Letter to the Editor: "The Return Back to Typical Practice from the 'Battle Plan' of the Coronavirus Disease 2019 (COVID-19) Pandemic: A Comparative Study".

In the article by Pressman et al., the authors describe their experience on a very relevant subject i.e., the return back to typical practice after coronavirus disease 2019 (COVID-19). They have focused on the handling of neurosurgical caseloads and their spectrum. The also share their experience with neurosurgical subspecialties amidst the COVID-19 outbreak. In the initial days of the pandemic, medical and surgical societies worldwide prepared guidelines and adopted protocols to ensure safe health care delivery.2, 3, 4, 5 This study, which was conducted over 4 weeks, found that the number of neurosurgical interventions did eventually increase in the post-battle plan period, with a particular surge in functional neurosurgery and neuro-oncosurgery.

D’Amico et al. have shared their concerns while reopening the neurosurgical services and provide suggestions for performing elective procedures including endoscopic neurosurgery. In various web-based surveys, suspension of elective cases has been noted more in public institutes than by private practitioners, with an increase in telemedicine-based outpatient services. , The World Federation of Neurosurgical Societies (WFNS) conducted a web-based survey to assess changes in global neurosurgical practice during the COVID-19 pandemic and found major changes in surgical planning by more than 90% of the responders. Although they have found that this impact was maximal for elective procedures, emergency and lifesaving neurosurgical procedures constituted the major chunk overall. This resulted in a postponement of neuro-oncological cases in 71% of responses. This also explains the delayed increase in brain tumor surgeries in the article by Pressman et al.

It is interesting to note that there was no significant change in the endoscopic interventions in the present study. It is in contrast to the studies in which it is highlighted that neurosurgical procedures having a high propensity of aerosol generation were particularly avoided and changed during the pandemic. It will be an adjunct if the authors can elaborate regarding their experience of safely handling these procedures in their practice. In summary, the world is going through a phase of uncertainty in the current pandemic, and neurosurgical practice is not immune to it. We agree with the authors that now the neurosurgical specialty and subspecialties need to prepare themselves to deliver services in the post–COVID-19 era. Although we expect changes in routine and emergency neurosurgical practice, the effect of such changes is not yet known in the current pandemic situation. The article by Pressman et al. can be considered as a beginning of an excellent debate and can be a yardstick to develop strategies that can be extended to address the needs of lager geographic and socioeconomic areas.