Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Post-operative care after neurosurgery should include:
- Monitoring and managing hydrocephalus: Assess for acute or chronic hydrocephalus based on symptoms and imaging, and consider cerebrospinal fluid drainage or diversion if neurological deterioration occurs NICE NG228.
- Ensuring euvolaemia and managing delayed cerebral ischaemia: Maintain normal blood volume and consider vasopressor treatment if symptoms of delayed cerebral ischaemia persist after subarachnoid haemorrhage NICE NG228.
- Developing and documenting a follow-up care plan: Agree on a follow-up plan with the patient, provide a paper copy to them and their carers, and include the plan in medical records and discharge summaries NICE NG228.
- Offering rehabilitation: Provide rehabilitation in line with NICE guidelines on stroke rehabilitation and rehabilitation after critical illness to support recovery NICE NG228.
- Follow-up neuroimaging: Consider follow-up imaging based on recovery extent and clinical need NICE NG228.
- Surveillance for late effects in brain tumour patients: Monitor for late-onset side effects such as cognitive decline, epilepsy, hearing loss, and endocrine dysfunction, and provide appropriate referrals for neuropsychology, ophthalmology, audiology, and stroke services as needed NICE NG99.
- Communication and support: Provide clear, honest information to patients and carers, manage expectations, and ensure a clear point of contact for ongoing advice and support NICE NG41.
- Specialist involvement: For spinal cord injuries or complex neurosurgical cases, ensure early involvement of specialist neurosurgical or spinal surgeons and coordinated care with spinal cord injury centres NICE NG41.