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American Association of Neurological Surgeons Archives - Neurosurgery Blog

AANS Neurosurgeon Spotlight: The State of Neurosurgical Education

By AANS Spotlight, Burnout, COVID-19, GMENo Comments

Recent global circumstances have had considerable effects on neurosurgery. In the latest articles from AANS Neurosurgeon, the official socioeconomic publication of the American Association of Neurological Surgeons (AANS), authors discuss the state of neurosurgical education. Practices have taken steps to not only adapt to a multitude of changes due to the COVID-19 pandemic, but to thrive among them, while helping their patients do the same. Browse the Education issue for a scientific, artistic and realistic view from those tasked with providing and navigating valuable educational experiences during a time when there is no such thing as “normal.”

Article Spotlight

This Crisis is an Opportunity
Lola B. Chambless, MD, FAANS

Dr. Chambless explains how the pandemic has provided an unprecedented opportunity to study, learn and reform.

A Combined Spine Surgery Fellowship
Jason Savage, MD ꟾ Michael P. Steinmetz, MD, FAANS

Discover the makings of a successful spine fellowship – strong leadership, constant re-evaluation and a collaborative surgeon group.

Pen versus Penfield: A Proposed New Training Modality for Neurosurgery Residents
Erin N. D’Agostino, MD

Dr. D’Agostino describes how art “can serve a role in surgical skill building, learning and teaching of anatomy, patient education and combating burnout.”

Read More

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Neurosurgeons Launch Campaign to Protect Patient Access to Care

By Access to Care, COVID-19, Guest Post, Health Reform, MedicareNo Comments

Our health care system is under extraordinary pressure. The COVID-19 pandemic has created an uncertain financial future for health care professionals. And now, coming on the heels of this devastating pandemic, Medicare is poised to implement drastic cuts. These cuts threaten patients’ access to timely surgical care and may impact the quality of life for the people neurosurgeons care for every day. To help policymakers and the public understand how these payment cuts will hurt patients and their neurosurgical care teams, on June 18, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS), along with 10 other national surgical associations, officially launched the Surgical Care Coalition (SCC).

The coalition, which represents more than 150,000 surgeons, was formed to stop these Medicare cuts to protect patients, improve their quality of life and ensure that our nation’s seniors have access to the neurosurgeon of their choice when they need life-saving neurosurgical care. Specifically, the SCC is worried about new Medicare payment policies for office and outpatient visits that the Centers for Medicare & Medicaid Services (CMS) will implement in January 2021. Changes to these visit codes — also known as evaluation and management (E/M) codes — will reduce payments for surgical care, which may lead to reduced access to care for older Americans. Working together, the coalition is putting this issue on the nation’s agenda and is urging Congress to pass legislation that will prevent these payment cuts.

To learn just how fragile our health care system is, the SCC recently commissioned a survey of more than 5,000 surgeons. According to this study, surgical practices are facing severe financial distress due to the COVID-19 pandemic. While the cuts were announced before the pandemic, with the combined impact of the planned CMS cuts and the economic challenges due to COVID-19, surgeons and hospitals will face difficult decisions to keep surgical practices afloat. For neurosurgeons, the survey found that even before the CMS cuts take effect:

  • More than one-half (54%) of respondents are concerned that they could be forced to shut down their practice, limiting choice and access to neurosurgical care;
  • Three-quarters (74%) of neurosurgeons are concerned about the finances of their practice, and to keep the doors open, 38% have cut their own salary, and one-quarter (24%) have taken on debt as a result of COVID-19; and
  • In the face of declining revenues, 86% of respondents are worried that they will have to cut employee’s salaries and 76% fear that they may have to permanently layoff employees.

In announcing the SCC initiative, John A. Wilson, MD, FAANS, president of the AANS, noted that “Neurosurgeons take care of critically ill patients who suffer from painful and life-threatening neurologic conditions such as traumatic brain injury, brain tumors, debilitating degenerative spine disorders and stroke, and without timely neurosurgical care, our patients can face permanent neurologic damage or death. He added, “The planned cuts to Medicare payments will further stress a healthcare system critically affected by the pandemic crisis and may negatively impact Medicare beneficiaries’ access to care.”

Echoing his remarks, Steven N. Kalkanis, MD, FAANS, president of the CNS, stated, “It is essential that policymakers understand how these payment cuts may impact access to surgical care. COVID-19 has placed an unprecedented strain on our health care system, and additional Medicare payment cuts will not only threaten timely access to quality care but will also stress an already fragile health care system.”

Our seniors need to take comfort in the fact that a neurosurgeon will be there if and when they ever require neurosurgical care. Medicare cuts hurt patients, and the Surgical Care Coalition is fighting to prevent payment cuts that threaten patients’ timely access to neurosurgical care.

Editor’s Note: Neurosurgery Blog encourages you to follow the coalition on Twitter and LinkedIn, and we invite you to join the conversation at #CutsHurtPatients.

Katie O. Orrico, Esq., director
AANS/CNS Washington Office

Reflecting on COVID19, the Death of George Floyd and the Need for Change

By COVID-19, Equity, Social JusticeNo Comments

“I want to touch the world.”
George Perry Floyd, Jr.

We are living in trying and turbulent times in our country. A global pandemic has claimed the lives of more than 100,000 people across America and has threatened to overwhelm our health care systems in some of the worst affected areas. On top of this health crisis, we are now facing the greatest civil unrest our country has experienced in over 50 years in response to a recent series of tragic deaths of black men and women — the cataclysmic event being the deplorable death of George P. Floyd, Jr. while in police custody.

While we look to our politicians for the political answers that will heal the strife in our country, we are all struggling with our personal feelings and response to these events. It has been extremely heartening, however, to see the expression and renewed commitment to inclusion and diversity, particularly within the medical community.

As voices cry out across the world underscoring the systemic problems of racism and inequality, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) have joined the chorus speaking out against all forms of discrimination and acts of violence — particularly that which is driven by intolerance and hatred. We reaffirm our commitment to inclusion and diversity. We reflect on the past and the messages of Dr. Martin Luther King, Jr. and Robert F. Kennedy. And we listen to our Black and Brown colleagues who provide a uniquely pertinent perspective on these issues, and we are thankful for their leadership and willingness to speak out.

We hope our readers will be inspired by the words of our colleagues from across the medical profession, which are reposted below in this piece. Millions around the world were horrified in disbelief at the killing of an unarmed man in police custody. As individuals and together as a society, we owe it to George Floyd and countless others to not let his death be in vain and to work to seek lasting change to stamp out racism, inequality and violence. We encourage you all to engage your patients, your colleagues and your communities in discussions as to how we can help heal our country and care for all who need us, including our most vulnerable.

In addition to the above message from the AANS and CNS, neurosurgeons and neurosurgical organizations spoke out.

A group of Black neurosurgeons who came together to publish an OpEd pointed out that as neuroscientists and surgeons, they see firsthand the effects of neurotrauma on those subjected to violence at especially alarming rates in the Black community. From the debilitating effects of blunt and penetrating trauma to the brain and spine to the “intangible neuropsychological effects stemming from fearing for one’s life on a daily basis,” there “is a slow but inevitable erosion of the state of health amongst Black people… This has culminated in a public health crisis shortening not only the lives of too many too early but diminishing the quality of life of those who remain to bear it.”

Reflecting on the shocking video depicting the death of George Floyd, neurosurgeon Fredric B. Meyer, MD, FAANS, the Juanita Kious Waugh Executive Dean for Education of the Mayo Clinic College of Medicine and Science and dean of the Mayo Clinic Alix School of Medicine, wrote to all medical students, residents and fellows. In his letter, Dr. Meyer reminded us “that although our country has made tremendous advances in civil and human rights, we all have significant work to do on so many levels to fight hatred, bigotry, and violence.” He recalled how Bobby Kennedy was one of his family’s heroes and how, as U.S. Attorney General, he was a strong advocate for civil rights. Dr. Meyer went on to note that in this time of terrible strife, anger, mistrust and hatred in our country, he is reminded of a powerful speech that Bobby Kennedy gave spontaneously on the back of a pickup truck when he learned of the assassination of Martin Luther King, Jr. He, along with his brother, President John F. Kennedy, and Dr. King, were all assassinated for the truth they spoke about human decency, civil rights, and a humane society. Dr. Meyer commends to the medical community the YouTube video of Bobby Kennedy announcing Dr. King’s death and to also listen to his speech on humanity, mindless violence and affirmation. His words are as relevant today as they were decades ago, and, as Dr. Meyer aptly stated, it is distressing that fifty years later, the same hatred that killed Dr. King continues to be pervasive in our society.

Leaders of the Society of Neurological Surgeons (SNS) — M. Sean Grady, MD, FAANS, president; Karin M. Muraszko, MD, FAANS, past-president; and Nathan R. Selden, MD, PhD, secretary — wrote to SNS members, neurosurgery department chairs and neurosurgical residency directors. In their message, they called on “educators to exemplify the highest moral and ethical standards for our trainees.” They noted that as educators and leaders in neurosurgery, we must ensure “that the American principles of fair and equal treatment for all are the bedrock of our Neurosurgical community.” Reaffirming a commitment to be “an inclusive organization reflective of the ‘higher’ principles,” they pledged “to grow and adapt and to listen to those we educate and those we serve. Although we may not have walked in their shoes, we will remain open to the knowledge and experience of every colleague and trainee and will respect and acknowledge them for their character and skills rather than for their appearance. Like our society, we believe we can continue to grow towards a more perfect union of our ideals and the reality in which we live,” and to strive together to reach higher ground.

The AANS/CNS Cerebrovascular Section, the Society of NeuroInterventional Surgery (SNIS) and the Society of Vascular & Interventional Neurology (SVIN) joined together to issue a statement acknowledging the difficult and disturbing times that the country is experiencing. These neurovascular organizations pointed out that “acts of violence and racism cause psychosocial stress that leads to poor well-being and cerebrovascular health, especially for communities of color. Given that heart disease and stroke are the leading causes of death for communities of color, our organizations are extremely disturbed by violent acts that cut to the core of the lives in our communities. We denounce the incidents of racism and all violence that continue to ravage our communities.”

Beyond the neurosurgical community, leading national medical organizations also spoke out.

The American College of Surgeons stated that it “stands in solidarity against racism, violence, and intolerance, noting that its “mission is to serve all with skill and fidelity, and that extends beyond the operating room. Racism, brutal attacks, and subsequent violence must end. We will help any injured, and we will use our voice in support of the health and safety of every person.”

Leaders from the American Medical Association (AMA) reminded us that AMA policy “recognizes that physical or verbal violence between law enforcement officers and the public, particularly among Black and Brown communities where these incidents are more prevalent and pervasive, is a critical determinant of health and supports research into the public health consequences of these violent interactions.”  The AMA continued, noting that the “disparate racial impact of police violence against Black and Brown people and their communities is insidiously viral-like in its frequency, and also deeply demoralizing… Just as the disproportionate impact of COVID-19 on communities of color has put into stark relief health inequity in the U.S.”

Finally, the Association of American Medical Colleges (AAMC) pointed out that “the coronavirus pandemic has laid bare the racial health inequities harming our Black communities, exposing the structures, systems, and policies that create social and economic conditions that lead to health disparities, poor health outcomes, and lower life expectancy.” The AAMC statement goes on to address how the brutal and shocking deaths of George Floyd, Breonna Taylor and Ahmaud Arbery “have shaken our nation to its core and once again tragically demonstrated the everyday danger of being Black in America.” Issuing a call to action, the AAMC expresses that “as healers and educators of the next generation of physicians and scientists, the people of America’s medical schools and teaching hospitals bear the responsibility to ameliorate factors that negatively affect the health of our patients and communities: poverty, education, access to transportation, healthy food, and health care.”

The AANS and CNS echo this call to action and concur that we “must move from rhetoric to action to eliminate the inequities in our care, research, and education of tomorrow’s doctors.”

Editor’s Note: Neurosurgery Blog invites you to join the conversation for social change at #WhiteCoatsforBlackLives and #ChangeTheSystem.

 

John A. Wilson, MD, FAANS
President, American Association of Neurological Surgeons
David L. and Sally Kelly Professor and Vice-Chair of the
Department of Neurosurgery, Wake Forest School of Medicine

 

 

Steven N. Kalkanis, MD, FAANS
President, Congress of Neurological Surgeons
Chief Executive Officer, Henry Ford Medical Group
Detroit, Mich.

Providing Comfort and Mercy: The U.S. Military’s COVID-19 Response Effort

By COVID-19, Guest Post, Health, Military Faces of NeurosurgeryNo Comments

Editor’s Note: Since the onset of the COVID-19 pandemic, neurosurgeons have helped bring aid and comfort to neurosurgical patients and those suffering from the novel coronavirus. Today, on Memorial Day, we wish to salute the efforts of the men and women serving in our U.S. Military, who, too, have provided comfort and mercy during this national emergency. On this day and always, you have our unwavering gratitude for your dedication and service.

I’ve been asked to comment about my experience mobilized in the military reserve in response to the COVID-19 pandemic. I do so without named authorship secondary to the fact that the mission is ongoing, and the focus should be on a genuinely profound group effort.

Bluntly, the United States military responded in a big way with a large and immediate tri-service response. It’s truly been incredible to see, and it’s been an honor to play a very small part. Nearly 1,600 U.S. Navy Selected Reserve Sailors have deployed globally to fight COVID-19.

The U.S. Navy has developed a neurosurgery presence on both the United States Naval Ship (USNS) Comfort and the USNS Mercy. The USNS Comfort has aided the effort in New York City while the USNS Mercy has helped in Los Angeles. Both undertook evolving missions to best help the civilian hospitals. The mission morphed as necessary from off-loading non-COVID-19 patients, to acting as a trauma and emergency surgery center, to ultimately focusing on treating COVID-19 patients. The leadership has been adaptive to the needs of the community. There are a lot of good people who are doing very impactful things with both missions. Navy Reserve neurosurgeons aided in neurosurgical coverage and general surgical call responsibilities on each of the ships with excellent mentorship from their active-duty counterparts as well as the Navy Reserve neurosurgery specialty leader.

The United States Army has also helped create a field hospital at the Javits Center with an ideal maximum capacity of up to 2,500 beds. This was mostly to off-load more stable patients with COVID-19, but the facility also had intensive care unit (ICU) capabilities. The Navy Reserve Expeditionary Medical Force Bethesda supported the medical relief efforts at the Javits Federal Medical Station with a top to bottom 400 sailor hospital staff unit. There was no neurosurgery occurring at the Javits Center, as the focus was on COVID-19. Other similar sites throughout the U.S. were also established.

Other Navy Reserve doctors and nurses are embedded into the New York City public city hospitals that have been decimated with COVID-19. Navy Reserve doctors and nurses are joining their civilian counterparts in treating COVID-19 patients in hospitals where they are most needed. Many are acting in new and expanded roles due to the dramatically increased ICU needs. The shortage does not call for additional neurosurgeons to perform neurosurgery but for additional coverage in overflowing ICUs. These are very sick patients, and neurosurgeons have a tremendous possibility to do some good within this structure. As our medical critical care colleagues take a pounding, neurosurgeons are very comfortable in the ICU, in treating critical patients, in dealing with mortality and in leading large health care teams to make pragmatic, direct and impactful decisions. Indeed, the Joint Section on Neurotrauma and Critical Care of the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) issued guidelines to help neurosurgeons managing COVID-19 ICUs. The Navy has been tremendous in organizing teams across multiple specialties to do just that work.

Neurosurgeons who no longer desire the ICU could also consider joining their hospital’s prone team to help flip acute respiratory distress syndrome (ARDS) type patients with COVID-19 throughout the hospital. These teams generally travel from unit to unit to supine and prone the sickest of the respiratory patients in the hospital. Anesthesiologists head these teams due to airway concerns, but they also include orthopaedic, spine and other surgical specialists comfortable in positioning complex patients. It is truly a service that makes a tangible difference when managing these patients within the ICU.

It goes without saying that service in the Navy Reserve rests upon the service of others. Colleagues back home have taken additional emergency call, increased their workload and served the local community in similar ways. Even more so, spouses have to work overtime at home, especially those with small children and those juggling their own virtual careers. Multiple people have come together in numerous ways to serve the people of New York City. And, the welcome in New York City has been one of deep gratitude both inside and outside the hospital.

The objective impact of the Navy Medical Response Team will be measured in patients treated, intubations and central lines. However, the subjective impact has been even more important. The military members here have truly made a difference fighting an invisible enemy.

*This is the author’s opinion only and in no way reflects the thoughts or opinions of anyone else in the United States Navy. It does not represent the official policy of the United States Navy, the Department of Defense or the United States Government.

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.

Answering the Call: From Neurosurgeon to Critical Care Physician During COVID-19

By COVID-19, Faces of Neurosurgery, Guest Post, HealthNo Comments

With the coronavirus pandemic sweeping the nation, some regions of our country are encountering a shortage of health care providers to look after the surge of hospitalized patients. As personnel resources are strained, neurosurgeons are being asked to care for critically ill patients — including ones that do not have neurological diagnoses.

Beyond a robust foundation in neurocritical care during training and daily practice, some neurosurgeons have additional training in critical care to become full-time neurointensivists. As such, neurosurgeons of all subspecialties may be tapped to care for patients in the intensive care unit (ICU). This is not surprising because of the skills all neurosurgeons develop to monitor patients closely and act swiftly and decisively when the need arises. The complexity of neurosurgical patients demands an extensive understanding of how the body’s organ systems interact and must be treated when acute multi-organ dysfunction exists. Patients with ruptured aneurysms, traumatic brain injuries, strokes and spinal cord compression may also have respiratory failure, cardiac disease and acute kidney injury.

While learning about critical care is a part of neurosurgical training, many neurosurgeons have not been practicing critical care medicine since leaving training. One strength of organized neurosurgery is its ability to draw neurosurgeons together for a common purpose. To aid neurosurgeons in their new mission, the Joint Section on Neurotrauma & Critical Care (Trauma Section) of the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) developed A Neurosurgeon’s Guide to Pulmonary Critical Care for COVID-19, a presentation that includes:

  • A review of pulmonary physiology;
  • Protocols to promote the safety of caregivers;
  • Basics of ventilator management;
  • Recommendations from multiple professional societies for the care of COVID-19 patients; and
  • A review of techniques to optimize patient care.

This presentation is available on the COVID-19 resource hubs of the AANS, the CNS and the American Board of Neurological Surgery.

The Trauma Section has also developed additional guidance, A Neurosurgeon’s Guide to Cardiovascular and Renal Critical Care for COVID-19, which is available from the AANS and the CNS.

While our nation faces a new challenge in the COVID-19 pandemic, organized neurosurgery is rising to meet it. The educational efforts of the AANS and the CNS, along with health care policy advocacy from the AANS/CNS Washington Committee, are helping to prepare neurosurgeons in all stages in their career to answer this call.

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.

Alan Hoffer, MD, FAANS
Chair, Critical Care Committee of the AANS/CNS Joint Section on Neurotrauma & Critical Care
University Hospitals of Cleveland
Case Western Reserve University

The Global Impact of the COVID-19 Pandemic on Neurosurgical Practice (Part III)

By AANS Spotlight, COVID-19, Faces of Neurosurgery, HealthNo Comments

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.

Join us in reading these free articles.

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.

The Global Impact of the COVID-19 Pandemic on Neurosurgical Practice (Part II)

By AANS Spotlight, COVID-19, Faces of Neurosurgery, HealthNo Comments

The American Association of Neurological Surgeons (AANS) and the Journal of Neurosurgery Publishing Group are pleased to announce the publication of eleven new editorials on the impact of the COVID-19 pandemic on neurosurgical practice. The series kicked off last week with three editorials and an introduction on the subject, which were published in the Journal of Neurosurgery and the Journal of Neurosurgery: Pediatrics.

Last week we heard from neurosurgeons in the United States, Canada, Italy and China on the impact of the pandemic on neurosurgical practice. This week’s installment adds editorials from the U.S., Republic of Korea and Singapore.

The editorials cover a wide variety of important areas demonstrating the impact of COVID-19 on the practice and training of neurosurgeons. Although other fields of medicine more readily come to mind when considering the battle against the virus known as SARS-CoV-2, neurosurgical practice has also had to adapt swiftly in response to the COVID-19 pandemic.

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

Join us in reading these free articles.

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.

The Global Impact of COVID-19 on Neurosurgical Practice

By AANS Spotlight, COVID-19, Faces of Neurosurgery, HealthNo Comments

The COVID-19 pandemic has significantly impacted medical practice across the globe. The effects are most notable in the fields of infectious disease, virology, emergency and critical care medicine, and epidemiology. Other medical specialties, including neurosurgery, however, are also impacted.

To highlight the effect of the pandemic on the neurosurgery practice, the Journal of Neurosurgery Publishing Group (JNSPG), the scholarly journal division of the American Association of Neurological Surgeons, is releasing a series of editorials on the impact of the COVID-19 pandemic on the practice of neurosurgery.

Douglas S. Kondziolka, MD, FAANS; William T. Couldwell, MD, PhD, FAANS; and James T. Rutka, MD, PhD, FAANS, introduce the series and highlight the impact the pandemic has had on neurosurgical practice. Three editorials are available, and additional papers on this topic will appear each Friday, so be sure to check back weekly.

Yirui Sun, MD, PhD, and Ying Mao, MD, PhD, provide an update on the pandemic in China. They speak of colleagues lost and the efforts of neurosurgeons to treat emergency cases regardless of the viral status of their patients. The authors also discuss how COVID-19 has given them “pause to reinforce [their] skillsets and redesign [their] mindsets to perform roles not only as neurosurgeons but also as executive officers.”

Marco Cenzato, MD, and colleagues speak from the Lombardy region of Italy. They describe a reorganization of neurosurgical facilities to expand the number of ICUs available to COVID-19 patients. Fifteen neurosurgical departments were temporarily consolidated into three locations, with neurosurgeons and patients shifted as well. As a result, “opening the hospital doors to neurosurgeons coming from other institutions has offered an unprecedented opportunity of collaboration and integration of teams.”

Leaders of the American Society of Pediatric Neurosurgeons address current management of COVID-19 in the pediatric neurosurgery community and provide recommendations on the preparation and response to the pandemic. Crucial areas addressed in their recommendations include children’s hospitals as a whole, operating rooms, pediatric neurosurgery clinical teams, and patients. Serious illness remains relatively rare among children with COVID-19. Nevertheless, the authors warn against complacency and stress the need for urgency in preparation and response to the pandemic.

Neurosurgeries must be prioritized, delaying less urgent cases so that increased hospital facilities and equipment can be made available for patients with COVID-19.

The COVID-19 pandemic has wreaked havoc in the lives of people across the world. The numbers of cases and deaths from the disease continue to climb at a rapid pace. Many deaths have occurred among health care workers. On both a personal and professional level, the JNSPG editors acknowledge, with sadness, the passing of fellow neurosurgeon James T. Goodrich, MD, Chief of Pediatric Neurosurgery, Montefiore Medical Center, New York City, from complications related to COVID-19 on March 30, 2020.