WHA) has been the major forum for discussion, debate, and approval of the global health agenda. As such, it informs the framework for the policies and budgets of many of its Member States. For most of its history, a significant portion of the attention of health ministers and Member States has been given to issues of clean water, vaccination, and communicable diseases. For neurosurgeons, the adoption of WHA Resolution 68.15 changed the global health landscape because the importance of surgical care for universal health coverage was highlighted in the document. This resolution was adopted in 2015, shortly after the publication of The Lancet Commission on Global Surgery Report titled "Global Surgery 2030: evidence and solutions for achieving health, welfare and economic development." Mandating global strengthening of emergency and essential surgical care and anesthesia, this resolution has led to the formation of surgical and anesthesia collaborations that center on WHO and can be facilitated via the WHA. Participation by neurosurgeons has grown dramatically, in part due to the official relations between WHO and the World Federation of Neurosurgical Societies, with the result that global neurosurgery is gaining momentum.
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Affiliation(s)
- Gail Rosseau
- 1Midwest Neurosurgical Associates, Oak Brook, Illinois
| | - Walter D Johnson
- 2Emergency and Essential Surgical Care Programme, World Health Organization, Geneva, Switzerland
| | - Kee B Park
- 3Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | | | - Franco Servadei
- 5Department of Neurosurgery, Humanitas University, Milan, Italy; and
| | - Kerry A Vaughan
- 3Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.,6Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Affiliation(s)
- Basant Kumar Misra
- P. D. Hinduja National Hospital and Medical Research Centre, Department of Neurosurgery and Gamma Knife Centre, V. S. Marg Mahim, Mumbai, Maharashtra, India.
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van Donkelaar CE, Bakker NA, Veeger NJGM, Uyttenboogaart M, Metzemaekers JDM, Eshghi O, Mazuri A, Foumani M, Luijckx GJ, Groen RJM, van Dijk JMC. Prediction of outcome after subarachnoid hemorrhage: timing of clinical assessment. J Neurosurg 2016; 126:52-59. [PMID: 27035175 DOI: 10.3171/2016.1.jns152136] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Currently, early prediction of outcome after spontaneous subarachnoid hemorrhage (SAH) lacks accuracy despite multiple studies addressing this issue. The clinical condition of the patient on admission as assessed using the World Federation of Neurosurgical Societies (WFNS) grading scale is currently considered the gold standard. However, the timing of the clinical assessment is subject to debate, as is the contribution of additional predictors. The aim of this study was to identify either the conventional WFNS grade on admission or the WFNS grade after neurological resuscitation (rWFNS) as the most accurate predictor of outcome after SAH. METHODS This prospective observational cohort study included 1620 consecutive patients with SAH admitted between January 1998 and December 2014 at our university neurovascular center. The primary outcome measure was a poor modified Rankin Scale score at the 2-month follow-up. Clinical predictors were identified using multivariate logistic regression analyses. Area under the receiver operating characteristic curve (AUC) analysis was used to test discriminative performance of the final model. An AUC of > 0.8 was regarded as indicative of a model with good prognostic value. RESULTS Poor outcome (modified Rankin Scale Score 4-6) was observed in 25% of the patients. The rWFNS grade was a significantly stronger predictor of outcome than the admission WFNS grade. The rWFNS grade was significantly associated with poor outcome (p < 0.001) as well as increasing age (p < 0.001), higher modified Fisher grade (p < 0.001), larger aneurysm size (p < 0.001), and the presence of an intracerebral hematoma (OR 1.8, 95% CI 1.2-2.8; p = 0.002). The final model had an AUC of 0.87 (95% CI 0.85-0.89), which indicates excellent prognostic value regarding the discrimination between poor and good outcome after SAH. CONCLUSIONS In clinical practice and future research, neurological assessment and grading of patients should be performed using the rWFNS to obtain the best representation of their clinical condition.
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Affiliation(s)
| | | | | | - Maarten Uyttenboogaart
- Departments of 4 Neurology and.,Radiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | | | - Omid Eshghi
- Radiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Aryan Mazuri
- Radiology, University Medical Center Groningen, University of Groningen, The Netherlands
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Tewari M, Aggarwal A, Mathuriya S, Gupta V. The outcome after aneurysmal sub arachnoid hemorrhage: a study of various factors. Ann Neurosci 2015; 22:78-80. [PMID: 26130911 DOI: 10.5214/ans.0972.7531.220205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/25/2014] [Accepted: 02/10/2015] [Indexed: 11/17/2022] Open
Abstract
Background Aneurysmal subarachnoid hemorrhage (A-SAH), despite improvement in surgical and medical treatments, is still a serious disease with high fatality and morbidity rates. Despite the huge advances in neurosurgical management of the disease, there has not been a proportional improvement in outcome of this condition. Purpose We studied various factors which can influence the final outcome and these included: World federation of neurosurgical societies (WFNS), Hunt & Hess (H&H) and Fisher grade, size of aneurysm, intra operative rupture (IOR), temporary clipping (TC) – and correlate their individual impact in final outcome. Methods We studied 100 patients of aneurysmal subarachnoid hemorrhage prospectively all of whom were operated upon .Post operative course was followed and final outcome studied. Results Pre operatively, higher WFNS and H&H grades had a worse outcome. This correlation was not found for Fisher grade. Nonetheless, presence of IVH(Fisher grade 4) acted as an independent risk factor for poor outcome. Conclusion Diabetes and smoking led to a worse outcome in contrast to hypertension . IOR led to poor outcome while temporary clipping did not.
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von Wild KR. "Quidquid agis prudenter agas et respice finem"--whatever you do, do it wisely and consider the end. World Neurosurg 2013; 80:464-6. [PMID: 24295992 DOI: 10.1016/j.wneu.2012.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 11/09/2012] [Indexed: 11/22/2022]
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Bohnstedt BN, Nguyen HS, Kulwin CG, Shoja MM, Helbig GM, Leipzig TJ, Payner TD, Cohen-Gadol AA. Outcomes for clip ligation and hematoma evacuation associated with 102 patients with ruptured middle cerebral artery aneurysms. World Neurosurg 2012; 80:335-41. [PMID: 22465372 DOI: 10.1016/j.wneu.2012.03.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/12/2011] [Accepted: 03/20/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Few studies have investigated the implications of intracerebral hematoma (ICH) due to rupture of a middle cerebral artery (MCA) aneurysm and patient outcomes. We hypothesized that patients with Hunt-Hess (HH) grade IV-V may not benefit from aggressive measures. METHODS A prospectively acquired aneurysm database was examined. We found 144 patients who harbored a ruptured MCA aneurysm and suffered from ICH or intrasylvian hematoma with or without subarachnoid hemorrhage. The mean age of our patients was 52.5 years (range, 10-82 years) with 87 women and 57 men. Of these, 122 (84.7%) underwent a combination of interventions, including clip ligation, hematoma evacuation, and/or endosaccular coiling; most patients underwent clip ligation at the same time as their hematoma was evacuated. The discharge information was not available for two patients. We examined significant associations among presenting details (e.g., age, sex, admission HH grade) and patients' final outcome. RESULTS The total in-hospital mortality rate was 49% (70 of 142 patients); 42% (51 of 120) for the patients who underwent an intervention and 86.4% (19 of 22) for those who did not undergo any intervention. Among our patients, approximately 52% with an admission HH grade of IV/V died in-hospital after surgery, whereas 21% with admission HH grade of I-III expired during the same time. In the patient cohort with presenting with HH grade IV and V, 4% (3 of 76) demonstrated Glasgow outcome scale 4-5 at discharge, whereas 15% (12 of 78) displayed Glasgow outcome scale 4-5 at 6-month follow-up. Age and sex did not affect outcome. CONCLUSIONS Aggressive clip ligation and hematoma evacuation remains a reasonable option for patients suffering from an ICH associated with a ruptured MCA aneurysm. Admission HH grade is the primary prognostic factor for outcome among this patient population as more than half of patients with HH grade IV and V expired during their hospitalization despite aggressive treatment of their hematoma and aneurysm. Long-term functional outcome was poor in up to 85% of surviving patients with HH grade IV-V. It may be beneficial to discuss these prognostic factors with the family before implementing aggressive measures.
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Affiliation(s)
- Bradley N Bohnstedt
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA
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