Neuropsychology will be a member of the neuro oncology MDT. This will allow;  

1. Identification of new patients at the neuro oncology MDT where there is a surgical plan that benefits from pre-op neuropsychology assessment.
2. Provide feedback to the neuro oncology MDT about patients under the care of neuropsychology (this includes patients who may not yet be listed for surgery). 
3. Provide consultation for the neuro oncology MDT to highlight patients who may need neuropsychology care and are not yet requiring surgical intervention.
4. Provide consultation to the neuro oncology team regarding psychology care/management of patients who may not be directly under the care of neuropsychology. 

Patients identified for surgery should be seen by the neuropsychology service at the following stages: 

a. Pre-operative  

1. 1. Baseline cognitive assessment – test battery. (See appendix 1) 
   2. Assessment of psychological function. 
   3. Working jointly with Neuro Oncology MDT to psychologically support and educate the patients and their families in their neuro-oncology surgical clinical care pathway incorporating; surgical (including awake craniotomy), surveillance and adjuvant treatment.  

b. Post-Operative  

1. 1. Usually within 7 days post-surgery and ideally to coincide with pathology results and treatment plan from oncology – no formal cognitive assessment, review to discuss post-operative neuropsychology follow up. 
   2. 3 and 12 months post-operative 

1. 1. 1. Review of cognitive function, identification of cognitive rehabilitation needs (where appropriate onward referral to community rehabilitation, neuropsychology services).  
      2. Assessment of mental health and psychological wellbeing, where appropriate onward referral to Clinical Health (Oncology) and local mental health services.   
      3. Neuropsychology team available for consultation for post-operative patients out with the above times frames. 

• The neuropsychology service will not provide routine input for patients under clinical surveillance. The neuropsychology team will be available to discuss and potentially accept referrals for patients in this clinical care pathway if there is a clinical need that can be met by the neuropsychology team.  

Neuropsychology will have representation at neuro-oncology MDTs. This will allow for early identification of patients who require surgical intervention and where the MDT surgical choice is to carry the procedure out awake.  

Prior to meeting with the patient, the Neuropsychology team will meet with the Awake Craniotomy MDT to;  

1. Establish the surgical plan which will include identification of eloquent area of cortex and tracts to plan intraoperative neuropsychological mapping. 
2. Agree a cognitive mapping plan, utilising Neuro mapper as the software platform. Neuro mapper plan should be documented. 
3. Agree intraoperative stimulation plan for each of the intraoperative paradigms. 
4. Agree administration of intraoperative paradigms. 
5. Agree a standardised protocol to address positive findings during stimulation.  
6. The above plan (eloquent areas, neuro mapper plan and stimulation) should be documented uploaded to clinical notes and shared with the wider Awake Craniotomy MDT.   

Patients and their families/carers will be invited to attend a neuropsychology appointment pre-operatively with the following aims; 

a. General psychological / mental wellbeing assessment including: 

1. 1. 1. Psychological exploration of patient suitability for awake procedure. 
      2. Highlighting any “risks” for example difficulties with emotional regulation, anxiety, including panic attacks, depression, PTSD. 
      3. The development of patient-led plan for psychological care during awake procedure. 
      4. The exploration of knowledge and insight into awake procedure and provide education as appropriate.  

b. Baseline assessment of general cognitive function examining the cognitive domains of memory, language, attention/concentration, executive function, motor/praxis, visual/visual spatial function. (See appendix 2) 

c. Intraoperative mapping baseline plan, using neuro mapper.  

d. Completion of consent to use neuro mapper as part of the awake procedure. 

e. Education about the awake surgical procedure as appropriate. 

f. Provision of education and practice of psychological strategies, techniques to support wellbeing during awake procedure and afterwards. (See appendix 2 as an example) 

Neuropsychology team will prepare a post assessment report and urgently communicate any concerns, issues raised, with awake MDT.  

Neuropsychology team will have a standard operating procedure for consent for intraoperative mapping and storage of clinical data. 

Neuropsychology team aim to see patient prior to entering the aesthetic room to review and confirm the patient led plan for psychological care during the awake procedure.  

Neuropsychology team will attend the pre-operative meeting with wider Awake Craniotomy MDT on the day of surgery and share:  

1. Patient’s psychological care plan 
2. Intraoperative mapping plan 

Neuropsychology team will administer the neuro mapper plan in accordance with the pre-operative plan.  

Neuropsychology team will be responsible for the delivery of the psychological well-being plan during the awake procedure. 

Appendix 1

Appendix 2