North Bristol NHS Trust | Neurosurgery MDT | Last update 31st Dec 2021
Referral to Multidisciplinary Team Meetings (MDT) at North Bristol Trust
The Bristol Neuro-Oncology MDTs based at North Bristol NHS Trust accepts referrals from healthcare professionals for all adults over the age of 16 for an opinion on neurosurgical intervention or advice about further management.
To seek Neurosurgical advice for Brain and Spinal tumours (including Pituitary tumours and Vestibular Schwannomas), Neurovascular disorders (excluding Stroke), and Complex Epilepsy.
If EMERGENCY TREATMENT or advice is required for any of these conditions, refer directly to the on-call neurosurgical team on 0117 414 5726 or via referapatient emergency neurosurgical pathway
The following imaging is mandatory for case discussion at the Neuro-Oncology MDT every Wednesday and for selected cases at the skullbase and neuro-vascular MDT:
MRI head with GAD contrast
CT Head will only be accepted if MRI head is contraindicated
It is the referrer’s responsibility to transfer scans to NBT PACs system via the local radiology department. If images are not available on NBT PACs system by Monday 12 noon, cases will be discussed the following week.
NBT PACs team can be contacted on the following email address:
Post MDT Discussion
MDT outcome will be sent to referrer within 24 hours of discussion and the GP surgery will be notified within 5 working days.
It is the responsibility of the referrer to provide the outcome to the patient and discuss the diagnosis and clinical information, whether the patient is an inpatient or outpatient.
If patients are suitable for clinical intervention, they will be contacted by the relevant team to arrange further appointments and discussion. The patient must be informed of MDT referral and outcome prior to further specialist appointments.
(for all services except Neurovascular referrals)
Meeting held every Wednesday morning.
Attended by neurosurgeons, neuro-radiologists, neuro-oncologists, neuro-oncology specialist nurses, specialist physiotherapists, occupational therapists and speech & language therapists as well as therapy radiographers.
Deadline for referrals is 12 noon on Monday every week. Late referrals will be discussed the following week.
All primary brain and spinal cord tumours at initial and subsequent presentations should be referred to this meeting to seek advice on further management. This includes all proven or suspected tumours within the brain or spinal cord substance (such as gliomas and lymphomas) as well as those secondary brain tumours (metastases) that require potential neurosurgery as part of overall management of the primary cancer. Potential extra axial tumours such as meningiomas can also be referred for an initial discussion, although if the meningioma or other extra axial tumour is located in the area of the skull base it should be referred and discussed in the Skull base MDT meeting (see below). All tumours within the spinal cord (intramedullary) as well as those within the spinal canal but outside the spinal cord (intradural extramedullary) should be referred to this MDT for advice. Metastatic tumours to the spine from a primary cancer to the vertebral body/bodies causing collapse/compression or intractable pain should if required be referred to the complex neuro-spinal MDT for an opinion on further management by emailing the MDT co-ordinator on: email@example.com
Meeting held on the 1st, 3rd and 5th Thursday every month
Attended by neurosurgeons, neuro-radiologists, neuro-oncologists, ENT surgeons, oral/maxillo-facial surgeons & ophthalmic surgeons (as required), nurse practitioners and a range of allied health professionals as required.
Deadline for referrals to the skull base MDT (and the vestibular schwannoma/pituitary MDT) will be 12 noon on Monday. All late referrals will be carried over to the next MDT.
All brain tumours located in the area of the skull base should be referred to this meeting. The area of skull base is difficult to define precisely but would cover the base of the anterior or middle cranial fossae of the skull or infra temporal fossa, involvement of critical vascular structures such as the internal carotid artery, vertebral artery or cavernous sinus, or other critical structures such as the optic nerves, pituitary stalk, jugular foramen or foramen magnum. If in doubt initial referral should be made to the Neuro-Oncology MDT (above) who will then redirect the referral to be discussed at the skull base MDT if required.
a. Vestibular Schwannoma MDT: This meeting is part of the above skull base MDT where referrals of patients with vestibular schwannoma are discussed.
b. Pituitary tumours MDT: This meeting is also part of the skull base MDT (above) where referrals of patients with pituitary tumours are discussed. This part of the meeting is attended by specialist pituitary endocrinologists in addition.
Meeting held every Thursday
Attended by neurosurgeons, interventional neuro-radiologists and advanced neuro vascular nurse practitioners.
Deadline for referrals to this MDT will be 12 noon on Wednesday. All late referrals will be discussed the following week.
All patients with suspected or proven aneurysms, arterio-venous malformations (AVMs) or cavernomas within the brain and spinal cord should be referred to this meeting for an advice on further management.