====== 🧠 Neurosurgical Plan ======

**Patient Name:**  
**MRN / ID:**  
**Date:**  
**Diagnosis:**  
**Planned Procedure:**  
**Surgeon:**  
**Assistants:**  
**Anesthesia:** General / Regional

----  

<folded Clinical Rationale>
  * Brief summary of presentation and indication for surgery.  
  * Include failed conservative treatments or progression of symptoms.  
  * Example: ''Patient presents with progressive left hemiparesis and seizures. MRI shows enhancing lesion in left parietal lobe with mass effect.''
</folded>

<folded Preoperative Imaging Findings>
  * Summarize relevant findings: MRI, CT, tractography, angio, etc.
  * Mention proximity to eloquent cortex, brainstem, vascular structures, or spine levels.
</folded>

<folded Surgical Objectives>
  * Gross total resection / decompression / biopsy / stabilization  
  * Symptom relief / CSF diversion / histological diagnosis  
  * Example: ''Maximal safe resection preserving motor cortex and arcuate fasciculus.''
</folded>

<folded Approach and Technique>
  * Positioning: supine, prone, lateral
  * Surgical approach: pterional, midline suboccipital, ACDF, etc.
  * Key tools: navigation, ultrasound, microscope, ultrasonic aspirator
</folded>

<folded Adjuncts and Technology>
  * Neuronavigation
  * Intraoperative monitoring (MEPs, SSEPs, EMG)
  * 5-ALA / Fluorescein / Intraop MRI / Endoscope
</folded>

<folded Risks and Mitigation Strategies>
^ Risk               ^ Mitigation Strategy                                         ^
| Bleeding           | Careful hemostasis, bipolar cautery, hemostatic agents      |
| Neurological deficit | IOM, gentle dissection, staged resection                  |
| CSF leak           | Watertight dural closure, graft, sealant                    |
| Infection          | Pre-op antibiotics, sterile technique                       |
</folded>

<folded Postoperative Plan>
  * ICU monitoring or floor depending on complexity
  * Early neuro exam and imaging (CT/MRI within 24–72h)
  * Post-op meds: steroids, antiepileptics, antibiotics
  * Physical therapy / Occupational therapy / Discharge planning
</folded>

<folded Contingency Plans>
  * What if the lesion is non-resectable?
  * What if neurophysiological alerts are triggered?
  * Backup strategies for bleeding or intraoperative findings
</folded>