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