Clinical Lead - Dr Antonio Tsahtsarlis
Catchment criteria applies for referrals for this service. Patient referrals from outside the Mater SEQ Catchment (which includes Metro South and West Moreton Hospital and Health Services) may not be accepted.
This page contains information for general practitioners on how to refer patients aged 16 years and over to Neurosurgery services at Mater Hospital Brisbane.
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.
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.
Bulk Billed Clinics
Mater Health Services offers patients the opportunity to attend bulk billed clinics. To provide your patient with the opportunity to attend a bulk billed specialist clinic, please provide a named referral to one of our specialists listed above.
Current Waiting Time for Appointments
We provide up to date data on how long patients are waiting for their first appointment by specialty here.
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
Emergency care
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:
Emergency conditions
Non Acute Skull Fracture/Non-acute traumatic brain injury
- Acute trauma
- Change in consciousness 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
- ollapse/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
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)
- Refer to Healthpathways or local guidelines
- 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)
- General Referral Information
- CT/CTA and/or MRI results
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
- Refer to Healthpathways or local guidelines
- 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)
- General Referral Information
- CT/CTA and/or MRI results
Additional referral information (useful for processing the referral)
- Family history of aneurysm or AVM
Other useful information for management (not an exhaustive list)
- Refer to Healthpathways or local guidelines
- 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)
- General Referral Information
- CT results
- Mechanism of injury
- Neurological deficits
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-morbidities 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 specialties but will be triaged in a unified manner by all specialties 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
- Refer to Healthpathways or local guidelines
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
| 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.
- Refer to Healthpathways or local guidelines
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.
Patient resources
- Chartered Society of Physiotherapy: 10 things you need to know about your back
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 |
| Appropriate category 2 patients will initially be assessed / reassessed and case managed by an expert musculoskeletal clinician
| Appropriate category 3 patients will initially be assessed / reassessed and case managed by an expert musculoskeletal clinician
|
Trigeminal Neuralgia and other Cranial Nerve Abnormalities
Essential information (referral will be declined without this)
- General Referral Information
- CT and/or MRI results
- Medications trialled
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
- Refer to Healthpathways or local guidelines
- CT and/or MRI
- Preferred that initial referral is sent 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)
- General Referral Information
- Relevant condition information
- Relevant pathology and imaging reports
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 |
Conditions not in scope
Non-routine 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
- Headache with Red flags: