First-in-man craniectomy and asportation of solitary cerebellar metastasis in COVID-19 patient: A case report. (2020)

• Record Type: Journal Article
• Authors: Lapolla, Pierfrancesco; Familiari, Pietro; Bruzzaniti, Placido; Arcese, Roberto; Matassa, Roberto; Frati, Alessandro; D'Andrea, Giancarlo; Santoro, Antonio
• Is Part Of: International journal of surgery case reports. Volume 77(2020)
• Page Start: 753
• Page End: 758
• Publication Date: 2020
• Subjects: COVID-19 -- Cerebellar metastasis -- Suboccipital craniectomy -- PPE -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.11.102
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: SARS-CoV-2 pandemic is changing the perioperative surgical practice worldwide. Specific protocols are essential for COVID-19 patient undergoing emergency surgery. COVID-19 asymptomatic patients can safely undergo major emergency surgeries. The first surgery for oesophagel metastatic lesion was performed on COVID-19 patient. Adequate resource planning for healthcare workers can minimise the risk of infection. Abstract: Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has an impact on the delivery of neurosurgical care, and it is changing the perioperative practice worldwide. We present the first case in the literature of craniectomy procedure and asportation of a solitary cerebellar metastasis of the oesophagus squamous carcinoma in a 77 years old woman COVID-19 positive. In these particular circumstances, we show that adequate healthcare resources and risk assessments are essential in the management of COVID-19 patients referred to emergency surgery. Presentation of case: The case here presented was treated in 2019 for squamous carcinoma of the oesophagus. In April 2020, she presented a deterioration of her clinical picture consisting of dysphagia, abdominal pain, hyposthenia and ataxia. A Head CT scan was performed, which showed the presence of a solitary cerebellar metastasis. Her associated SARS-CoV-2 positivity status represented the principal clinical concern throughout her hospitalisation. Discussion: The patient underwent a suboccipital craniectomy procedure with metastasis asportation. She tested positive for SARS-CoV-2 in the pre- and post-operative phases, but she was not admitted to the intensive care unit because she did not present any respiratory complications. Her vital parameters and inflammation indexes fell within the reference ranges, and she was kept in isolation for 16 days in our neurosurgical unit following strict COVID-19 measures. She was asymptomatic and not treated for any of the specific and non-specific symptoms of COVID-19. Conclusion: This is the first case reported of solitary cerebellar metastasis of oesophagus carcinoma operated on a COVID-19 positive patient. It shows that asymptomatic COVID-19 positive patients can undergo major emergency surgeries without the risk of infecting the operating team if adequate Personal Protection Equipment (PPE) is used. The patient remained asymptomatic and did not develop the disease's active phase despite undergoing a stressful event such as a major emergency neurosurgical procedure. In the current crisis, a prophylactic COVID-19 screening test can identify asymptomatic patients undergoing major emergency surgery and adequate resource planning and Personal Protective Equipment (PPE) for healthcare workers can minimise the effect of the COVID-19 pandemic.