Neurosurgery

The Department of Neurosurgery is a tertiary service based in Ninewells, that provides specialist neurosurgical management for patients with cranial and spinal conditions, as part of the Scottish Neurosurgical Managed Service Network.

We offer a 24-hour acute/urgent advice on-call service through our Registrar and Advance Practitioner team.

Our Consultant team consists of five surgeons utilising close links to national specialist neurovascular services and paediatric services. We provide input for patients with emergency presentations from across Tayside and North East Fife as well as elective care for patients from Tayside and Fife.

URGENT/SAME DAY

• Patients with possible Cauda Equina Syndrome who have had a full neurological examination including,  if appropriate, perianal sensory assessment and digital rectal examination.
• Patients with suspicion of cerebral spinal fluid (CSF) shunt malfunction. 
• Post-operative patients with suspicion of CSF leak or non-superficial wound infections. Patients are advised to contact the ward (23B Ninewells) directly if leakage of CSF is evident during the wound healing phase.

OUTPATIENTS

• Patients with degenerative spine conditions; radiculopathies with probable or confirmed nerve root compression not responding to maximal analgesia/ neuropathic agents and guided physiotherapy. MRI scan of the lumbar spine should have been performed prior to referral.
• Patients with signs of myelopathy and experience progressive functional deterioration. Urgent referral should be considered.
• Patients with other conditions for whom surgery should be considered after maximal medical management, i.e. Normal Pressure Hydrocephalus (NHP), Idiopathic Intracranial Hypertension (IIH), Trigeminal Neuralgia.

• Patients with suspected subarachnoid haemorrhage should be discussed with ED/AMU.
• Any new cranial or spinal presentation suspicious of cancer, and requiring admission, should have diagnostic work up under the care of Acute Medical Physicians prior to onward neurosurgical referral.
• In cases of known malignancy, referral should be made to the treating Oncologist.
• Patients with acute pain management issues relating to possible sciatica/radiculopathy if no CES concerns or no confirmed surgical target.
• Outpatients with neck/back pain as the primary symptom and no evidence of worsening radicular arm or leg pain.
• Lumbar spine presentations with no imaging to support surgical opinion.
• Patients with a degenerative spine presentation, that have not fully engaged with conservative strategies such as medication and physiotherapy. (80% will improve with time and conservative management).
• Facet or nerve root injections are not offered by the Neurosurgery service.

URGENT/SAME DAY queries via Ninewells switchboard 01382 660111, bleep 3110 (Neurosurgery on-call).

OUTPATIENT REFERRALS - SCI-gateway system is the preferred option as it provides timely feedback to referrers. Non urgent clinical advice is also available via SCI Gateway Letters addressed to the Neurosurgery Department, Ninewells, are also accepted.