What are the indications for referring a patient with a ruptured cerebral aneurysm to a neurosurgeon?

Indications for referring a patient with a ruptured cerebral aneurysm to a neurosurgeon include:

• Confirmation of subarachnoid haemorrhage (SAH) caused by a ruptured intracranial arterial aneurysm, typically diagnosed by CT angiography showing an aneurysm with a compatible pattern of subarachnoid blood.
• Any patient with suspected or confirmed subarachnoid haemorrhage should be referred immediately to an emergency department and reviewed urgently by a senior clinical decision-maker, which includes neurosurgical assessment.
• If CT angiography shows an intracranial arterial aneurysm, whether the pattern of bleeding is compatible or not with aneurysm rupture, specialist opinion from a neurosurgeon should be sought without delay.
• Patients with neurological deterioration due to complications such as acute hydrocephalus may require neurosurgical intervention for cerebrospinal fluid drainage or diversion.
• Early referral is critical because the risk of rebleeding is highest within 24 hours of symptom onset, and timely neurosurgical management can prevent rebleeding and reduce disability and death.

Therefore, any patient with confirmed or strongly suspected ruptured cerebral aneurysm causing subarachnoid haemorrhage should be referred urgently to a neurosurgeon for assessment and management planning.

References: NICE NG228