Neurosurgical pre-operative investigations

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Objectives

Guidance for the per-operative investigation of neurosurgical patients, including transfusion requirements according to the procedure being performed. 

Scope

Paediatric neurosurgical patients requiring surgery.

Audience

Medical and nursing staff caring for children who require a neurosurgical procedure, the neurosurgical team and the anaesthetic team. 

All patients should have a full history taken and examination documented in the notes. This should include basic observations and a neurological exam. In emergency admissions there is often a degree of urgency and performing investigations, particularly cross-matching blood is a priority.

Major/Moderate Surgery (e.g. craniotomy; spinal surgery; craniofacial surgery)
  • Require U+E’s, FBC and Coagulation screen
  • Other investigations as determined by history and examination
Minor Surgery (e.g. Shunt surgery; ICP monitor; MRI/CT; excision of scalp lumps)
  • No investigations required unless suggested by history e.g. FBC & CRP in patient with potential infected shunt, U+E’s if vomiting.
Neurosurgical MSBOS

Cross-match 4 units &consider ordering platelets 10ml/kg.

  • Craniotomy for large or vascular tumour (e.g. choroid plexus papilloma) 

Cross-match 3 units

  • Correction of craniosynostosis (incl. cranial vault expansion)

Cross-match 2 units

  • All other craniotomies incl. trauma
  • Major spinal procedures incl. spinal tumours 

Cross-match 1 unit

  • VP shunt < 5kg or Hb < 100g/l 

Group and Save

  • Other shunt procedures (incl. endoscopic)
  • Moderate/minor spinal surgery e.g. untethering of cord
  • EVD insertion
  • Consider cross-matching 10ml/kg if Hb <100g/l or < 5kg

Cross-matching for other craniofacial/maxillofacial procedures (e.g. mandibular distraction; complex mid-face surgery) should be discussed with the Consultant Surgeon beforehand. If there is any doubt about how much to cross-match, discuss with the Neurosurgical/Anaesthetic Consultant.

 

Editorial Information

Last reviewed: 01 March 2014

Author(s): Colin Goutcher (Neuroanaesthesia) Jennifer Brown (Neurosurgery)