Background: The novel coronavirus disease 2019 (COVID-19) pandemic has set a huge challenge to the delivery of neurosurgical services including the transfer of patients . We aimed to share our strategy in handling neurosurgical emergencies at a remote center in Borneo Island . Our objectives included discussing the logistic and geographical challenges faced during the COVID-19 pandemic .
Methods: Miri General Hospital (MGH) is a remote center in Sarawak, Malaysia, serving a population with difficult access to neurosurgical services . Two neurosurgeons were stationed here on a rotational basis every fortnight during the pandemic to handle neurosurgical cases . Patients were triaged depending on their urgent needs for surgery or transfer to a neurosurgical center and managed accordingly . All patients were screened for potential risk of contracting COVID-19 prior to the surgery . Based on this, the level of personal protective equipment required for the healthcare workers involved was determined .
Results: During the initial six weeks of the Movement Control Order (MCO) in Malaysia, there were 50 urgent neurosurgical consultations . Twenty patients (40 %) required emergency surgery or intervention . There were nine vascular (45 %), five trauma (25 %), four tumor (15 %), and two infection cases (10 %). Eighteen patients were operated at MGH, among whom 17 (94.4 %) survived . Ninety percent of anticipated transfers were avoided . None of the medical staff acquired COVID-19 .
Conclusions: This framework allowed timely intervention for neurosurgical emergencies (within a safe limit), minimized transfer, and enabled uninterrupted neurosurgical services at a remote center with difficult access to neurosurgical care during a pandemic.