The American Association of Neurological Surgeons (AANS) and the Journal of Neurosurgery (JNS) Publishing Group are pleased to announce the publication of four editorials on the impact of the COVID-19 pandemic on neurosurgical practice. This batch of editorials concludes our rapid-response collection on this topic. Altogether the collection boasts 19 papers, an introduction and 18 editorials, published in the Journal of Neurosurgery, Journal of Neurosurgery: Pediatrics or Journal of Neurosurgery: Spine. All of the articles are posted online, and they will also be accessible by PubMed Central as part of the Public Health Emergency COVID-19 Initiative.

The following articles cover neurosurgeons’ experiences and lessons learned thus far during the COVID-19 pandemic:

Xiaoguang Tong, MD, and Yuanfan Yang, MD, discuss precautions taken at Huanhu Hospital in Tianjin, China, for performing emergency cerebrovascular procedures during the pandemic. All patients entering the emergency department are assumed to have COVID-19 until proven otherwise. The hospital rearranged equipment and facilities to isolate patients throughout their treatment. Full personal protective equipment (PPE) — including N95 masks, face shields, goggles and full gown — were worn by all health care workers. Extra layers of face protection were worn during emergency intubation. Whenever possible, minimally invasive procedures were performed. Additional steps to protect health care workers and patients are also covered in this editorial. The authors state the precautions resulted in no infections among the health care workers and patients.

Sepideh Amin-Hanjani, MD, FAANS, and coauthors representing multiple academic institutions throughout the U.S. and Canada weigh in on the overall impact of COVID-19 on neurosurgical practice. The authors discuss the conservation of skilled staff, the heightened risk of some neurosurgical approaches, postponement of elective cases, the necessity of wearing appropriate PPE and the need to convert some specialty facilities into treatment sites for COVID-19 patients. The authors also share resources for neurosurgeons during the pandemic offered by the AANS, Congress of Neurological Surgeons, Centers for Medicare & Medicaid Services, the American College of Surgeons and additional societies.

Adair Prall, MD, FAANS, FACS, John D. Davis, IV, MD, FAANS, and N. Ross Jenkins, MD, FAANS, share their insights on changes in community practice during the COVID-19 pandemic. As independent private practitioners, these authors describe how disorienting it has been to suddenly have “many decisions made for them and [be] required to limit, change, or stop altogether their workflow.” The authors mention new ways of treating patients using phone or video conversations. They also discuss how hospital or ambulatory surgery center administrators may view urgent and elective surgeries differently from surgeons, and how neurosurgeons must advocate for patients whose conditions may not appear urgent but indeed are so. Lastly, the authors speak to the issue of small business ownership during the pandemic, dealing with a reduced caseload and income while trying to retain skilled employees.

A neurosurgical resident at Massachusetts General Hospital, Victoria Clark, MD, PhD, describes the experience of being locked out of the lab during the pandemic. Being unable to continue lab benchwork, she evaluates other avenues of research that can be followed by the resident at this time — such as working on bioinformatics-based projects or chart-based/clinical analyses or focusing on scientific writing. Laboratory research is extremely important overall, and an integral part of residency training, and Dr. Clark offers several suggestions on how labs can be reopened and neurosurgical research can continue using safe, socially distant methods.

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Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.

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