Neurosurgical pre-operative investigations
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Objectives
Guidance for the pre-operative investigation of neurosurgical patients, including transfusion requirements according to the procedure being performed.
Scope
Paediatric neurosurgical patients requiring surgery.
Audience
Medical and nursing staff caring for children who require a neurosurgical procedure, the neurosurgical team and the anaesthetic team.
All patients should have a full history taken and examination documented in the notes. This should include basic observations and a neurological exam. In emergency admissions there is often a degree of urgency and performing investigations, particularly cross-matching blood is a priority.
- Require U+E’s, FBC and Coagulation screen
- Other investigations as determined by history and examination
- No investigations required unless suggested by history e.g. FBC & CRP in patient with potential infected shunt, U+E’s if vomiting.
Cross-match 4 units & discuss with anaesthetist the need for ordering platelets / FFP / Cryoprecipitate
- Craniotomy for large or vascular tumour (e.g. choroid plexus papilloma)
- Monoblock advancement
Cross-match 2 units
- All other craniotomies incl. trauma
- Major spinal procedures incl. spinal tumours
- Correction of craniosynostosis (incl. cranial vault expansion)
Cross-match 1 unit
- VP shunt < 5kg or Hb < 100g/l
Group and Save
- Other shunt procedures (incl. endoscopic)
- Moderate/minor spinal surgery e.g. untethering of cord
- EVD insertion
- Consider cross-matching 10ml/kg if Hb <100g/l or < 5kg
Cross-matching for other craniofacial/maxillofacial procedures (e.g. mandibular distraction; complex mid-face surgery) should be discussed with the Consultant Surgeon beforehand. If there is any doubt about how much to cross-match, discuss with the Neurosurgical/Anaesthetic Consultant.
Last reviewed: 22 February 2024
Next review: 28 February 2027
Author(s): Colin Goutcher (Neuroanaesthesia) Jennifer Brown (Neurosurgery)