• Aditya S Pandey, Andrew J Ringer, Ansaar T Rai, Peter Kan, Pascal Jabbour, Adnan H Siddiqui, Elad I Levy, Kenneth V Snyder, Howard Riina, Omar Tanweer, Michael R Levitt, Louis J Kim, Erol Veznedaroglu, Mandy J Binning, Adam S Arthur, J Mocco, Clemens Schirmer, Byron Gregory Thompson, David Langer, and Endovascular Neurosurgery Research Group (ENRG).
• Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA adityap@med.umich.edu.
• J Neurointerv Surg. 2020 Jul 1; 12 (7): 643-647.

BackgroundInfection from the SARS-CoV-2 virus has led to the COVID-19 pandemic. Given the large number of patients affected, healthcare personnel and facility resources are stretched to the limit; however, the need for urgent and emergent neurosurgical care continues. This article describes best practices when performing neurosurgical procedures on patients with COVID-19 based on multi-institutional experiences.MethodsWe assembled neurosurgical practitioners from 13 different health systems from across the USA, including those in hot spots, to describe their practices in managing neurosurgical emergencies within the COVID-19 environment.ResultsPatients presenting with neurosurgical emergencies should be considered as persons under investigation (PUI) and thus maximal personal protective equipment (PPE) should be donned during interaction and transfer. Intubations and extubations should be done with only anesthesia staff donning maximal PPE in a negative pressure environment. Operating room (OR) staff should enter the room once the air has been cleared of particulate matter. Certain OR suites should be designated as covid ORs, thus allowing for all neurosurgical cases on covid/PUI patients to be performed in these rooms, which will require a terminal clean post procedure. Each COVID OR suite should be attached to an anteroom which is a negative pressure room with a HEPA filter, thus allowing for donning and doffing of PPE without risking contamination of clean areas.ConclusionBased on a multi-institutional collaborative effort, we describe best practices when providing neurosurgical treatment for patients with COVID-19 in order to optimize clinical care and minimize the exposure of patients and staff.© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

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