Mater Specialist Quick Find

Neurosurgery – public patients

Purpose

This page contains information for general practitioners on how to refer patients aged 16 years and over to Neurosurgery services at Mater Hospital Brisbane.

Service 

The Mater Centre for Neurosciences provides a comprehensive service for patients throughout Queensland, and has been designed to meet the specific needs of patients and their families. From one dedicated location, Mater Centre for Neurosciences provides specialist care for stroke, epilepsy, neurosurgery, neurology and spinal surgery.

How to Refer 

If referral for care is indicated please list all of the General Referral Information, reason for request, and essential information as indicated below.

Referrals can be sent by:

Smart Referrals

Digital referrals in your practice software that include templates linked with referral criteria for quality handover for any public hospital

SmartForms

Cloud solution in your practice software that eliminates the need for template management

Secure messaging

Medical Objects:   HM4101000R8

HealthLink EDI: materref     

Fax         07 3163 8548

For fax and secure messaging our latest Mater Adult Referral Form or Antenatal Form are available to  embed into most major Practice Management software systems.  

Emergency 

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergency medical advice if in a remote region:

 

View list of conditions:

 

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.


Non Acute Skull Fracture/Non-acute traumatic brain injury

  • Acute trauma
  • Change in conscious level or deteriorating neurological functions
  • Head trauma with seizures

Brain Tumours (intracerebral, meningioma, skull base, pituitary)

  • Symptoms of signs of raised intracranial pressure
  • Severe and increasing headache
  • Deteriorating neurological function
  • Seizures

Neurovascular disorder (aneurysm, AVMs, other)

  • Symptoms of signs of raised intracranial pressure
  • Severe and increasing headache
  • Deteriorating neurological function
  • Seizures
  • Clinical suspicion or subarachnoid haemorrhage or intracerebral haemorrhage

Hydrocephalus and VP shunt

  • Symptoms of signs of raised intracranial pressure
  • Increasing severity of headache
  • Deteriorating neurological function
  • Seizures
  • Swelling pain or redness along shunt tract
  • Abdominal pain or swelling
  • Clinical suspicion of shunt infection

Trigeminal neuralgia and other cranial nerve abnormalities

  • Severe intractable pain preventing adequate fluid intake

Spine

  • Actual or threatened cauda equina syndrome
    • bilateral nerve pain (leg pain below knees)
    • unexplained or unexpected loss of bladder or bowel function
    • perineal anaesthesia
    • progressive weakness
  • Spinal tumour with significant pain and/or neurological deficit
  • Clinical signs spinal nerve root compression or spinal cord compression with rapidly progressive neurological signs/symptoms
  • Spinal trauma with significant pain and/or neurological deficit
  • Spinal fractures demonstrated on imaging
  • Clinical suspicion of spinal infections
  • High risk of irreversible deficit if not assessed urgently

Peripheral Nerve compression including carpel tunnel syndrome, ulnar nerve entrapment neuropathy, common peroneal and lateral cutaneous nerve of thigh compression syndromes

  • Acute development of peripheral nerve compression symptoms following trauma

Other referrals to emergency not covered within conditions:

  • Collapse/altered level of consciousness/new neurological deficit
  • Suspected subarachnoid haemorrhage or other intracranial haemorrhage
  • Headache with concerning features:
    • sudden onset/thunderclap headache
    • severe headache with signs of systemic illness (fever, neck stiffness, vomiting, confusion, drowsiness)
    • first severe headache age over 50 years
    • severe headache associated with recent head trauma
  • Symptomatic benign or malignant space-occupying lesion
  • Suspected or proven blocked or infected VP shunt
  • Acute hydrocephalus
  • Head injuries/trauma including extensive scalp laceration or suspected traumatic brain injury
  • Trigeminal neuralgia – severe uncontrollable pain

 

Scope of Service

Conditions out of scope

The following conditions are not routinely provided at Mater Hospital Brisbane:

View list of conditions:

  • Chronic neck and back pain with degenerative changes on imaging and no neurological abnormality on examination
  • chronic pain is defined as any pain lasting more than 6 months. Back and neck chronic pain – degenerative changes nil acute neurology
  • Non-specific headache without red flags or requiring surgical intervention
  • Headache with Red flags:
    • Sudden onset/thunderclap headache
    • Severe headache with signs of systemic illness (fever, neck stiffness,
    • Vomiting, confusion, drowsiness)
    • First severe headache age over 50 years
    • Severe headache associated with recent head trauma

 

Conditions in scope

Brain Tumours (Intracerebral, Meningioma, Skull Base, Pituitary

Essential information (Referral will be declined without this)

  • General Referral Information
  • CT/MRI results
  • Pituitary function tests including prolactin if suspected pituitary tumour (e.g. prolactin, random cortisol, growth hormone and IGF1, TFT's)

Additional referral information (useful for processing the referral)

  • Details of previous malignancy including treatment/any relevant imaging results

Other useful information for management (not an exhaustive list)

  • Monitor neurological function
  • CT+/-contrast and/or MRI for patients with suspected space-occupying lesion;
  • headache suspicious for raised intracranial pressure i.e. morning headache, vomiting and papilloedema and/or
  • associated neurological features i.e. new onset seizures, cognitive, behavioural or personality changes, neurological deficits
  • Consider endocrinology referral for any of the following:
  • functioning pituitary adenoma
  • pituitary tumours with slowly progressive visual field deficit
  • marked hyper-prolactinemia serum prolactin > 5000 mU/L
  • pituitary tumours with no visual impairment

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Intracerebral space-occupying lesion, (suspected or confirmed on CT) with minimal and/or slowly progressing symptoms

Symptomatic small benign intracranial tumours (e.g. acoustic neuroma/vestibular schwannoma, meningioma, craniopharyngioma epidermoid cyst, arachnoid cyst) without cerebral oedema

Pituitary tumour associated with visual field deficits and/or symptomatic hyper/hypopituitarism

Functioning or non-functioning pituitary adenoma, pituitary tumours with slowly progressive visual field deficit

Incidental finding on imaging e.g. epidermoid cyst, arachnoid cyst and/or unusual pathology e.g. adults with newly diagnosed chiari malformation, empty sella, temporal lobe herniation, venous angioma

Pituitary tumours with no visual impairment, normal pituitary function and/or mild hyper-prolactinemia

 

Hydrocephalus and Ventriculoperitoneal (VP) Shunt

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • Details of previous treatment

Other useful information for management (not an exhaustive list)

  • CT for patients with suspected raised intracranial pressure
  • Consider neurology referral for debilitating persistent intracranial hypertension despite treatment including medical therapy and lumbar puncture:
  • suggestive symptoms i.e. morning headache, vomiting and papilloedema
  • associated neurological features i.e. new onset seizures, cognitive, behavioural or personality changes, neurological deficits

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Previously diagnosed hydrocephalus with evidence of raised intracranial pressure

New diagnosis of hydrocephalus on CT or MRI

Patient with complications or suspected complications of an in situ VP shunt

Idiopathic intracranial hypertension – in patients with persistent symptoms or visual deterioration despite medical therapy including repeat lumbar punctures

 

No category 2 criteria

Routine review of VP shunt in an asymptomatic patient

 

Neurovascular Disorders (Aneurysm, Ateriovenous Malformation (AVM), other)

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • Family history of aneurysm or AVM

Other useful information for management (not an exhaustive list)

  • Monitor neurological function
  • CT+/-contrast and/or MRI for patients with suspected space-occupying lesion:
  • headache suspicious for raised intracranial pressure i.e. morning headache, vomiting and papilloedema
  • associated neurological features i.e. new onset seizures, cognitive, behavioural or personality changes, neurological deficits

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Asymptomatic AVM or aneurysm or brain and spine, i.e. not associated with an intracranial haemorrhage or acute neurological deficit

 

 

No category 2 criteria

Counselling – investigation of patients at high risk of intracerebral aneurysms e.g. family history in first degree relatives, polycystic kidney disease, inherited connective tissue diseases, coarctation of the aorta

 

Non Acute Skull Fracture / Non Acute Traumatic Brain Injury

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • Co-morbidities e.g. patient taking anti-platelets or anti coagulants

Other useful information for management (not an exhaustive list)

  • No other information

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Non-acute skull fracture

Non-acute traumatic brain injury

 

No category 2 criteria

No category 3 criteria

 

Peripheral Nerve Compression including carpal tunnel syndrome, ulnar nerve entrapment neuropathy, common peroneal and lateral cutaneous nerve of thigh compression syndromes

Essential information (Referral will be declined without this)

  • General Referral Information
  • Duration and rate of progression of clinical symptoms
  • Clinical examination findings including neurological findings relating to compression neuropathy syndrome in question
  • Treatment trialled to date including physiotherapy and occupational therapy.
  • Relevant co-morbities e.g. diabetes, obesity, history of trauma

Additional referral information (useful for processing the referral)

  • Nerve conduction studies (desirable and every effort to obtain, but should not cause significant delay for Cat 1 referrals)

Other useful information for management (not an exhaustive list)

  • CTS can be referred to the following specialities but will be triaged in a unified manner by all specialities concerned:
    • Orthopaedics
    • Plastic and Reconstructive surgery
    • Neurosurgery
    • General Surgery
  • Chronic disease requires to be optimized prior to referral or the patients may not proceed to surgery

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Peripheral nerve compression syndrome with 

  • rapidly progressing and or severe neurological deficit or
  • associated with disabling pain syndrome

 

Frequent and / or progressive peripheral nerve compressive symptoms with corresponding clinical signs

Recurrence of significant symptoms or clinical signs after surgical decompression

Intermittent or mild symptoms of peripheral nerve compression failing to respond to reasonable and appropriate non- operative measures of greater than 6 months duration and considered to warrant assessment for surgical decompression

 

Spinal (Neurosurgery)

Essential information (Referral will be declined without this)

  • General referral information
  • Presence and duration of neurological signs and symptoms
  • Mechanism of injury
  • Functional status
  • Management to date (including previous spinal surgery and non-operative management)
  • General medical history
  • Relevant imaging results (may include plain x-ray, CT and MRI)
  • Presence or absence of concerning features
    • age (at onset) < 16 or > 50 with new onset pain
    • motor deficit e.g. foot weakness
    • recent significant trauma
    • weight loss (unexplained)
    • previous history malignancy (however long ago)
    • history of IV drug use
    • previous longstanding steroid use
    • recent serious illness
    • recent significant infection

Additional referral information (useful for processing the referral)

 

  • Other relevant reports from any providers in a public or private sector related to the presenting problem
  • FBC, ELFT, ESR, CRP results, rheumatoid serology, Calcium and phosphate, electrophoresis, immunoglobin’s, PSA (if relevant)
  • For any lumbar spondylolisthesis plain lateral standing films in flexion and extension are helpful in addition to the CT/MRI
  • Spinal referral questionnaire

Other useful information for management (not an exhaustive list)

  • Determine the potential for underlying sinister pathology
  • Concerning features
    • age (at onset) < 16 or > 50 with new onset pain
    • motor deficit e.g. foot weakness
    • recent significant trauma
    • weight loss (unexplained)
    • previous history malignancy (however long ago)
    • history of IV drug use
    • previous longstanding steroid use
    • recent serious illness
    • recent significant infection
  • Most Category 2 and 3 patients referred for a surgical opinion do not require surgery. Evidence demonstrates that non-surgical management is as effective for a number of spinal conditions.
  • Appropriate category 2 and 3 patients will initially be assessed / reassessed and case managed by an expert musculoskeletal physiotherapist. Outcomes may include provision of appropriate non-surgical management plans, discussion or appointment with a spinal surgeon or discharge.

Management

  • Caution should be used in prescribing opiates for spinal pain which should be prescribed in line with current guidelines
  • Advice, education and reassurance
    • Heat, activity modification, normal activity
  • Physiotherapy and exercise
  • Anti-inflammatory and analgesia may be considered
  • Complete ‘Keele STarT Back’ screening tool to identify risk of developing chronic spinal pain [2, 6]
    • Low to medium risk suggests ongoing management in primary care maybe appropriate
  • Imaging of the spine is not recommended in most patients with an acute presentation or with a stable chronic presentation unless there is the indication of sinister or serious pathology (concerning features). If there are no signs of sinister or serious pathology, imaging may be indicated after a trial of conservative therapy. (Imaging pathways)

Patient resources

 

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

  • Risk irreversible deficit if not seen within 1-4 weeks
  • Significant spinal nerve root compression or spinal cord compression with evolving neurological signs/symptoms
    • moderate to severe sciatica with new onset reflex & muscle power deficit eg. Foot drop
    • moderate to severe neck & arm pain with new onset reflex & muscle power deficit
  • Spinal tumours (benign or malignant)
  • Stable spinal fractures without evolving neurological deficit

 

 

 

Appropriate category 2 patients will initially be assessed / reassessed and case managed by an expert musculoskeletal clinician

  • Severe spinal disorders with significant functional impairment
  • Acute cervical & lumbar disc prolapse with moderate to severe radicular symptoms and stable neurological signs
  • Documented severe lumbar canal stenosis with significant neurogenic claudication/limitation of walking distance
  • Anterolisthesis/spondylolisthesis with lower limb neurology and/or instability on x-rays
  • Significant scoliosis in young adult

Appropriate category 3 patients will initially be assessed / reassessed and case managed by an expert musculoskeletal clinician

  • Chronic cervical and lumbar disc prolapse and degenerative spinal disorders without progressive neurological deficit

 

Trigeminal Neuralgia and other Cranial Nerve Abnormalities

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • No additional information

Other useful information for management (not an exhaustive list)

  • Trial of directed neuropathic pain medications as a priority
  • CT and/or MRI
  • Consider initial referral to neurology for confirmation of diagnosis and/or pain clinic for medical optimisation of pain

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Severe/intractable trigeminal neuralgia

Failed maximal medical management, including difficulty swallowing /eating/ drinking

 

Moderately severe trigeminal neuralgia partially controlled with medication for consideration of surgical treatment including patients with side effects to medical therapy

No category 3 criteria

 

Other Neurosurgical Condition

Essential information (Referral will be declined without this)

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

 

 

 

Our Specialists 

Dr Martin Wood

Director of Neurosurgery

Dr Robert Campbell Neurosurgeon
Dr Damian Amato

Neurosurgeon

Dr Jason McMilen

Neurosurgeon

Dr Sarah Olson

Neurosurgeon

Dr Jason Papacostas

Neurosurgeon

Dr Anthony Tsahtsarlis

Neurosurgeon

Dr Anthony Athanasiov

Spinal Surgeon

Dr Ian Cheung

Spinal Surgeon

Dr Simon Gatehouse

Spinal Surgeon

 

Bulk Billed Clinics 

Mater Health offers patients the opportunity to attend bulk billed clinics. To provide your patient with the opportunity to attend a bulk billed clinic, please provide a named referral to one of the specialists listed above.

Contact Us

If you would like to discuss a referral, including clinical criteria, or update the status of a current patient please contact our priority GP phone line on 07 3163 2200 .

Current Waiting Time for Appointments

We provide up to date data on how long patients are waiting for their clinic first appointment by specialty here

Referral Guideline Development

These Mater Referral Guidelines align with standardised best practice tools for referral to publicly funded specialist outpatient services developed in Queensland through the Clinical Prioritisation Criteria project.

 

Content last reviewed: 5/12/19

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