Neurosurgical Praxis Guidelines during the COVID-19 Outbreak. Consensus-based on currently available literature.

INTRODUCTION: The World Health Organization recommended several strategies to contain the COVID-19 pandemic, including optimization of care for all patients, especially the seriously ill. Given the strain, the pandemic has posed on healthcare systems around the world, many neurosurgical associations have provided triage recommendations for patients to save resources for the pandemic. We aimed to provide practical recommendations based on specific illnesses requiring surgical procedures commonly performed by neurosurgeons on a life-threatening basis of patient illness. We consider this guideline will help neurosurgeons for the appropriate triage of patients on a daily-situation basis during this pandemic. METHODS: The Mexican Society of Neurological Surgery integrated a special COVID-19 guidelines Committee to develop a guideline based on a three-tier route to a consensus using a modified Delphi Method. RESULTS: We found twenty-nine papers relating to surgical praxis recommendations since the COVID-19 outbreak in December 2019. Five reports made a classification for the priority of emergencies based on illness severity and the time that could be elapsed to provide surgical care to avoid becoming a life-threatening illness. From those, we chose the classification made in Lombardi, Italy related to oncology patients in neurosurgery (Table 1). We adapted the Lombardy Classification to all neurosurgical specialties (Table 2). Appendix 1 shows tables universally applying the modified Lombardy classification to each of the neurosurgical subspecialties. Six papers gave specific recommendations on surgical room setting and personal equipment protection. We made a summary of recommendations in Appendix 2. we recommend adding a compliment to the informed consent of the surgical procedure relating to the COVID-19 outbreak. This complement can be consulted in Appendix 3. CONCLUSIONS: We present the following recommendations provided that we are in a very early stage of the illness knowledge, and further research is needed to increase the certainty of recommendations. For specific situations not covered in this document, we encourage individual hospitals to trust in the local neurosurgeon criteria. Provided that situations and patient characteristics are highly variable, the local neurosurgeon will always have the last word in every case as he/she is in close contact with the patient and its medical records.