Outcomes and Surgical Considerations for Neurosurgical Patients Hospitalized with COVID-19-A Multicenter Case Series

Abstract

Objective: Neurosurgical patients are at a higher risk of having a severe course of coronavirus disease 2019 (COVID-19). The objective of this study was to determine morbidity, hospital course, and mortality of neurosurgical patients during the coronavirus disease 2019 (COVID-19) pandemic in a multicenter health care system.

Methods: A retrospective observational study was conducted to identify all hospitalized neurosurgical patients positive for COVID-19 from March 11, 2020 to November 2, 2020 at Mayo Clinic and the Mayo Clinic Health System.

Results: Eleven hospitalized neurosurgical patients (0.68%) were positive for COVID-19. Four patients (36.6%) were men and 7 (63.3%) were women. The mean age was 65.7 years (range, 35-81 years). All patients had comorbidities. The mean length of stay was 13.4 days (range, 4-30 days). Seven patients had a central nervous system malignancy (4 metastases, 1 meningioma, 1 glioblastoma, and 1 schwannoma). Three patients presented with cerebrovascular complications, comprising 2 spontaneous intraparenchymal hemorrhages and 1 ischemic large-vessel stroke. One patient presented with an unstable traumatic spinal burst fracture. Four patients underwent neurosurgical/neuroendovascular interventions. Discharge disposition was to home in 5 patients, rehabilitation facility in 3, and hospice in 3. Five patients had died at follow-up, 3 within 30 days from COVID-19 complications and 2 from progression of their metastatic cancer.

Conclusions: COVID-19 is rare among the inpatient neurosurgical population. In all cases, patients had multiple comorbidities. All symptomatic patients from the respiratory standpoint had complications during their hospitalization. Deaths of 3 patients who died within 30 days of hospitalization were all related to COVID-19 complications. Neurosurgical procedures were performed only if deemed emergent.

Keywords: COVID; Coronavirus; Neurosurgery; Neurosurgical.

Figure 1

Imaging of hospitalized patients with COVID-19 with neurovascular complications. (A) Noncontrast head computed tomography (CT) showing large right cerebellar intraparenchymal hemorrhage with associated mass effect and leftward transtentorial herniation with effacement of the cerebral aqueduct. (B) Noncontrast head CT showing a multifocal intraparenchymal hemorrhage within the left parietal lobe associated with surrounding edema. (C) Non–contrast-enhanced head CT showing a core infarction in the left frontotemporal region involving the anterior cerebral artery–middle cerebral artery and middle cerebral artery–posterior cerebral artery watershed regions and left opercular cortex.

Figure 2

Imaging of hospitalized patients with neuro-oncologic COVID-19 who underwent emergent neurosurgical operative intervention. (A) Preoperative axial and coronal T1 postgadolinium magnetic resonance imaging (MRI) showing lobulated, heterogeneously enhancing right extra-axial mass (3.2 × 3.9 × 3.6 cm) with increased mass effect on the right dorsomedial premotor region. (B) Postoperative axial and coronal T1 postgadolinium MRI showing near-total resection of right frontal mass. (C) Preoperative axial and coronal T1 postgadolinium MRI, showing a mass within the left parietal cortex and subcortical white matter with central necrosis and irregular thickened marginal enhancement. (D) Postoperative noncontrast head computed tomography showing removal of left parietal mass.

Figure 3

Imaging of hospitalized patient with COVID-19 who underwent emergent neurosurgical operative spine intervention. (A) Preoperative axial and (B) sagittal noncontrast chest computed tomography (CT) showing an acute moderately displaced fracture through the anterior T8 vertebral body extending into the T7-T8 and T8-T9 disc spaces without evidence of retropulsion or spinal canal narrowing as well as a right hemothorax. (C) Postoperative axial and (D) sagittal noncontrast chest CT 1 day after surgery showing posterior fusion of the thoracic spine with interval placement of pedicle fixation screws and fixation rods from T6 to T10 and moderate right pleural effusion and patchy bilateral ground-glass opacities consistent with COVID-19 pneumonia.

Figure 4

Imaging of hospitalized patient with COVID-19 who underwent an emergent neuroendovascular intervention. (A) Preoperative non-contrast–enhanced head and neck computed tomography and (B) carotid angiogram, left side, lateral projection showing in-stent thrombosis. (C) Post–mechanical thrombectomy noncontrast head and neck computed tomography and (D) carotid angiogram, left side, lateral projection showing restitution of blood flow within the left internal carotid artery.