What are the indications for referring a patient with suspected brain tumours to neurosurgery?

Indications for referring a patient with suspected brain tumours to neurosurgery include:

• Suspected glioma identified on imaging, requiring referral to a specialist multidisciplinary team including neurosurgery at first radiological diagnosis for management of the tumour.
• Patients with progressive, sub-acute loss of central neurological function warrant urgent direct access MRI (or CT if MRI contraindicated) to assess for brain or CNS cancer, which may lead to neurosurgical referral.
• New or changing neurological symptoms or signs in a patient with glioma at any time should prompt clinical review and appropriate imaging, potentially leading to neurosurgical intervention.
• Initial surgery is indicated for suspected low-grade glioma, with surgical expertise including awake craniotomy and intraoperative monitoring, implying neurosurgical referral.
• Suspected meningioma diagnosed on MRI also requires referral for specialist assessment and potential neurosurgical management.

These indications emphasize the need for early specialist involvement, including neurosurgery, once brain tumour is suspected or diagnosed on imaging, especially when neurological function is affected or tumour characteristics suggest surgical intervention.

References: NICE NG99, NICE NG12