Neurosurgery
We care for patients with a range of brain, nerve and spine disorders.
Phone
7117 3007
Neurosurgery is involved in the assessment and treatment of a range of brain, nerve and spine disorders.
What we do
The Department of Neurosurgery provides specialist services for patients with brain, spine and peripheral nerve disorders who are referred for assessment by a medical practitioner, and via internal referrals.
Conditions commonly managed by neurosurgery:
- Spinal disorders
- Radiculopathy
- Spinal claudication
- Tumours
- Cervical/thoracic myelopathy
- Cauda Equina Syndrome
- Brain and peripheral nerve disorders:-
- Brain tumour
- Peripheral nerve tumour
- Peripheral nerve entrapment ( e.g. carpal tunnel syndrome, ulnar nerve compression)
- Vascular lesions (e.g. Arteriovenous malformations/Aneurysms)
- Hydrocephalus
- Chiari malformation
- Arachnoid cysts
- Head injury
- Trigeminal neuralgia and other cranial nerve abnormalities
Where to find us
Neurosurgery Outpatient clinics
Outpatient Department, Level 3F 186.10, Royal Adelaide Hospital.
Neurosurgery Spinal Assessment Clinic
Outpatient Department, Level 3G 326.02, Royal Adelaide Hospital.
Who we are
Consultants
- Dr Simon Sandler – Head of Unit
- Associate Prof. Amal Abou-Hamden
- Dr Xenia Doorenbosch
- Dr Stephen Santoreneos
- Dr Adam Wells
- Associate Prof. Andrew Zacest
Accessing this service
Patients need a referral from a general practitioner (GP) or specialist to access this service.
You need a referral letter from your GP or medical practitioner to access this service.
Once referred, we will contact you within clinically recommended times, depending on the waiting list length. If there is no waiting list, you will receive an appointment booking letter, or we will contact you to arrange a suitable time.
You may also be referred to neurosurgery via the Emergency Department.
Neurosurgery offers a service to all patients residing across the metropolitan/country local health networks (LHNs) and some adjacent regions of New South Wales and Victoria for whom SA services are more accessible.
Telephone consultations
In the first instance, you may be contacted by Neurosurgery via phone. Telephone consultations allow rapid access to Neurosurgery.
Neurosurgery Spinal Assessment Clinic (SAC)
A triage system identifies priority spinal cases which are usually allocated an appointment directly in a consultant led clinic.
Semi-Urgent and Non-urgent cases are allocated to the Neurosurgery Spinal Assessment Clinic at the RAH (SAC). Please note, non-urgent cases that do not require specialist assessment may not be offered an appointment, or may be managed via a Virtual Clinic service.
The SAC provides assessment and management services for patients with spinal disorders. Physiotherapists who work in advanced practice roles consult in these clinics, with support provided by the spinal consultants as required. These clinics provide rapid assessment of patients who would normally expect to experience long wait times.
Outpatient services
Find out information about specialist outpatient appointments, how to be referred, plus information when attending an outpatient clinic.
Visiting a patient
If visiting an inpatient, please enquire at front desk at entrance to hospital, Level 3 (ground floor) for further information.
The Neurosurgery Department require a written referral from a GP or specialist before patients can access this service.
All referrals to Neurosurgery outpatient clinics are assessed to determine urgency. Referrals are assessed to ensure patients are seen / assessed in clinically appropriate time frames based on triage category.
Referring a patient
All referrals to this service MUST contain the following:
- A clear outline of symptoms
- A clear summary of medical history and the history of the current complaint
- A clear outline of physical examination findings. This must include an outline of the patient’s neurological examination findings and a clear outline of any neurological deficit
- A report outlining recent radiological examination. A CT scan or MRI is preferable where indicated and where possible. Note that there is a Medicare item for some GP-initiated cervical spine MRI scans.
- Copies of any previous specialist’s letters or reports relating to the spinal compliant
Appointments will not be allocated until an appropriate referral is received:
- A triage system identifies priority cases, which are usually allocated an appointment directly in a consultant-led clinic.
- Semi-urgent and Non-urgent cases are allocated to the Neurosurgery Spinal Assessment Clinic at the RAH. Please note that non-urgent cases that do not require specialist assessment may not be offered an appointment or may be managed via a Virtual Clinic service (see details below).
For urgent referrals, please contact the RAH switchboard at 7074 000 and ask for the Neurosurgery registrar/fellow on call to discuss your concerns.
Our registrars are on call 24 hours a day, 7 days a week.
Patients who are unstable and require immediate assessment should be sent directly to the Emergency Department after contacting the Neurosurgery registrar/fellow via the RAH switchboard at 7074 0000.
The following should be directed immediately to the RAH Emergency department:
- Subarachnoid haemorrhage
- Brain tumours associated with midline shift, hydrocephalus or severe neurological deficits
- Spinal cord compression with severe or rapidly progressive neurological deficit
- Acute Cauda Equina Syndrome
- Blocked or infected VP shunt
- First epileptic seizure
- Mass lesion (tumour or abscess) on CT/MRI with headache, increasing drowsiness, increasing weakness and vomiting
Consultants
- Associate Prof. Amal Abou-Hamden
- Dr Xenia Doorenbosch
- Dr Simon Sandler (Head of unit)
- Dr Stephen Santoreneos
- Dr Adam Wells
- Associate Prof. Andrew Zacest
On call registrar/fellow
Call RAH switchboard (08) 7074 000
Expected wait time
The Neurosurgery Department require a written referral from a GP or specialist before patients can access this service.
All referrals to Neurosurgery spinal outpatient clinics are assessed to determine urgency. Referrals are assessed to ensure patients are seen / assessed in clinically appropriate time frames based on triage category.
Telephone RAH: (08) 7074 000
Fax number: (08) 7074 6247
Outpatient call centre: 1300 153 853
Referring a patient
All referrals to this service MUST contain the following:
- A clear outline of symptoms
- A clear summary of medical history and the history of the current complaint
- A clear outline of physical examination findings. This MUST include an outline of the patient’s neurological examination findings and a clear outline of any neurological deficit
- A report outlining RECENT radiological examination. A CT scan or MRI is preferable where indicated and where possible. Note there is a Medicare item for some GP initiated cervical spine MRI scans.
- Copies of any previous specialist’s letters or reports, relating to the spinal compliant
Appointments will not be allocated until an appropriate referral is received
- A triage system identifies priority cases which are usually allocated an appointment directly in a consultant led clinic.
- Semi-Urgent and Non-urgent cases are allocated to the Neurosurgery Spinal Assessment Clinic at the RAH. Please note, non-urgent cases that do not require specialist assessment may not be offered an appointment, or may be managed via a Virtual Clinic service (see details below).
Clinical categories and process
- Cauda Equina syndrome
- Radiculopathy/myelopathy with severe/rapidly progressing neurological deficit
- Post-operative complications such as wound break down, infection, DVT
Refer immediately to the Emergency Department or call the on call Neurosurgery registrar via RAH switchboard Ph(08) 7074 0000
Spinal disorder with accompanying red flags identified (such as tumour, infection).
A condition that has a high probability of requiring surgical care and there is likely to be a significant adverse impact on outcomes and quality of life if surgery or assessment is delayed.
These cases should be discussed with the Neurosurgery registrar via RAH switchboard Ph (08) 7074 6247
Radiculopathy, not improving after 4-6 weeks of community based management and surgery is being considered. Spinal Claudication with symptoms of sufficient duration and severity for patient to consider surgery.
Condition has the potential to have some impact on surgical outcome if assessment is delayed.
Refer to the neurosurgery OPD via fax to referral management. Consider options for community-based management as appropriate Fax (08) 7074 6247
Patients with non-specific low back pain who are considering surgical treatment. Condition is unlikely to deteriorate quickly or require more complex care if assessment is delayed.
Refer to the neurosurgery OPD via fax to referral management. Consider options for community-based management as appropriate Fax (08) 7074 6247
Condition is unlikely to benefit from surgical intervention.
Patients with non-specific spinal pain including:
- strain/sprain
- spondylosis
- discogenic pain
- facet joint arthropathy
- osteoporotic compression fractures
- spondylolysis/spondylolisthesis
These conditions are usually best managed by the GP using options such as medication and physical therapy.
Referrals that are incomplete, or would be better managed by an alternative specialty will not be accepted Following careful clinical triage, if an appointment with neurosurgery is not clinically indicated, the referral will not be accepted.
These referrals may however be managed via a Virtual Clinic (see further details below).
Neurosurgery spinal services
These clinics operate from the RAH and are staffed by spinal consultants/fellows and registrars and are for the management of priority cases. Most commonly, this includes the assessment and follow-up of patients who are triaged as being urgent or semi-urgent candidates for possible surgical intervention.
Consultants (in alphabetical order)
- Associate Prof. Amal Abou-Hamden
- Dr Xenia Doorenbosch
- Dr Simon Sandler (Head of unit)
- Dr Stephen Santoreneos
- Dr Adam Wells
- Associate Prof. Andrew Zacest
On call Registrar/Fellow
Call RAH switchboard (08) 7074 000
Patients identified as warranting semi-urgent or non-urgent surgical consultation are seen in the SAC. The SAC provides assessment and management services for patients with spinal disorders.
Physiotherapists who work in advanced practice roles consult in these clinics, with support provided by the spinal consultants as required. These clinics provide rapid assessment of patients who would normally expect to experience long wait times.
Lead physiotherapist
- Eamonn McCole
The objective of a neurosurgical outpatient appointment is to provide an assessment of the patient, form a diagnostic opinion (which may require further imaging or investigation), and outline a management plan.
Surgical intervention is recommended in a small percentage of cases and minor interventions (such as injection therapy) may be trialled where clinically indicated in the management of radicular or claudicant problems.
The majority of patients require education, guidance regarding appropriate conservative management approaches and then transfer back to community-based care supported by their general practitioner. Most patient consultations span over one or two visits, followed by formal discharge.
Surgical candidates may attend over a more extended period of time with necessary follow-up post spinal intervention.
Clinical Conditions appropriate for assessment
Clinical conditions appropriate for assessment in Spinal Outpatient Clinics include:
- Spinal disorders with accompanying clinical red flags identified
- Radiculopathy (and symptoms severe enough to consider surgical intervention)
- Spinal claudication (with symptoms of sufficient duration and severity to consider surgical intervention)
- Patients with non-specific low back pain who are considering surgical treatment
Clinical Conditions not appropriate for assessment
Clinical conditions not appropriate for assessment in Neurosurgery Outpatient Clinics include:
- Acute or sub-acute non-specific spinal pain
- Chronic non-specific spinal pain when surgical intervention is not a consideration
- Radiculopathy or Spinal Claudication when symptoms are not severe enough to consider surgical intervention
- Spinal pain with systemic inflammatory disorder suggested by symptoms or blood tests (refer to Rheumatology)
- Spinal fractures and adults with scoliosis should be referred to the Orthopaedic Spinal Surgical Service.
- Children with scoliosis can be directly referred to the Women’s and Children’s Hospital scoliosis clinic.
- Ineligible patients include all overseas students and visitor from countries who do not have a Reciprocal Health Care Agreement with Australia. Ineligible patients may be charged for public hospital services. Compensable patients e.g. WorkCover are also not eligible to access this publicly funded service as compensation covers the cost of private medical expenses.
- Emergency Department (ED) staff can directly refer patients to Neurosurgery outpatient clinics only with prior approval from a Neurosurgery consultant/fellow/registrar.
- Access to Neurosurgery outpatient clinics via this route is appropriate for patients who fit the urgent triage classification, such as patients with spinal disorders who do not require immediate consultation but are considered to require assessment within a four-week period (accompanying clinical red flags identified).
- All non-urgent cases should be returned to the care of their general practitioner.
Resources
Spinal clinical information sheets
- Acute Cauda Equina Syndrome (PDF 69KB)
- Non-specific spinal pain (PDF 113KB)
- Spinal claudication lumbar (PDF 70KB)
- Spinal disorder with associated red flags (PDF 69KB)
- Spinal disorder with suspected inflammatory component (PDF 69KB)
- Spinal myelopathy-cervical or thoracic spine (PDF 70KB)
- Spinal radiculopathy (PDF 70KB)