Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Chemistry, Union College, Schenectady, New York, USA.
World Neurosurg. 2022 Feb;158:e196-e205. doi: 10.1016/j.wneu.2021.10.155. Epub 2021 Oct 27.
Urgent neurosurgical interventions for pediatric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are rare. These cases pose additional stress on a potentially vulnerable dysregulated inflammatory response that can place the child at risk of further clinical deterioration. Our aim was to describe the perioperative course of SARS-CoV-2-positive pediatric patients who had required an urgent neurosurgical intervention.
We retrospectively analyzed pediatric patients aged ≤18 years who had been admitted to a quaternary children's hospital with a positive polymerase chain reaction test result for SARS-CoV-2 virus from March 2020 to October 2021. The clinical characteristics, anesthetic and neurosurgical operative details, surgical outcomes, and non-neurological symptoms were collected and analyzed.
We identified 8 SARS-CoV-2-positive patients with a mean age of 8.83 years (median, 8.5 years; range, 0.58-18 years). Of the 8 patients, 6 were male. All children had had mild or asymptomatic coronavirus disease 2109. The anesthetic and surgical courses for these patients were, overall, uncomplicated. All the patients had been admitted to a specialized isolation unit in the pediatric intensive care unit for cardiopulmonary and neurological monitoring. The use of increased protective personal equipment during anesthesia and surgery did not impede a successful neurosurgical operation.
SARS-CoV-2-positive pediatric patients with minimal coronavirus disease 2019-related symptoms who require urgent neurosurgical interventions face unique challenges regarding their anesthetic status, operative delays due to SARS-CoV-2 polymerase chain reaction testing, and requirements for additional protective personal equipment. Despite these clinical challenges, the patients in our study had not experienced adverse postoperative consequences, and no healthcare professional involved in their care had contracted the virus.
儿科严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）患者的紧急神经外科干预很少见。这些病例会对潜在的易失调的炎症反应造成额外的压力，从而使患儿有进一步临床恶化的风险。我们的目的是描述需要紧急神经外科干预的 SARS-CoV-2 阳性儿科患者的围手术期过程。
我们回顾性分析了 2020 年 3 月至 2021 年 10 月期间，因 SARS-CoV-2 病毒聚合酶链反应检测结果阳性而入住一家四级儿童医院的≤18 岁的儿科患者。收集并分析了患者的临床特征、麻醉和神经外科手术细节、手术结果和非神经症状。
我们共确定了 8 例 SARS-CoV-2 阳性患者，平均年龄为 8.83 岁（中位数为 8.5 岁；范围为 0.58-18 岁）。这 8 例患儿均为男性。所有患儿均患有轻度或无症状的 2019 年冠状病毒病。总体而言，这些患者的麻醉和手术过程都较为顺利。所有患者均被收入儿科重症监护病房的专门隔离单元进行心肺和神经监测。麻醉和手术过程中增加使用个人防护装备并未妨碍成功的神经外科手术。
需要紧急神经外科干预的、SARS-CoV-2 阳性且 2019 年冠状病毒病相关症状轻微的儿科患者，在麻醉状态、因 SARS-CoV-2 聚合酶链反应检测而导致的手术延迟以及对额外个人防护装备的需求方面面临独特的挑战。尽管存在这些临床挑战，但本研究中的患者并未出现术后不良后果，且参与其治疗的医护人员均未感染该病毒。
