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Neurosurgery

Emergency Immediate transfer to the Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

Non-acute skull fracture/ non- acute traumatic brain injury

  • Acute trauma
  • Change in consciousness level or deteriorating neurological functions
  • Head trauma with seizures

Brain tumours (intracerebral, meningioma, skull base, pituitary)

  • Symptoms or signs of raised intracranial pressure
  • Severe and increasing headache
  • Deteriorating neurological function i.e. increasing headache and/or nausea vomiting, decrease in conscious level, seizure, development of focal neurological signs
  • Seizures
  • Suspected glucocorticoid deficiency

Neurovascular disorders (aneurysm, AVMs, other)

  • Symptoms of signs of raised intracranial pressure
  • Severe and increasing headache
  • Deteriorating neurological function
  • Seizures
  • Clinical suspicion or subarachnoid haemorrhage or intracerebral haemorrhage

Hydrocephalus and VP shunt

  • Symptoms of signs of raised intracranial pressure
  • Increasing severity of headache
  • Deteriorating neurological function
  • Seizures
  • Swelling pain or redness along shunt tract
  • Abdominal pain or swelling
  • Clinical suspicion of shunt infection

Trigeminal neuralgia and other cranial nerve abnormalities

  • Severe intractable pain preventing adequate fluid intake

Back and/or Neck Pain

  • Cauda equina syndrome
  • High energy spinal trauma
  • Suspected epidural abscess or discitis

Peripheral nerve compression including carpal tunnel syndrome, ulnar nerve entrapment neuropathy, common peroneal and lateral cutaneous nerve of thigh compression syndromes

  • Acute development of peripheral nerve compression symptoms following trauma

Other Neurosurgical Conditions

  • Symptoms of signs of raised intracranial pressure
  • Severe and increasing headache
  • Deteriorating neurological function
  • Seizures

Other referrals to emergency not covered within conditions:

Adult

  • Collapse/altered level of consciousness/new neurological deficit
  • Suspected subarachnoid haemorrhage or other intracranial haemorrhage
  • Headache with concerning features:
  • sudden onset/thunderclap headache
  • severe headache with signs of systemic illness (fever, neck stiffness, vomiting, confusion, drowsiness)
  • first severe headache age over 50 years
  • severe headache associated with recent head trauma
  • Symptomatic benign or malignant space-occupying lesion
  • Suspected or proven blocked or infected VP shunt
  • Acute hydrocephalus
  • Head injuries/trauma including extensive scalp laceration or suspected traumatic brain injury
  • Trigeminal neuralgia – severe uncontrollable pain

Paediatric

  • Benign or malignant space occupying lesion associated with midline shift, hydrocephalus, neurological or endocrine deficit
  • Acute hydrocephalus
  • Suspected or proven blocked or infected VP shunt
  • Vascular disorders – suspected subarachnoid haemorrhage or other intracranial haemorrhage e.g. Thunderclap headache, collapse/altered level of consciousness, headache with vomiting, new neurological deficit
  • Cranial trauma – extradural, subdural haematoma, large cerebral contusion, concussion injuries, diffuse axonal injury, skull fractures, CSF fistula/leakage spinal trauma or other spinal conditions with severe or rapidly progressive deficit e.g. Loss of sensation, muscular weakness or cauda equina syndrome
  • Generalised seizures, prolonged focal seizures and persistent neurological deficits

Are you referring to the right service?

  • Please refer patients with:
    • Pituitary tumours to Endocrinology Department (see Pituitary Mass for essential information). The referral will be forwarded to Neurosurgery if appropriate for surgery.
    • Movement disorders such as benign essential tremor, Parkinson Disease and dystonia to Neurology Department. The referral will be forwarded to Neurosurgery if appropriate for surgery.
    • Metro South does not offer a Paediatric Neurosurgery service please refer to the nearest Paediatric service (Queensland Children’s Hospital for patients residing in the Metro South catchment).

Urgent referrals Arranging urgent review

To arrange a very urgent outpatient appointment, please phone the Princess Alexandra Hospital on 3176 2111 and ask to speak to the Neurosurgery Registrar On-Call

Conditions

Adults

Out of scope services

Find assessment and management information on some out of scope conditions at Brisbane South HealthPathways.
The following are not routinely provided in a public Neurosurgery service.

  • Fusion for back pain due to degenerative disease without correlating clinical symptoms or signs of neural compression
  • Back and neck chronic pain – degenerative changes nil without acute neurology (please refer to Spinal CPC) (Chronic pain is defined as any pain lasting more than 6 months.)
  • Non-specific headache without concerning features or not requiring surgical intervention should be referred to neurology.
  • Pathology of the sacrum: refer to orthopaedics
     

Out of Catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 16 February 2024