Preoperative evaluation of neurosurgical patients

摘要

Neurosurgery encompasses a wide range of established intracranial and spinal procedures as well as rapidly advancing techniques in areas such as functional neurosurgery, interventional neuroradiology and magnetic resonance imaging (MRI). This article focuses on the required preoperative preparation of neurosurgical patients. Both intracranial and spinal surgery is associated with significant morbidity (22 % and 11 %, respectively). There is an overall estimated 30-day mortality risk of around 0.5% for spinal surgery, rising to 4.8 % for intracranial surgery. The most common complications include: the need for re-intervention, blood transfusion, pneumonia and urinary tract infection. Preoperative assessment must consider the surgical procedure being undertaken, pathology and its presentation, as well as patient related factors that can be optimized prior to surgery. It also allows individualized preoperative risk stratification and shared decision-making, informed consent and appropriate planning of perioperative care. Careful documentation of preoperative neurological status is essential for postoperative assessment and management. A thorough understanding of the impact of surgery and anaesthesia on intracranial physiology is also required. This ensures high quality, safe care and excellent patient experience.