Impact of a pandemic on surgical neuro-oncology - maintaining functionality in crisis

Background: The Coronavirus disease 2019 (COVID-19) pandemic has extraordinarily impacted global healthcare. Neuro-oncological surgery units have peculiar features that make them highly relevant in the strategic reaction to the pandemic. In this Chinese Society of Neuro-Oncology (CSNO) initiated survey, we appraise the changes implemented in neurosurgery hospitals across different Asian countries and provide expert recommendations for responses at different stages of the pandemic.Methods: A 42-question survey was distributed to neurosurgery hospitals across different Asian countries by the CSNO on April 1, 2020, with responses closed on April 18, 2020.Results: 144 hospitals completed the questionnaire. Most were in WHO post-peak phase of the pandemic and reported a median reduction in neurosurgery volume of 25-50%. Most(67.4%) resumed elective surgery in only COVID-19 negative patients;11.1% performed only emergency cases irrespective of COVID-19 status;2.1% suspended all surgical activity. Ninety-one(63.2%) relocated personnel from neurosurgery to other departments. Fifty-two(36.1%) hospitals suspended post-operative adjuvant therapy and 94(65.2%) instituted different measures to administer post-operative adjuvant therapy. Majority(59.0%) of the hospitals suspended research activity. Most(70%) respondents anticipate that current neurosurgery restrictions will continue to remain for >1 month.Conclusions: Majority of the respondents to our survey reported reduced neurosurgery activity, policy modification, personnel reallocation, and curtailment of educational/research activities in response to the COVID-19 pandemic. The persistent widespread interruption of surgical neuro-oncology in even post-peak phases of the pandemic raises serious concerns about the long-term impact of the pandemic on neuro-oncological patients and highlights the essence of timely measures for pandemic preparedness, patient triage, and workforce protection.