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Neurosurgery

Checked: 23-08-2020 by Vicky Ryan Next Review: 23-08-2021

Introduction

NBT has a neurosurgical department. This is a tertiary referral unit and therefore does not usually accept referrals directly from GPs. There is now however some access to certain neurosurgery clinics via eReferral and these are described in the directory of services of eRS. Please note that many of these clinics are Referral Assessment Services (RAS) so referrals may be returned to referrer if not appropriate.

Patients with suspected cranial or spinal trauma should usually be referred to the local Accident and Emergency Department for imaging prior to onward referral if necessary.

Patients with suspected cancer should be referred via the Brain and CNS 2WW pathway.

Patients for other neurosurgical procedures will normally be referred from other secondary care specialties or MSK Interface Service.

The service provides all aspects of Neurosurgical practice, including:

Cranial & Spinal Trauma
Neuro-Oncology
Complex Skull Base Surgery
Complex Cerebro-Vascular Surgery
Epilepsy Surgery
Pituitary Surgery
Spinal Surgery Including Spinal Tumors
Neuro-modulation For Pain
Neuro-modulation For Movement Disorders Including Parkinson’s Disease
Surgery For Trigeminal Neuralgia
Paediatric Neurosurgery
Surgery For Hydrocephalus
Neuro-Endoscopy

Referral

Suspected Malignancy

Please use the Brain and CNS 2WW pathway.

Neuro-oncology MDT

Radiology reports will sometimes advise that images should be reviewed in the neuro-oncology MDT for other lesions not suspected to be malignant. The only current way to do this is through the Bristol Neuro-Oncology website which links to a specific referapatient form which allows a referral to the weekly Neuro-Oncology MDT. Recent MRI with contrast (or CT scan if MRI contraindicated) is required. Warning- This can be a timeconsuming process and not ideal for primary care referrals so time and patience is required! Unfortunately there is no other way at present.

Advice and Guidance

Neurosurgery Advice & Guidance for urgent / same day concerns is available via: Referapatient (https://www.referapatient.org/Home/Index).

There is no neurosurgery advice and guidance service on eRS so non-urgent problems should be referred via the appropriate RAS on eRS if indicated. Advice may be returned from the RAS if a clinic appointment is not required.

Acute Referrals

For acute, on the day neurosurgical advice please use referapatient.org. (Southmead - Neurosurgery). Details on how to use it can be found at: https://www.bloomsburyhealth.org/referapatient-how-it-works . This service is secure and meets all data protection requirements so full patient details can be included i.e full name rather than initials.

Suspected Cauda Equina

Any referrals for consideration of cauda equina should be referred to the local emergency department for assessment and consideration of imaging, rather than directly to neurosurgery.

Please also see the Back pain/Spinal pathway page.

Neurosurgery Clinics available on eRS

Most of this clinics visible on eRS are not appropriate for direct referral from GPs so please check the directory of services carefully before making a referral.

There are a limited number of neurosurgery RAS options on eRS:

Hydrocephalus (adult)
Acoustic neuroma/ Vestibula schwannoma - usually tertiary referral only.
Craniofacial pain/trigeminal neuralgia/hemifacial spasm - usually tertiary referral only.
Skull base - for skull base meningiomas and other rare skull base tumours seen on MRI.
Neuromodulation - only available via pain clinic referral
Vascular - for intracranial and intraspinal vascular pathologies
Lumbar spine - referrals should not be made from primary care - should only come via MSK Interface Service

Links

Neurosurgery

Neuro-oncology

Neuro-oncology (BNOG) Referrals

Head Injury Therapy Unit (HITU)

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