Preoperative assessment

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

• 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.

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

• Glasgow Coma Scale (GCS)
• Focal deficits (motor, sensory, language)
• Seizure history and control
• Intracranial pressure signs (headache, nausea, papilledema)

• Preoperative MRI / CT
• Angiography or tractography if required
• Routine bloodwork (CBC, coagulation, renal function, electrolytes)
• ECG / Chest X-ray (if risk factors present)

• ASA Physical Status Classification
• Revised Cardiac Risk Index
• Anesthetic risk notes

• Karnofsky Performance Status (if tumor patient)
• Barthel Index or modified Rankin Scale
• Nutritional status

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

• Procedure explained and documented
• Informed consent signed
• Pre-op fasting instructions
• Medication adjustment plan (e.g. stop anticoagulants, continue antiepileptics)

• All findings to be documented in the preoperative checklist.
• Multidisciplinary discussion recommended for high-risk or complex cases.