• Peh Hueh Low, Manvinder Singh Mangat, Liew Donald Ngian San DNS Department of Neurosurgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia., and Wong Albert Sii Hieng ASH Department of Neurosurgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia..
• Department of Neurosurgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia. Electronic address: peh.hueh@gmail.com.
• World Neurosurg. 2020 Dec 1; 144: e710-e713.

BackgroundThe novel coronavirus disease 2019 (COVID-19) pandemic has set a huge challenge to the delivery of neurosurgical services, including the transfer of patients. We aimed to share our strategy in handling neurosurgical emergencies at a remote center in Borneo island. Our objectives included discussing the logistic and geographic challenges faced during the COVID-19 pandemic.MethodsMiri General Hospital is a remote center in Sarawak, Malaysia, serving a population with difficult access to neurosurgical services. Two neurosurgeons were stationed here on a rotational basis every fortnight during the pandemic to handle neurosurgical cases. Patients were triaged depending on their urgent needs for surgery or transfer to a neurosurgical center and managed accordingly. All patients were screened for potential risk of contracting COVID-19 prior to the surgery. Based on this, the level of personal protective equipment required for the health care workers involved was determined.ResultsDuring the initial 6 weeks of the Movement Control Order in Malaysia, there were 50 urgent neurosurgical consultations. Twenty patients (40%) required emergency surgery or intervention. There were 9 vascular (45%), 5 trauma (25%), 4 tumor (20%), and 2 hydrocephalus cases (10%). Eighteen patients were operated at Miri General Hospital, among whom 17 (94.4%) survived. Ninety percent of anticipated transfers were avoided. None of the medical staff acquired COVID-19.ConclusionsThis framework allowed timely intervention for neurosurgical emergencies (within a safe limit), minimized transfer, and enabled uninterrupted neurosurgical services at a remote center with difficult access to neurosurgical care during a pandemic.Copyright © 2020 Elsevier Inc. All rights reserved.

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