Preoperative evaluation of neurosurgical patients

Neurosurgery encompasses a wide range of established intracranial and spinal procedures as well as rapidly advancing techniques in areas such as functional neurosurgery, interventional radiology and magnetic resonance imaging (MRI). This article focuses on the required preoperative preparation of neurosurgical patients. Intracranial and spinal surgery are associated with significant morbidity (23.6% and 11.2%, respectively), with overall 30-day mortality around 0.4-2.3% for intracranial surgery. 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 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.