EMERGENCY CRANIAL NEUROSURGERY IN A TERTIARY CARE CENTRE: CLINICAL BURDEN, TREATMENT DELAYS AND SERVICE CHALLENGE

Background: Emergency cranial neurosurgical conditions are time-sensitive, and avoidable in-hospital delay may permitprogression of mass effect, intracranial hypertension, herniation, or secondary neurological injury. This study describes theemergency cranial workload of a newly established tertiary neurosurgical service, identifies modifiable delays, and outlines aprotocol-based service response. Materials and Methods: A retrospective clinical audit was conducted in the Department ofNeurosurgery, ESIC Medical College and Superspeciality Hospital, Hyderabad, from August 2025 to March 2026.Consecutive emergency cranial cases requiring urgent surgery or a definitive neurosurgical disposition were reviewed.Demographic data, presentation, operative procedure, time to operation theatre (OT), causes of delay, and referral wererecorded. Results: A total of 140 emergency cranial cases were reviewed. Of these, 128 (91.4%) underwent surgery locallyand 12 (8.6%) were referred. Among the operated patients, the mean age was 49.8 ± 13.3 years, 95 (74.2%) were male, 83(64.8%) had non-traumatic emergencies, and 45 (35.2%) had traumatic emergencies. The mean time to OT was 4.75 hours(range 1.5-14.5 hours). Important barriers included non-availability of a dedicated emergency OT, occupancy of electiveOTs, delays in investigations and blood-product readiness, administrative processing, and non-availability of a high-speeddrill, implants, or other essential equipment. The retrospective dataset was not structured for a formal pre- versus postprotocoleffect analysis. Conclusion: Emergency cranial neurosurgery requires coordinated hospital-wide action. Parallelactivation of laboratory, transfusion, anaesthesia, OT, nursing, and administrative services, together with protectedemergency OT access and reliable equipment availability, may reduce avoidable delay and prevent resource-related referral.