{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T05:43:56Z","timestamp":1778996636312,"version":"3.51.4"},"reference-count":105,"publisher":"Universiti Sains Malaysia","issue":"5","license":[{"start":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T00:00:00Z","timestamp":1603756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["MJMS"],"abstract":"<jats:p>The newly discovered coronavirus disease 2019 (COVID-19) is an infectious disease introduced to humans for the first time. Following the pandemic of COVID-19, there is a major shift of practices among surgical departments in response to an unprecedented surge in reducing the transmission of disease. With pooling and outsourcing of more health care workers to emergency rooms, public health care services and medical services, further in-hospital resources are prioritised to those in need. It is imperative to balance the requirements of caring for COVID-19 patients with imminent risk of delay to others who need care. As Malaysia now approaches the recovery phase following the pandemic, the crisis impacted significantly on neurosurgical services throughout the country. Various emergency measures taken at the height of the crisis may remain as the new normal in the provision of neurosurgical services and practices in Malaysia. The crisis has certainly put a strain on the effective delivery of services and as we approach the recovery era, what may have been a strain may prove to be a silver lining in neurosurgical services in Malaysia. The following details are various measures put in place as the new operational protocols for neurosurgical services in Malaysia.<\/jats:p>","DOI":"10.21315\/mjms2020.27.5.14","type":"journal-article","created":{"date-parts":[[2020,10,30]],"date-time":"2020-10-30T02:25:03Z","timestamp":1604024703000},"page":"141-195","source":"Crossref","is-referenced-by-count":4,"title":["COVID-19 Pandemic and Its Impact on Neurosurgery Practice in Malaysia: Academic Insights, Clinical Experience and Protocols from March till August 2020"],"prefix":"10.21315","volume":"27","author":[{"given":"Azman","family":"Raffiq","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Penang General Hospital, Pulau Pinang, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liew","family":"Boon Seng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Sungai Buloh, Selangor, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lim","family":"Swee San","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sarawak General Hospital, Ministry of Health, Kuching, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zaitun","family":"Zakaria","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ang","family":"Song Yee","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana Noma","family":"Fitzrol","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wan Mohd Nazaruddin","family":"Wan Hassan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zamzuri","family":"Idris","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdul Rahman Izaini","family":"Ghani","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azmin Kass","family":"Rosman","sequence":"additional","affiliation":[{"name":"National Head\/Coordinator for Neurosurgical Services, Ministry of Health, Malaysia Care of Department of Neurosurgery, Hospital Sungai Buloh, Selangor, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jafri Malin","family":"Abdullah","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"8963","published-online":{"date-parts":[[2020,10,27]]},"reference":[{"key":"ref0","unstructured":"Ministry of Health Malaysia. 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On pandemics: The impact of covid-19 on the practice of neurosurgery. J Neurosurg. 2020;133(1):1\u20132. https:\/\/doi.org\/10.3171\/2020.3.jns201007","DOI":"10.3171\/2020.3.jns201007"},{"key":"ref38","unstructured":"Malaysia Health Technology Assessment Section (MaHTAS). Early management of head injury in adults [Internet]; 2020. Available at: https:\/\/ www.moh.gov.my\/moh\/resources\/maklumat%20 terkini\/DRAF%20CPG\/Draft_CPG_Early_Management_of_Head_Injury_23.11_.2015_.pdf"},{"key":"ref39","unstructured":"Ministry of Health Malaysia. Guidelines 2019 novel coronavirus (2019 nCOV) management in Malaysia no. 2\/2020 [Internet]; 2020. Available at: https:\/\/mpaeds.my\/wp-content\/ uploads\/2020\/01\/Guidelines-2019-NovelCoronavirus-2019-nCoV-Management-InMalaysia-No.-22020.pdf"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Maves RC, Downar J, Dichter JR, Hick JL, Devereaux A, Geiling JA, et al. Triage of scarce critical care resources in COVID-19. 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Guidelines for the management of aneurysmal SAH: a guideline for healthcare professionals from the american heart association\/american stroke association. Stroke. 2012;43(6):1711\u20131737. https:\/\/doi.org\/10.1161\/STR.0b013e3182587839","DOI":"10.1161\/str.0b013e3182587839"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Lawton MT. Arteriovenous malformation (AVM) [Internet]. USA: Barrow Neurological Institute; 2020 [Retrieved 2020 February 27]. Available at: https:\/\/www.barrowneuro.org\/specialty\/ arteriovenous-malformation-avm\/","DOI":"10.1007\/springerreference_184750"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"Elhammady MS, Heros RC. Management of incidental cerebral AVMs in the post-aruba era. J Neurosurg. 2014;121(5):1011\u20131014. https:\/\/doi.org\/10.3171\/2014.3.jns14135","DOI":"10.3171\/2014.3.jns14135"},{"key":"ref46","doi-asserted-by":"publisher","unstructured":"Magro E, Darsaut TE, Mezui EDO, Bojanowski MW, Ziegler D, Gentric JC, et al. Arteriovenous malformations of the posterior fossa: a systematic review. Acta Neurochir (Wien). 2020;162(4):905\u2013910. https:\/\/doi.org\/10.1007\/s00701-020-04260-6","DOI":"10.1007\/s00701-020-04260-6"},{"key":"ref47","doi-asserted-by":"publisher","unstructured":"Magro E, Gentric JC, Darsaut TE, Ziegler D, Msi, Bojanowski MW, et al. Responses to aruba: a systematic review and critical analysis for the design of future arteriovenous malformation trials. J Neurosurg. 2017;126(2):486\u2013494. https:\/\/doi.org\/10.3171\/2015.6.jns15619","DOI":"10.3171\/2015.6.jns15619"},{"key":"ref48","doi-asserted-by":"publisher","unstructured":"Gupta A, Periakaruppan A. Intracranial dural arteriovenous fistulas: a review. Indian J Radiol Imaging. 2009;19(1):43-48. https:\/\/doi.org\/10.4103\/0971-3026.45344","DOI":"10.4103\/0971-3026.45344"},{"key":"ref49","doi-asserted-by":"publisher","unstructured":"Rudd AG, Bowen A, Young GR, James MA. The latest national clinical guideline for stroke. Clin Med (Lond). 2017;17(2):154\u2013155. https:\/\/doi.org\/10.7861\/clinmedicine.17-2-154","DOI":"10.7861\/clinmedicine.17-2-154"},{"key":"ref50","doi-asserted-by":"publisher","unstructured":"Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association. Stroke. 2015;46(7):2032\u20132060. https:\/\/doi.org\/10.1161\/str.0000000000000069","DOI":"10.1161\/str.0000000000000069"},{"key":"ref51","doi-asserted-by":"publisher","unstructured":"Lyden P. Using the National Institutes Of Health Stroke Scale: a cautionary tale. Stroke. 2017;48(2):513\u2013519. https:\/\/doi.org\/10.1161\/strokeaha.116.015434","DOI":"10.1161\/strokeaha.116.015434"},{"key":"ref52","doi-asserted-by":"publisher","unstructured":"Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association. Stroke. 2019;50(12):e344\u2013e418. https:\/\/doi.org\/10.1161\/str.0000000000000211","DOI":"10.1161\/str.0000000000000211"},{"key":"ref53","doi-asserted-by":"publisher","unstructured":"Temporary emergency guidance to us stroke centers during the coronavirus disease 2019 (COVID-19) pandemic: on behalf of the American Heart Association\/American Stroke Association Stroke Council Leadership. Stroke. 2020;51(6):1910\u20131912. https:\/\/doi.org\/10.1161\/strokeaha.120.030023","DOI":"10.1161\/strokeaha.120.030023"},{"key":"ref54","doi-asserted-by":"publisher","unstructured":"Zhao J, Rudd A, Liu R. Challenges and potential solutions of stroke care during the coronavirus disease 2019 (COVID-19) outbreak. Stroke. 2020;51(5):1356\u20131357. https:\/\/doi.org\/10.1161\/strokeaha.120.029701","DOI":"10.1161\/strokeaha.120.029701"},{"key":"ref55","unstructured":"Ministry of Health Malaysia. Perioperative mortality review (POMR): prioritisation of cases for emergency and elective surgery (2nd revision) [Internet]. Malaysia: Medical Development Division; 2020 [Retrieved 2020 April 24]. Available at: https:\/\/www.moh.gov. my\/moh\/resources\/Penerbitan\/POMR\/GARIS_ PANDUAN_POMR_PRIORITISATION_OF_"},{"key":"ref56","doi-asserted-by":"publisher","unstructured":"Society of American Gastrointestinal and Endoscopic Surgeons. COVID-19 statement and recommendations from the Asociacion Espanola De Cirujanos [Internet]; 2020 [Retrieved 2020 April 24]. Available at: https:\/\/www.sages.org\/ covid-19-statement-and-recommendations-fromthe-asociacion-espanola-de-cirujanos\/","DOI":"10.37351\/2020312.3"},{"key":"ref57","doi-asserted-by":"publisher","unstructured":"Lie SA, Wong SW, Wong LT, Wong TGL, Chong SY. Practical considerations for performing regional anesthesia: Lessons learned from the covid-19 pandemic. Can J Anaesth. 2020;67(7):885\u2013892. https:\/\/doi.org\/10.1007\/s12630-020-01637-0","DOI":"10.1007\/s12630-020-01637-0"},{"key":"ref58","doi-asserted-by":"publisher","unstructured":"Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng SY, et al. Preparing for a covid-19 pandemic: A review of operating room outbreak response measures in a large tertiary hospital in Singapore. 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Providing patient care remotely in a pandemic [Internet]; 2020. [Retrieved 2020 March 27]. Available at: https:\/\/www.ama-assn.org\/delivering-care\/ethics\/ providing-patient-care-remotely-pandemic"},{"key":"ref82","doi-asserted-by":"publisher","unstructured":"Garfin DR, Silver RC, Holman EA. The novel coronavirus (COVID-2019) outbreak: amplification of public health consequences by media exposure. Health Psychol. 2020;39(5):355\u2013357. https:\/\/doi.org\/10.1037\/hea0000875","DOI":"10.1037\/hea0000875"},{"key":"ref83","doi-asserted-by":"publisher","unstructured":"Mouchtouris N, Lavergne P, Montenegro TS, Gonzalez G, Baldassari M, Sharan A, et al. Telemedicine in neurosurgery: lessons learned and transformation of care during the COVID-19 pandemic. 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Fluorescence and electron microscopic localization of F-actin in the ependymocytes. J Histochem Cytochem. 2009;57(8):741\u2013751. https:\/\/doi.org\/10.1369\/jhc.2009.953646","DOI":"10.1369\/jhc.2009.953646"},{"key":"ref90","doi-asserted-by":"publisher","unstructured":"World Health Organization. World Health Organization (WHO) information note: Tuberculosis and COVID-19 [Internet]; 2020 [Retrieved 2020 May 12]. Available at: https:\/\/www.who.int\/docs\/default-source\/documents\/ tuberculosis\/infonote-tb-covid-19.pdf","DOI":"10.20944\/preprints202007.0051.v2"},{"key":"ref91","doi-asserted-by":"publisher","unstructured":"Brancusi F, Farrar J, Heemskerk D. Tuberculous meningitis in adults: a review of a decade of developments focusing on prognostic factors for outcome. 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