The Impact of Imposed Delay in Elective Pediatric Neurosurgery: An Informed Hierarchy of Need in the Time of Mass Casualty Crisis

Childs Nerv Syst. 2020 Jul;36(7):1347-1355. doi: 10.1007/s00381-020-04671-x. Epub 2020 May 20.


SARS-CoV-2 COVID-19, coronavirus, has created unique challenges for the medical community after national guidelines called for the cancellation of all elective surgery. While there are clear cases of elective surgery (benign cranial cosmetic defect) and emergency surgery (hemorrhage, fracture, trauma, etc.), there is an unchartered middle ground in pediatric neurosurgery. Children, unlike adults, have dynamic anatomy and are still developing neural networks. Delaying seemingly elective surgery can affect a child's already vulnerable health state by further impacting their neurocognitive development, neurologic functioning, and potential long-term health states. The purpose of this paper is to demonstrate that "elective" pediatric neurosurgery should be risk-stratified, and multi-institutional informed guidelines established.

Keywords: Brachial plexus; COVID-19; Coronavirus; Craniosynostosis; Pediatric neurosurgery; SARS-CoV-2 COVID-19.

Publication types

  • Review

MeSH terms

  • Betacoronavirus*
  • Child
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / surgery*
  • Elective Surgical Procedures / trends*
  • Health Services Needs and Demand / trends
  • Humans
  • Mass Casualty Incidents* / prevention & control
  • Neurosurgical Procedures / trends*
  • Pandemics
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / surgery*
  • Time-to-Treatment / trends*

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2