Table 1.
Classification System of Pediatric Neurosurgical Procedures Stratified by Timing
| Classification | Pediatric Neurosurgical Procedure |
|---|---|
| Class 1: emergent and urgent neurosurgical procedures requiring immediate surgical treatment within 24–48 hours | |
| Shunt placement or revision for acute hydrocephalus with unstable neurological symptoms | |
| External ventricular drain placement for acute hydrocephalus with unstable neurological symptoms | |
| Exploration of penetrating spinal cord or peripheral nerve injury or cauda equina syndrome | |
| Spinal fusion for trauma and instability with neurological compromise | |
| Embolization, clipping, or coiling for ruptured vascular malformations/aneurysms | |
| Wound revision or washout for infection or CSF leakage | |
| Evacuation of epidural, subdural, intraventricular or intraparenchymal hemorrhage | |
| Decompressive hemicraniectomy for severe TBI, cerebral herniation | |
| Closure of myelomeningocele | |
| Craniotomy for epidural/subdural empyema | |
| Resection of brain or spinal tumors associated with neurological compromise | |
| Class 2: semi-elective neurosurgical treatment within 1–2 weeks | |
| Shunt placement or revision for acute hydrocephalus with stable neurological symptoms | |
| External ventricular drain placement for acute hydrocephalus with stable neurological symptoms | |
| Resection of brain or spinal tumors associated with increased risk of neurological compromise | |
| Spinal fusion for trauma and instability with increased risk of neurological compromise | |
| Class 3: elective neurosurgical conditions with optimal treatment <1–2 months | |
| Revascularization for moyamoya disease for unstable neurological symptoms | |
| Stereotactic EEG lead placement | |
| Hemispherotomy | |
| Resection of seizure focus | |
| Laminectomy for stenosis or spinal fusion in nontraumatic spondylolisthesis with worsening neurological symptoms | |
| Craniosynostosis reconstruction (minimally invasive) | |
| Resection of brain or spinal tumors associated without neurological compromise | |
| Class 4: neurosurgical conditions able to delay treatment >1–2 months | |
| Chiari decompression | |
| Revascularization for asymptomatic or chronic symptoms of moyamoya disease | |
| Laminectomy for tethered cord release | |
| Arachnoid cyst fenestration for nonruptured arachnoid cysts | |
| Cranioplasty | |
| Selective dorsal rhizotomy | |
| Intrathecal baclofen pump | |
| Laminectomy for stenosis or spinal fusion in non-traumatic spondylolisthesis with stable neurological symptoms | |
| Craniosynostosis reconstruction (whole vault) | |
| Nonruptured resection of vascular malformations, clipping/coiling of aneurysms | |
| Benign skull/scalp lesions |