Abstract BACKGROUND Evolving requirements for patient and physician safety and rapid regulatory changes have stimulated interest in neurosurgical telemedicine in the COVID-19 era. OBJECTIVE To conduct a systematic literature review investigating treatment of neurosurgical patients via telemedicine, and to evaluate barriers and challenges. Additionally, we review recent regulatory changes that affect telemedicine in neurosurgery, and our institution's initial experience. METHODS A systematic review was performed including all studies investigating success regarding treatment of neurosurgical patients via telemedicine. We reviewed our department's outpatient clinic billing records after telemedicine was implemented from 3/23/2020 to 4/6/2020 and reviewed modifier 95 inclusion to determine the number of face-to-face and telemedicine visits, as well as breakdown of weekly telemedicine clinic visits by subspecialty. RESULTS A total of 52 studies (25 prospective and 27 retrospective) with 45 801 patients were analyzed. A total of 13 studies were conducted in the United States and 39 in foreign countries. Patient management was successful via telemedicine in 99.6% of cases. Telemedicine visits failed in 162 cases, 81.5% of which were due to technology failure, and 18.5% of which were due to patients requiring further face-to-face evaluation or treatment. A total of 16 studies compared telemedicine encounters to alternative patient encounter mediums; telemedicine was equivalent or superior in 15 studies. From 3/23/2020 to 4/6/2020, our department had 122 telemedicine visits (65.9%) and 63 face-to-face visits (34.1%). About 94.3% of telemedicine visits were billed using face-to-face procedural codes. CONCLUSION Neurosurgical telemedicine encounters appear promising in resource-scarce times, such as during global pandemics.

中文翻译：

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神经外科远程医疗：从 COVID-19 时代及以后的文献系统回顾中吸取的教训

摘要背景对患者和医生安全的不断变化的要求以及快速的监管变化刺激了 COVID-19 时代对神经外科远程医疗的兴趣。目的 进行系统的文献综述，调查通过远程医疗对神经外科患者的治疗，并评估障碍和挑战。此外，我们回顾了最近影响神经外科远程医疗的监管变化，以及我们机构的初步经验。方法 进行了系统评价，包括所有调查通过远程医疗治疗神经外科患者的成功性的研究。在 2020 年 3 月 23 日至 2020 年 4 月 6 日实施远程医疗后，我们审查了我们科室的门诊账单记录，并审查了修改器 95 的包含，以确定面对面和远程医疗就诊的次数，以及按专科划分的每周远程医疗诊所就诊的细分。结果 共分析了 52 项研究（25 项前瞻性研究和 27 项回顾性研究），涉及 45 801 名患者。共有 13 项研究在美国进行，39 项在国外进行。99.6% 的患者通过远程医疗成功管理患者。远程医疗就诊失败162例，其中81.5%是由于技术故障，18.5%是由于患者需要进一步面对面的评估或治疗。共有 16 项研究将远程医疗与替代的患者就诊媒介进行了比较；在 15 项研究中，远程医疗相当于或优于远程医疗。2020年3月23日至2020年4月6日，我科远程就诊122人次（65.9%），面诊63人次（34.1%）。约 94。3% 的远程医疗访问是使用面对面的程序代码计费的。结论 神经外科远程医疗在资源稀缺时期似乎很有希望，例如在全球大流行期间。