Table 1

Prioritization of neurosurgical cases based on color domains and priority categories

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
• Acute progressive neurologic deficits caused by trauma, tumor, infection, and other compressive pathologies interfering with the ability to perform activities of daily living
• 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
• 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*
• Patients with acute high ICP caused by hydrocephalus or mass effect
• Shunt malfunction/infection
• Open neural tube defect (encephalocele, myelomeningocele) **
• 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
• 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
• 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
• Newly diagnosed low-grade primary brain tumors
• Intracranial tumors with slowly progressive symptoms related to mass effect and/or radiological growth
• Ruptured AVM with no nidal aneurysms
• High grade dural AV fistulae with ICH
• Carotid revascularization (endarterectomy or stenting) for symptomatic carotid stenosis
• 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