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Guidelines for Preoperative Testing for Neurosurgery in Coronavirus Disease 2019(COVID-19) Era: Indian Viewpoint Amidst Global PracticeNitish Agarwal, Amol Raheja, Ashish SuriINTRODUCTIONAs the coronavirus disease 2019 (COVID-19) pandemic continues to affect livesacross the globe, one of the mostdiscussed issues in the management of thepandemic remains safe and effectivedelivery of surgical care. While theexponentially rising toll of conf i rmedCOVID-19 cases has stretched the medicalresources to the brink, there has been amounting rise in the unmet need forsurgical care among patients. Sound pre-paredness and planning is quintessentialto provide safe and robust surgical care inthese unprecedented times. Since theinception of the pandemic in December2019, neurosurgical societies, associa-tions, and groups of prominent neuro-surgeons around the world have put forthguiding strategies for preoperativeevaluation and testing of patients in theCOVID-19 era. Through this manuscript,we provide a comprehensive literaturereview of these guidelines and also discussthe Indian viewpoint pertaining to preop-erative testing. We would f i rst like todiscuss the various available testingstrategies, emphasizing their strengths,weaknesses, and utility in the presentscenario (Table 1).METHODS FOR LABORATORY DIAGNOSISReal-time Reverse TranscriptasePolymerase Chain Reaction (RT-PCR)Real-time RT-PCR tests are the mostwidely used laboratory tests for detectionof RNA viruses. 1,2 RT-PCR involves viralRNA isolation and purif i cation, RT tocomplementary DNA, followed byamplif i cation of specif i c regions of com-plementary DNA with RT-PCR equipmentand f l uorescent signal detection usingspecif i c probes. 3,4 RT-PCR is currentlyconsidered the gold standard for diag-nosing severe acute respiratory syndromecoronavirus 2 (SARS-CoV-2) infectionbecause of its easy methodology, exten-sively validated standard operatingprocedure, and high sensitivity andspecif i city. 2,5,6 It is especially useful indetecting the virus in the setting of anacute illness. 7,8 A positive test caninform the individual of a currentinfection with the virus so that they cananticipate the course of illness and takemeasures to prevent furthertransmission. 7 However, a negative testdoes not rule out infection and needs tobe interpreted with caution, consideringclinical features, radiologic f i ndings, andeven repeat testing in cases with strongclinical suspicion of COVID-19. 1,5,9According to World Health Organiza-tion and U.S. Centers for Disease Controland Prevention, the recommended samplefor initial COVID-19 testing is an upperrespiratory specimen (nasopharyngealswab, oropharyngeal swab, or wash inambulatory patients) and/or lower respi-ratory specimen in patients with moresevere respiratory disease (endotrachealaspirate, bronchoalveolar lavage for pa-tients on mechanical ventilation orsputum, if produced). 10,11 Wang et al. 12 intheir paper investigating thebiodistribution of SARS-CoV-2 amongdifferent tissues of inpatients with COVID-19 recently reported that bronchoalveolarlavage has the greatest positive viraldetection rates (93%), followed by sputum(72%), nasal swabs (63%), bronchoscopebrush biopsy (46%), throat swabs (32%),feces (29%), and blood (1%). Based onthese and similar f i ndings, many otherauthors have recommended collectingpreferably nasopharyngeal swabs with orPreoperative testing and evaluation for coronavirus disease 2019 (COVID-19)have been an enigmatic challenge for the neurosurgical community during thepandemic. Since the beginning of the pandemic, laboratory diagnostic methodshave evolved substantially, and with them has been the necessity for readilyavailable, fast, and accurate preoperative testing methods. In this article, weprovide an overview of the various laboratory testing methods that are presentlyavailable and a comprehensive literature review how various institutes andneurosurgical communities across the globe are employing them to ensure safeand effective delivery of surgical care to patients. Through this review, wehighlight the guiding principles for preoperative testing, which may serve as aroad map for other medical institutions to follow. In addition, we provide anIndian perspective of preoperative testing and share our experience in thisregard.Key words- COVID-19- Diagnostic assay- Neurosurgery- Preoperative testingAbbreviations and AcronymsCB-NAAT: Cartridge-based nucleic acid amplificationtestCOVID-19: Coronavirus disease 2019CT: Computed tomographyICMR: Indian Council of Medical ResearchPOC: Point of careRT-PCR: Reverse-transcription polymerase chainreactionSARS-CoV-2: Severe acute respiratory syndromecoronavirus 2Department of Neurosurgery, All India Institute of MedicalSciences, New Delhi, IndiaTo whom correspondence should be addressed:Ashish Suri, M.Ch.[E-mail: surineuro@gmail.com]Citation: World Neurosurg. (2021) 146:103-112.https://doi.org/10.1016/j.wneu.2020.10.086Journal homepage: www.journals.elsevier.com/world-neurosurgeryAvailable online: www.sciencedirect.com1878-8750/$ - see front matter ª 2020 Elsevier Inc. Allrights reserved.WORLD NEUROSURGERY 146: 103-112, F EBRUARY 2021 www.journals.elsevier.com/world-neurosurgery 103Literature Review