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The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm

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

The COVID-19 pandemic is disrupting neurosurgical care at medical centers throughout the United States. Institutional and governmental recommendations are not specific to neurosurgery. Protocols are urgently needed to help neurosurgeons triage cases based on acuity, and also to minimize the risk of infection for both patients and peri-operative medical staff. In many academic tertiary care hospitals, there is limited personal protective equipment and staffing shortages.

Given that there is insufficient data to create formal guidelines, physicians from the University of California San Francisco (UCSF) Department of Neurological Surgery and Department of Anesthesia have presented their institutional neurosurgical treatment algorithm during the California COVID-19 shelter in place order. The UCSF protocols are based on outbreak “surge levels,” and using these levels to guide operating room utilization based on the acuity of neurosurgical cases. The protocols and checklists from UCSF, which are published online in Neurosurgery — the official journal of the Congress of Neurological Surgeons (CNS) —  offer some guidance to neurosurgeons in other centers.

Click here to read “Letter: The Coronavirus Disease 2019 Global Pandemic: A Neurosurgical Treatment Algorithm.”

The CNS also offers a related webinar presentation, “UCSF’s Experience with COVID-19 in the Midst of the California Shelter-in-place Order.”  Click here to view the webinar.

John F. Burke MD, PhD
Resident, Neurological Surgery
University of California San Francisco
San Francisco, California

 

 

Praveen V. Mummaneni, MD
Professor, Neurological Surgery
University of California San Francisco
San Francisco, California

April 3, 2020
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CNS Publishes New Concussion Guidelines

By CNS Spotlight, Concussion, Cross Post, GuidelinesNo Comments

Published online in Neurosurgery, the official journal of the Congress of Neurological Surgeons (CNS), in August, the “Concussion Guidelines Step 2: Evidence for Subtype Classification,” provides support for re-thinking the way we diagnose concussion.

Angela K. Lumba-Brown, MD, co-director of the Stanford Brain Performance Center, Assistant Professor of Emergency Medicine at Stanford University, and co-author of the guideline, states that because concussion symptoms may vary greatly from person to person, early subtyping can direct strategies for recovery.

The study represents the work of a multidisciplinary team of experts across the country, unified to define five common concussion subtypes:

1. Headache/Migraine
2. Vestibular
3. Cognitive
4. Oculomotor
5. Anxiety/Mood

Notably, two concussion-associated conditions — sleep disturbance and cervical strain — often occur in relation to subtypes, but do not stand alone as concussion diagnostic criteria.

Through a rigorous review of the scientific literature and meta-analysis, the expert workgroup identified differences in the prevalence of each subtype shortly following head injury. Studying the first few days following a concussion is critical because the majority of scientific literature to-date examines concussion signs and symptoms spanning the first week to a month following injury, during which large variability in recovery patterns occur.

  • This study provides support for the presence of all five subtypes as early as three days following injury — directing an urgent change in the way concussion is currently diagnosed. For example:
    Anxiety and mood symptoms, often thought to manifest much later in the concussion course, are present in a large portion of patients early on.
  • Both children and adults exhibit vestibular impairments immediately following a concussion, representing an opportunity for early intervention with vestibular therapies.

This work demonstrates that a comprehensive, initial concussion assessment should incorporate evaluations of all five subtypes and two associated conditions. This work was supported by the Brain Trauma Evidence-Based Consortium, a U.S. Department of Defense-funded project in collaboration with the Brain Performance Center at Stanford University and the Brain Trauma Foundation.

To read the full Neurosurgery article, click here.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #CNSGuidelines.

January 2, 2020
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