Article Figures & Data
Tables
- Table 1
Prioritization of neurosurgical cases based on color domains and priority categories
Priority Definition Procedure Priority 1(immediate or within 24 h) Immediate: Acute life-threatening condition that needs immediate attention* Trauma: • Acute TBI with EDH or SDH requiring surgery • Elevated ICP that cannot be controlled by medical/critical care • Insertion of an EVD or ICP monitoring for patients with severe injuries Within 24 h: Loss of life or significant function that can be saved by intervention within 24 h • Chronic SDH associated with neurological deficits • Open depressed skull fracture Spine: • Acute progressive neurologic deficits caused by trauma, tumor, infection, and other compressive pathologies interfering with the ability to perform activities of daily living Oncology: • All intracranial tumours affecting consciousness or causing hemodynamic instability due to increased intracranial pressure, hydrocephalus, or herniation * • Tumors causing acute vision loss caused due to optic nerve/chiasm compression Vascular: • Acute stroke thrombectomy* • Coiling or clipping of a ruptured saccular aneurysm with subarachnoid hemorrhage • Craniotomy or embolization of a ruptured AVM with pre-nidal/nidal aneurysms • Decompressive craniectomy or hematoma evacuation* Pediatrics: • Patients with acute high ICP caused by hydrocephalus or mass effect • Shunt malfunction/infection • Open neural tube defect (encephalocele, myelomeningocele) ** Infections: • Symptomatic intracranial or implant infections Functional and epilepsy: • Implant replacement [intrathecal baclofen pump (ITP), vagal nerve stimulation (VNS) and implanted pulse generator (IPG)] due to malfunction, infection, or non-functioning devices, when associated with symptoms or signs of therapy/medications’ debridement Peripheral nerve: • Nerve repair for open sharp cut (clean) nerve injuries • Debridement and nerve tagging for open contaminated nerve injuries Priority 2(within 1 week) Life or significant functional loss that can be saved by intervention within 1 week. Spine: • Subacute progressive neurologic deficit (developed over few weeks) due to degeneration, trauma, or tumors • Spinal instability without neurologic deficit due to trauma, tumor, or infection • Suspected cancer or infection that needs biopsy or resection Oncology: • High grade primary brain tumors • Resection or biopsy for metastatic brain lesions • All intracranial brain tumors causing acute or subacute progressive neurological deficits and/or aggressive radiological features Vascular: • Complex ruptured intracranial aneurysm requiring special preparation or equipment Functional and epilepsy surgery: • Hardware replacement (ITP, VNS, and IPG) due to infection or malfunctioning or non-functioning devices, not associated with symptoms or signs of therapy or medications’ debridement Peripheral nerve surgery: • Malignant peripheral nerve sheet tumor Priority 3(from 1 to 4 weeks) Life or significant functional loss that can be saved by intervention within 1 month. Spine: • Higher (worsening) chronic neurologic deficit or spinal instability (developed over few weeks) caused by degeneration, trauma, or tumors Oncology: • Newly diagnosed low-grade primary brain tumors • Intracranial tumors with slowly progressive symptoms related to mass effect and/or radiological growth Vascular: • Ruptured AVM with no nidal aneurysms • High grade dural AV fistulae with ICH • Carotid revascularization (endarterectomy or stenting) for symptomatic carotid stenosis Pediatrics: • Hydrocephalus with chronically elevated ICP • Craniosynostosis with evidence of high ICP Functional and epilepsy surgery: • Medically intractable severe epilepsy requiring urgent surgical intervention • Elective replacement of implants (ITP, VNS, and IPG) Priority 4(More than 1 month) Cases where life or significant function would not be affected by waiting for more than 4 weeks • Any neurosurgical procedure that can be delayed for more than 1 month • The patient’s condition requires re-evaluation on a regular basis and the priority will change depending on the change in the condition ↵* Patients must be treated as soon as possible,
↵** Patients can be treated up to/within 48 h
AVM - arteriovenous malformation
AV–arteriovenous
EDH - epidural hematoma
EVD - external ventricular drain
ICH - intracranial hemorrhage
ICP - intracranial pressure
SDH - subdural hematoma
TBI - traumatic brain injury
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