Clinical Priority Access Criteria

CLINICAL PRIORITY ACCESS CRITERIA

Service Category: Neurosurgery Patient Type: Outpatient (1st Assessment)

Category Definitions: Urgent Semi-urgent Routine If a patient presents to the general practitioner with any of the following acute neurological symptoms please contact the Neurosurgery registrar on call at Sir Charles Gairdner Hospital for consultation and advice: o Markedly elevated or rapidly increasing ICP with deteriorating consciousness o Coma, spinal cord or cauda equina compression from any cause

Some examples are:: Cranial Trauma: Cranial non-Trauma: o Acute Extradural or subdural haematoma o Large intracerebral or intracerebellar o Large cerebral contusion o haematoma o Large chronic subdural haematoma o Acute hydrocephalus o Compound depressed skull fracture o Some intracranial tumours with markedly raised ICP o Pituitary tumour causing acute visual failure/pituitary apoplexy o Acute hydrocephalus and shunt malfunction / blockage

Category Criteria Examples (not an exhaustive list) Urgent o significant nerve root compression Cranial: with slower evolving neurological o Slow developing or Chronic subdural haematoma symptoms/signs o less severe or more long-standing Cranial non Trauma: pain o Biopsy or excision as appropriate of most intracranial tumours (extrinsic and intrinsic) including large pituitary tumours with severe progressive visual failure. o Insertion of most CSF shunts. o Endoscopic third ventriculostomy for selected cases of hydrocephalus. o Severe/intractable trigeminal neuralgia.

Spinal: o Spinal decompression operations for tumours (benign or malignant) where there is a significant but lesser neurological deficit than in Category 1 including: e.g. foot drop.

Other: o Decompression of peripheral nerve for acute entrapment where there is a significant neurological deficit or severe pain syndrome.

Updated December 2014 CPAC Neurosurgery

Category Criteria Examples (not an exhaustive list) Semi- o Patients in this category should be Cranial: urgent informed of average/likely waiting o Remainder of intracranial tumours which may time they are likely to expect before present with epilepsy and where there is mild-to- undergoing their Neurosurgical moderate mass effect – extrinsic such as small-to- treatment moderate sized meningioma, acoustic neuroma and intrinsic such as glioma, metastatic tumour, pituitary tumours with slowly progressive visual failure. o Small benign extrinsic intracranial tumours such as meningioma, secreting and non-secreting and pituitary tumours with no visual impairment. o Non-ruptured intracranial aneurysm. o Surgery for severe pain syndrome such as trigeminal neuralgia. o Hydrocephalus where ICP is not critically elevated. o New genetic conditions eg neurofibromatosis, tuberous sclerosis as specialist discretion.

Spinal: o Spinal tumours with minimal neurological deficit.

Other: o Peripheral nerve entrapment syndromes with severe pain and/or progressive neurological deficit.

Routine Stable neurological symptoms/signs Cranial: Pain that is manageable or reasonably o Hydrocephalus where ICP is chronically elevated. controlled without regular narcotics o Surgery for epilepsy. o Surgery for movement disorders.

Patients with neurosurgical conditions Spinal: for which a neurosurgical operation is o Most cases of cervical and lumbar disc prolapse and proposed and in whom: degenerative spinal disorders with minimal o there is minimal pain neurological deficit o there is a stable mild neurological o mild/intermittent limb pain causing interference with deficit which is unlikely to progress ADL including lumbar canal stenosis / neurogenic if left untreated in whom a good claudication surgical outcome is uncertain o Patients in this category should be Other: informed of the average/likely o Peripheral nerve lesions such as carpal tunnel waiting time they are likely to expect syndrome, ulnar nerve entrapment, thoracic outlet before undergoing their syndrome. Neurosurgical treatment. NOTES: o Neurosurgical/neurological history and other relevant medical/surgical history o Relevant clinical/examination findings o A brief pertinent description of appropriate signs and symptoms o Details of relevant investigations especially radiological including date and place of radiological studies such as X-rays/CT scan/MRI scan, ultrasound examination, and of blood tests such as anticonvulsant levels o A provisional diagnosis if possible / or reason for referral

This CPAC guideline is largely adapted from the following guidelines for neurosurgery: Clinical Priority Assessment Criteria (CPAC) : Neurosurgery New Zealand (2004) Reference: http://www.cdhb.govt.nz/waitlist/pdf/Neurosurgery_Guidelines_2004.pdf

Updated December 2014 Page 2 of 2