Preoperative assessment [Neurosurgery Wiki]

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====== Preoperative assessment ======


===== Purpose =====
To evaluate the patient’s medical, neurological, and functional status prior to neurosurgical intervention, aiming to reduce perioperative risk and improve surgical outcomes.

===== Objectives =====
  * Identify neurological and systemic risk factors.
  * Optimize the management of comorbidities (e.g. epilepsy, hypertension, anticoagulation).
  * Classify anesthetic and surgical risk (ASA, cardiac risk index).
  * Plan perioperative neuro-monitoring and imaging.
  * Ensure informed consent and patient education.

===== Key Components =====

==== 1. Medical History ====
  * Past medical conditions (HTN, DM, epilepsy, etc.)
  * History of neurosurgical disease or previous neurosurgery
  * Medications (antiepileptics, anticoagulants, corticosteroids)
  * Allergies
  * Substance use (tobacco, alcohol, drugs)

==== 2. Neurological Assessment ====
  * Glasgow Coma Scale (GCS)
  * Focal deficits (motor, sensory, language)
  * Seizure history and control
  * Intracranial pressure signs (headache, nausea, papilledema)

==== 3. Imaging and Laboratory Studies ====
  * Preoperative MRI / CT
  * Angiography or tractography if required
  * Routine bloodwork (CBC, coagulation, renal function, electrolytes)
  * ECG / Chest X-ray (if risk factors present)

==== 4. Risk Classification ====
  * ASA Physical Status Classification
  * Revised Cardiac Risk Index
  * Anesthetic risk notes

==== 5. Functional Status ====
  * Karnofsky Performance Status (if tumor patient)
  * Barthel Index or modified Rankin Scale
  * Nutritional status

==== 6. Anesthesia and Surgical Planning ====
  * Anesthesia type and special considerations (e.g. awake craniotomy)
  * Intraoperative neurophysiological monitoring plan
  * Blood products / ICU bed reserved
  * Antibiotic prophylaxis and DVT prevention plan

==== 7. Consent and Patient Instructions ====
  * Procedure explained and documented
  * Informed consent signed
  * Pre-op fasting instructions
  * Medication adjustment plan (e.g. stop anticoagulants, continue antiepileptics)

===== Notes =====
  * All findings to be documented in the [[preoperative checklist]].
  * Multidisciplinary discussion recommended for high-risk or complex cases.