<p><strong>BACKGROUND: </strong>Urgent neurosurgical interventions in pediatric patients with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) are rare. These cases pose an additional stressor on a potentially vulnerable dysregulated inflammatory response which may put the child at risk for further clinical deterioration. Our aim was to describe the perioperative course of SARS-CoV-2 positive pediatric patients who required an urgent neurosurgical intervention.</p>

<p><strong>METHODS: </strong>We retrospectively analyzed pediatric patients ≤18 years of age admitted to a quaternary children's hospital with a positive PCR for SARS-CoV-2 virus from March 2020 to October 2021. Clinical characteristics, anesthetic and neurosurgical operative details, surgical outcomes, and non-neurological symptoms were collected and analyzed.</p>

<p><strong>RESULTS: </strong>Eight SARS-CoV-2 positive patients were identified with a mean age of 8.83 years (median 8.5 years; range 0.58 -18 years). 6 of the 8 patients were male. All children had mild disease or were asymptomatic with regards to COVID symptoms. The anesthetic and surgical courses for these patients were overall uncomplicated. All patients were admitted to a specialized isolation unit in the pediatric intensive care unit (PICU) for cardiopulmonary and neurologic monitoring. Increased protective personal equipment (PPE) during anesthesia and the operation did not impede a successful neurosurgical operation.</p>

<p><strong>CONCLUSIONS: </strong>SARS-CoV-2 positive pediatric patients with minimal COVID-related symptoms who require urgent neurosurgical interventions face unique challenges regarding their anesthetic status, operative delays due to SARS-CoV-2 PCR testing and additional PPE requirements. Despite these clinical challenges, the patients in our study had no adverse post-operative consequences and no healthcare professionals involved contracted the virus.</p>