The challenges of the medical service system in Osaka Prefecture during the COVID-19 pandemic: A review of emergency craniotomy

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  • COVID-19パンデミックにおける大阪府の診療体制と課題：緊急開頭手術の検討から
  • COVID-19 パンデミック ニ オケル オオサカフ ノ シンリョウ タイセイ ト カダイ : キンキュウカイトウ シュジュツ ノ ケントウ カラ

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Abstract

<p>We reviewed the measures against novel corona virus disease 2019 (COVID-19) infections in Osaka Prefecture and presented two patients who underwent craniotomy in the 6th wave of the COVID pandemic. Case 1 was an 86-year-old man with acute subdural hematoma. He took a talk and deteriorated course and arrived with a Glasgow Coma Scale of 3, requiring 6.5 hours from the time of injury to the start of surgery. He had moderate COVID pneumonia. He underwent evacuation of hematoma but died without recovery. Case 2 was a 73-year-old woman with a subarachnoid hemorrhage. She was conscious, but her consciousness declined to 200 on the Japan Coma Scale during transportation. A COVID screening in the emergency room revealed her positive. She underwent successful clipping for ruptured anterior communicating and unruptured Azygous anterior cerebral artery aneurysms. She was treated prophylactically for COVID pneumonia and had a favorable outcome. Both patients took longer than usual from arrival to the operating room. Case 1 could recover by early surgery, and Case 2 took time to wean from the ventilator. Under strict infection control measures, the craniotomy was performed safely, but the delay in surgery was considered problematic.</p>

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