Cerebral and spinal neurological complications in patients with COVID-19: authors’ clinical experience and literature review

Objective ‒ to highlight the high probability and features of neurological complications in patients with COVID-19 pneumonia.Materials and methods. A retrospective cohort study was done of 57 patients with COVID-19 pneumonia who were treated at the COVID-location of the Department of Vascular and Minimally Invasive Neurosurgery and Neurology of the Clinical Emergency Hospital of Lviv in the period from June 29 to September 28, 2020 (91 day).Results. Out of the 57 patients 14 (24.6 %) were selected by prospective analysis that had a clear association between COVID-19 pneumonia and neurological complications. Neurological complications of COVID-19 were manifested as ischemic stroke in 57.1 % of patients, encephalopathy with convulsions and without seizures ‒ in 35.7 %, polyneuropathy with tetraparesis, secondary purulent-inflammatory lesions of the spine ‒ in 7.2 %. Neurological complications occurred on average (20. 4 ± 6.1) days after the onset of the disease.Conclusions. Lesions of the spine and structures in the spinal canal after coronavirus infection had a significant spread along the axis of the spine and severe course. The largest (57.1 %) was the proportion of ischemic stroke in the structure of neurological complications of COVID-19, which indicated the severity of the coronavirus infection and its aggressive effect on the nervous system. The effectiveness of treatment of COVID-19 neurological complications depends on the urgency of hospitalization of patients, as evidenced by the correlation between favorable treatment outcomes and the time from disease onst to admission to either therapeutic (r = + 0.37) or neurological department (r = +0.32).

Retractorless brain surgery: technical considerations

Background Retraction is necessary to access deep areas in the brain and skull base, but prolonged and forceful use of fixed retraction might be injurious. Several techniques were developed, in the concept of minimally invasive neurosurgery, to eliminate or minimize the use of fixed retractors. The authors discuss the technical considerations and limits in applying dynamic retraction in brain surgery for a variety of lesions using different approaches. Results We retrospectively collected 123 cases with brain lesions in diverse locations, were dynamic retraction, using the tools in the operator hands and was achieved successfully instead of fixed retraction. Cases with aneurysms were excluded, although retraction was applied during clipping only. Superficial and large masses that do not require fixed retraction as a routine were excluded also. We relied mainly on patient positioning to benefit from the gravity, proper design of the craniotomy, arachnoid dissection, cerebrospinal fluid aspiration, and internal decompression of the mass when possible. Different approaches for different lesions were utilized in our patients, subfrontal or pterional and their modifications in 45.5% of cases, suboccipital in 21.1%, retrosigmoid in 13%, the interhemispheric approach in 10.5%, transcortical to lateral ventricles in 7.3%, and posterior subtemporal in 2.4%. Dynamic retraction with the surgical tools was used successfully in all cases except 7 patients (5.6%) where we had to use fixed retraction transiently. Conclusion Several considerations are helpful and amenable to achieve successful brain surgery without fixed retraction. Utilizing the gravity, unlocking of the brain, choosing the surgical corridor, cerebrospinal fluid suctioning, and mastering of the microsurgical techniques are the keys.

Measurement of Intraoperative Blood Loss in Minimally Invasive Neurosurgery

Surgeries that take place in medicine and dentistry or during any form of childbirth results in a significant amount of blood loss. The prevalent measurement methods that surgeons and anesthesiologists utilize as the “gold - standard” has several drawbacks. There are numerous other methods to measure blood loss, which, however, due to their impracticality and limitations, are not ideal either. This paper focuses on minimally invasive neurosurgery in particular, by taking into account a surgical technique known as Endoscopic Endonasal Transphenoidal surgery (EETS), which is used to treat pituitary tumors and adenomas. Along with the review of the existing literature pertaining to blood loss management, this paper proposes a modified electrode probe method along with the concept of usage, computer interface, and the system of integration. The probe is intended to measure the hematocrit count from the collected blood under all circumstances, such that the medical practitioner is assisted to improve the blood loss management technique for better patient recovery.

Surgery for Coagulopathy-Related Intracerebral Hemorrhage: Craniotomy vs. Minimally Invasive Neurosurgery

Coagulopathy-related intracerebral hemorrhage (ICH) is life-threatening. Recent studies have shown promising results with minimally invasive neurosurgery (MIN) in the reduction of mortality and improvement of functional outcomes, but no published data have recorded the safety and efficacy of MIN for coagulopathy-related ICH. Seventy-five coagulopathy-related ICH patients were retrospectively reviewed to compare the surgical outcomes between craniotomy (n = 52) and MIN (n = 23). Postoperative rebleeding rates, morbidity rates, and mortality at 1 month were analyzed. Postoperative Glasgow Outcome Scale Extended (GOSE) and modified Rankin Scale (mRS) scores at 1 year were assessed for functional outcomes. Morbidity, mortality, and rebleeding rates were all lower in the MIN group than the craniotomy group (8.70% vs. 30.77%, 8.70% vs. 19.23%, and 4.35% vs. 23.08%, respectively). The 1-year GOSE score was significantly higher in the MIN group than the craniotomy group (3.96 ± 1.55 vs. 3.10 ± 1.59, p = 0.027). Multivariable logistic regression analysis also revealed that MIN contributed to improved GOSE (estimate: 0.99650, p = 0.0148) and mRS scores (estimate: −0.72849, p = 0.0427) at 1 year. MIN, with low complication rates and improved long-term functional outcome, is feasible and favorable for coagulopathy-related ICH. This promising result should be validated in a large-scale prospective study.