Neurosurgical emergency management during the lockdown period in health care regions in Spain with different COVID-19 impact: lessons learned to improve outcomes on the future waves.

BACKGROUND: COVID-19 has overloaded health care systems, testing the capacity and response in every European region. Concerns were raised regarding the impact of resources' reorganization on certain emergency pathology management. The aim of the present study was to assess the impact of the outbreak (in terms of reduction of neurosurgical emergencies) during lockdown in different regions of Spain. METHODS: We analyzed the impact of the outbreak in four different affected regions by descriptive statistics and univariate comparison with same period of two previous years. These regions differed in their incidence level (high/low) and in the time of excess mortality with respect to lockdown declaration. That allowed us to analyze their influence on the characteristics of neurosurgical emergencies registered for every region. RESULTS: 1185 patients from 18 neurosurgical centers were included. Neurosurgical emergencies that underwent surgery dropped 24.41% and 28.15% in 2020 when compared with 2019 and 2018, respectively. A higher reduction was reported for the most affected regions by COVID-19. Non-traumatic spine experienced the most significant decrease in number of cases. Life-threatening conditions did not suffer a reduction in any health care region. CONCLUSIONS: COVID-19 affected dramatically the neurosurgical emergency management. The most significant reduction in neurosurgical emergencies occurred on those regions that were hit unexpectedly by the pandemic, as resources were focused on fighting the virus. As a consequence, life-threating and non-life-threatening conditions' mortality raised. Results in regions who had time to prepare for the hit were congruent with an organized and sensible neurosurgical decision-making.

Four cases of nocardial brain abscess.

BACKGROUND: Nocardial brain abscesses are a rare central nervous system infection with high morbidity and mortality. Infection is acquired through inhalation or direct innoculation and then spreads hematogenously. They are usually associated with immunocompromised patients but may appear in otherwise healthy individuals. Treatment is based on surgical aspiration and antibiotics for several months. CASE DESCRIPTION: We present four cases of nocardial brain abscesses treated at our institution and review the literature regarding these lesions. Ages ranged from 22 to 71 years. One patient was a healthy individual without any predisposing condition. Patients were treated with surgical evacuation and long term parenteral antibiotics. Two patients made a full recovery; one patient died and one recovered with significant morbidity. In one case malignancy was suspected, probably delaying diagnosis. CONCLUSIONS: Nocardial brain abscesses are a rare condition that needs to be considered in the differential diagnosis of brain lesions. They are not necessarily associated with predisposing factors such as immunosupresion. Treatment must be started as soon as possible with surgical evacuation and long term parenteral antibiotics in order to avoid significant morbidity.

Malignant peripheral nerve sheath tumor of the infratemporal fossa with intracranial extension.

Malignant peripheral nerve sheath tumor (MPNST) is an uncommon neoplasm that rarely involves the head and neck region. We report the case of a 66-year-old man who presented with symptoms compatible with uncinate seizures. Imaging studies detected a left infratemporal fossa tumor with bone tissue destruction and extension into the intracranial compartment, which exerted a mass effect on the temporal lobe. Histologic studies identified the tumor as an MPNST. Complete removal of the lesion was not possible, so the patient was treated with adjuvant radiotherapy. He died 6 months later. This rare case of MPNST with intracranial involvement illustrates the dismal prognosis for patients with such a lesion. Survival is limited because of the difficulty of performing radical surgery with free margins in such a location.