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 and reason for request, and essential information as indicated below.

To refer, please fill in the Mater Adult Referral Form, available to download and embed into most major Practice Management software applications.

Referrals can be sent by:

Secure messaging  Medical Objects:   HM4101000R8
  HealthLink EDI:    materref   
Fax    07 3163 8548

 

 

 

 

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:

  • Collapse/altered level of consciousness/new neurological deficit
  • Suspected subarachnoid haemorrhage or other intracranial haemorrhage
  • 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
  • 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
  • Spine, Neck, Back Pain
  • NB: contact the Neurosurgery/Spine/Orthopaedic Registrar on-call for advice.
  • High risk of irreversible deficit if not assessed urgently
  • Spinal infections
    • Significant spinal nerve root compression or spinal cord compression with progressive neurological signs/symptoms e.g.
    • Spinal cord compression with severe or rapidly progressing neurological deficit
    • Cauda equina syndrome
      • Bilateral nerve pain (leg pain below knees)
      • Bladder / bowel dysfunction
      • Perineal anaesthesia
      • Progressive weakness
    • Bone infection

 

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)

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
  • normal pituitary function
  • mild hyper-prolactinemia

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

 

Hydocephalus and Ventriculoperitoneal (VP) Shunt

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • CT and/or MRI results
  • 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, 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)

  • No additional information

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

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • Medications trialled
  • Nerve conduction studies (desirable and every effort to obtain, but not cause significant delay)

Other useful information for management (not an exhaustive list)

  • Rest, physiotherapy, splint
  • Consider anti-inflammatory medication/steroid injection
  • Nerve conduction studies for suspected carpal tunnel syndrome and ulnar neuropathy

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

Carpal tunnel syndrome or severe ulnar entrapment neuropathy with weakness/wasting and electrophysiological confirmation of diagnosis

Peripheral nerve compression with neurological deficit and/or severe pain syndrome

 

No category 2 criteria

Carpal tunnel syndrome refer after 6 months of maximal medical management

Ulnar entrapment neuropathy when no response to ≥ 6 months of maximal medical management

 

Spinal Fractures (Acute osteopathic / pathological fracture not requiring admission for pain relief)

Essential information (Referral will be declined without this)

  • General referral information
  • History of:
  • symptoms
  • date
  • time
  • mechanism
  • severity or evolution of injury
  • Management to date (immobiliser, splint or cast etc.)
  • XR results - instruct patient to bring imaging films/results to clinic appointment

Additional referral information (useful for processing the referral)

  • Investigation and management of bone density if suspected osteoporotic fracture

Other useful information for management (not an exhaustive list)

  • Timing of first review appointments at orthopaedic outpatient’s/fracture clinic
  • if there is documentation indicating adequate alignment and satisfactory initial treatment of fracture – to be seen within 14 days of referral
  • all other fracture cases, delayed presentation of tendon and nerve injuries - to be seen within 7 days of referral
  • Do not delay referral for open, unstable fractures — refer to emergency or contact the orthopaedic registrar on-call.
  • Please refer early as treatment may change with a delayed referral
  • Chronic disease requires to be optimized prior to referral or the patients may not proceed to surgery
  • Management
    • Pain management
    • Physiotherapy
    • Orthopaedic Physiotherapy Screening Clinic pathways (OPSC)
    • Management of osteoporosis
    • Treatment of underlying cause

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

Refer directly to emergency if:

  • osteoporotic / pathological fracture suspected infection (refer to list of referral to emergency)

Osteoporotic / pathological fracture suspected malignancy

 

 

 

 

No category 2 criteria

Osteoporotic / insufficiency fracture with ongoing pain with the absence of Red flags

Red flags

  • Age (at onset) < 16 or > 55
  • Motor deficit e.g. foot weakness
  • Recent significant trauma
  • Unexplained weight loss
  • History of cancer
  • History of IV drug use
  • Prolonged use of corticosteroids
  • Severe night pain
  • Infection/fever
  • Sheffield Back Pain, Red flags in back pain
 

 

Spine, Neck and Back Pain

Essential information (Referral will be declined without this)

  • General Referral Information
  • Presence and duration of neurological signs and symptoms
  • Weight loss, loss of appetite and lethargy
  • Fever and sweats
  • Management to date (including previous spinal surgery)
  • History of malignant disease / IV drug use
  • Recurrence of injury and mechanism
  • Severity or evolution of injury
  • General medical condition
  • Continence difficulties/sexual function
  • Work status, functional impairment/time of work
  • XRay results – AP & lateral spine including standing views and CT/MRI results (if available)
  • FBC, ELFT, ESR, CRP results, rheumatoid serology (in specific cases)

Additional referral information (useful for processing the referral)

  • Any weakness, myelopathy or cauda equina signs must be documented so they may obtain urgent review
  • For any lumbar spondylolisthesis plain lateral standing films in flexion and extension are helpful in addition to the CT/MRI
  • Spinal referral questionnaire
  • Calcium and phosphate, electrophoresis, immunoglobin’s, PSA, Rheumatoid serology (in specific cases)
  • Physiotherapist report (if available)

Other useful information for management (not an exhaustive list)

NB: Back pain with red flags – If clinical circumstances indicate the patient requires immediate treatment, refer to emergency.               

Sheffield back pain Red Flags:

  • age (at onset) < 16 or > 55
  • motor deficit e.g. foot weakness
  • recent significant trauma
  • unexplained weight loss
  • history of cancer
  • history of IV drug use
  • prolonged use of corticosteroids
  • severe night pain
  • infection/fever
  • Many Category 2 and 3 patients referred for a surgical opinion do not require surgery or a surgical opinion. Evidence demonstrates that non-surgical management is as effective for a number of spinal conditions.
  • Where services are available, category 2 and 3 patients will initially be assessed / reassessed and case managed by an expert musculoskeletal physiotherapist. Outcomes from this or subsequent review may include discharge, provision of appropriate non-surgical management plans, discussion or appointment with a spinal surgeon

Management

  • Analgesia/anti-inflammatories/ NSAIDs as appropriate
  • Physiotherapy/hydrotherapy/ back education group (if available) – minimum 6-week program
  • Strengthening exercises and aerobic fitness training
  • Activity modification (remain comfortably active)
  • Heat/gentle massage/acupuncture
  • Monitor neurological function
  • Complete ‘Keele STarT Back’ screening tool to identify risk of developing chronic spinal pain. Low to medium risk suggests ongoing management in primary care is appropriate. 

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 slower evolving neurological signs/symptoms

Severe pain with significant functional impairment

Suspected spinal tumours (benign or malignant)

Moderate to severe sciatica with recent reflex & muscle power deficit eg. Foot drop

Moderate to severe neck & arm pain with recent reflex & muscle power deficit

 

 

 

Less severe and more long-standing pain with significant functional impairment

Acute cervical & lumbar disc prolapse with stable neurological signs/symptoms

Severe degenerative spinal disorders with limitation of ADL

Acute cervical or lumbar disc prolapse with mod-severe limb pain but minimal neurological deficit

Documented severe lumbar canal stenosis with significant neurogenic claudication/limitation of walking distance

Acute Pars defect in young adult

Anterolisthesis/spondylolisthesis with lower limb neurology and/or instability on flex/ext x-rays

Mechanical lower back pain without lower limb pain

Stable MILD neurological symptoms/signs which is unlikely to progress if left untreated or in whom a good surgical outcome is uncertain

Pain that is manageable or reasonably controlled with analgesia

Chronic LBP/neck pain (without leg or arm pain)

Most cases of chronic cervical and lumbar disc prolapse and degenerative spinal disorders with no to stable mild neurological deficit

Long-standing spondylolisthesis with stable neurology

 

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 Robert Cambell

Director of Neurosurgery

Dr Damian Amato

Neurosurgeon

Dr Jason McMilen

Neurosurgeon

Dr Sarah Olson

Neurosurgeon

Dr Jason Papacostas

Neurosurgeon

Dr Anthony Tsahtsarlis

Neurosurgeon

Dr Martin Wood

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: 12 June 2018

  • Mater at Home

    Providing local communities with access to integrated health care & services.

    Read more

  • Professional Development

    GP Education, Maternity Shared Care Alignment Program and Events.

    Read more

  • Featured Event

    Mater Private Hospital Redland GP Education evening - Tuesday 19 June

    Read more