I had not realized how unique the situation was in New York until I was on a panel discussing the possibility of performing endonasal surgery on a patient with COVID. It was sometime around mid-April and several papers had been published from prominent centers on protocols for patient selection and safety guidelines, based on the premise of an overwhelmed health care system. I was chatting with one the authors of one of these papers and asked him casually how many patients they had in their ICU with COVID. When he responded that there were five patients, my jaw almost dropped. The NewYork-Presbyterian Hospital system at that time had 2,500 COVID-positive patients in the hospital with 750 in the ICUs on ventilators. It quickly became clear to me that what we were seeing in New York was not typical of the rest of the country. This was not a theoretical situation for which we had to be prepared, this was an ongoing crisis which we were currently facing.<\/p>\n
Needless to say, the practice of neuro-oncology in NYC was dramatically altered for a period of a few months. When the operating rooms closed, we were all asked to make a list of patients scheduled for surgery and grade them based on urgency. The 5cm GBM in the occipital lobe and the lymphoma biopsies had to go or adjuvant therapy would be delayed too long. The planum meningioma losing vision also needed to be addressed; however, few other cases made the cut. I recall a 9 year old girl with a newly diagnosed 6 cm chordoma. She waited three months for surgery. Luckily, there was little interval growth. What about the chondrosarcoma with the third nerve palsy? Well \u2026 It wasn\u2019t really progressing, and he had it for a few weeks. Didn\u2019t make the cut. All cases needed to be run by a committee and required approval. There were no exceptions. We couldn\u2019t spare the PPE and all but three of our ORs had been converted into ICUs. I started to wonder if the population of New York realized that the quality of neuro-oncologic care they were receiving was substandard? Were we being negligent? On the other hand, there were clearly cases I likely would have rushed to surgery and benign tumors that needed to come out at some point that were probably not shortchanged by the temporary delay.<\/p>\n
How to manage endoscopic endonasal cases became one of the biggest dilemmas. Reports of massive aerosolization of virus and infection of health care workers had come out of Wuhan, which were later retracted. What was the truth? In the first months of the pandemic we were not able to test our patients before surgery. The hospital did not have the capacity. I lived in fear of the apoplexy case with visual deterioration in a patient with unknown infection status. I guess we would do a craniotomy, but was that the ideal treatment? I knew one thing for certain, I hated operating in full PPE. My mask would fog, I couldn\u2019t hear the nurses and they couldn\u2019t hear me, and I would sweat through my scrubs. I began working with one of my ENT partners on a device to make endonasal surgery safer. We designed a negative pressure antechamber that sits over the face and removes aerosolized particles. Working with a talented medical student and biomedical engineer we could 3D print them in a matter of hours. Soon we started operating endonasally using this device, testing its utility and proving its efficacy. We submitted a patent and are working on FDA approval to make it available to other medical centers. Not only is this crisis far from over, but who knows when the next pandemic will occur. Maybe we should be protecting ourselves better from seasonal influenza virus among other respiratory infections.<\/p>\n
COVID taught us several valuable lessons. The ability to provide state of the art neuro-oncologic and neurosurgical service to our patients should not be taken for granted. We, as neurosurgeons, think we are at the top of the medical food chain, but in the face of a pandemic we are an inessential luxury item. We also learned that with a bit of ingenuity, progress can be made and obstacles overcome. COVID taught us humility and resilience, lessons we had already learned as neurosurgical residents that have served us well over the years.<\/p>\n","protected":false},"excerpt":{"rendered":"
I had not realized how unique the situation was in New York until I was on a panel discussing the possibility of performing endonasal surgery on a patient with COVID. It was sometime around mid-April and several papers had been published from prominent centers on protocols for patient selection and safety guidelines, based on the […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":386,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"NewsletterTOC.php","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-396","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"\n