Mongardi Lorenzo, Lefevre Etienne, Litrico Stéphane, Hesler Marie-Charlotte, Torrente Ugo, Coll Guillaume, Nanty Léo, Vignes Jean-Rodolphe, Fuentes Stephane, Roblot Paul
Neurosurgery Unit, Médipôle Koutio, Centre Hospitalier Territorial de Nouvelle-Calédonie, 98 835, Dumbéa-Sur-Mer, New Caledonia.
Department of Neurosurgery, University Hospital of Pitié-Salpêtrière, 75013 Paris, France.
Neurochirurgie. 2025 Jul;71(4):101695. doi: 10.1016/j.neuchi.2025.101695. Epub 2025 Jun 19.
The aim of the study is to ascertain which neurosurgical procedures can be safely and effectively performed in an isolated rural neurosurgical unit, despite the lack of advanced technological infrastructure available in tertiary neurosurgical departments in high-income countries.
The authors draw upon their experience of establishing a first-line neurosurgical unit in a remote Pacific archipelago, which was accomplished without significant technological investments. All the patients operated in the neurosurgical unit of the Territorial Hospital of Nouméa, New Caledonia, from December 1, 2023, to February 1, 2025, were included. The primary outcome measure was a composite endpoint, including the mortality within three months post-surgery, reoperation within three months post-surgery, secondary transfer due to postoperative complications.
134 patients underwent 155 procedures. Among them, 129 patients underwent cranial surgery while 5 patients underwent spinal cord surgery. Among the 155 procedures, 107 (69.0%) were emergency surgeries, 48 (31.0%), were planned surgeries. The most frequent indications for emergency surgery were traumatic brain injuries (TBI) (47/107-43.9%), CSF disorders (24/107-22.4%), and spontaneous cranial infections (13/107-12.1%). Among the planned surgeries, 31 were tumor resection (31/48-64.5 %) while 12 were heterologous cranioplasties (12/48-25.0%). The postoperative course was favorable for 93.8% of planned surgeries. Among the 107 emergency surgeries, 14 (14/107-13.1%) required reoperation (4 postoperative infections, 2 postoperative hematomas, 1 postoperative intracranial hypertension, 2 recurrences of chronic subdural hematomas and 5 wound infections).
Our experience confirmed that the majority of neurosurgical cases can be safely manage on site without all the technological tools even if the possibility to transfer high complexity cases in a center equipped with advanced surgical devices still plays a fundamental role. In isolated regions where transfer to a tertiary center within four hours is impossible, the presence of such a unit is not only safe but essential to improve the quality of healthcare services. Having a resident neurosurgeon in a rural unit can also be beneficial in reducing the need for secondary transfers due to the possibility to manage on-site post operative complication.
本研究的目的是确定在一个偏远的农村神经外科单元中，哪些神经外科手术能够在安全且有效的情况下进行，尽管缺乏高收入国家三级神经外科科室所具备的先进技术基础设施。
作者借鉴了在一个偏远太平洋群岛建立一线神经外科单元的经验，该单元的建立未进行重大技术投资。纳入了2023年12月1日至2025年2月1日在新喀里多尼亚努美阿地区医院神经外科接受手术的所有患者。主要结局指标是一个复合终点，包括术后三个月内的死亡率、术后三个月内的再次手术、因术后并发症进行的二次转诊。
134例患者接受了155例手术。其中，129例患者接受了颅脑手术，5例患者接受了脊髓手术。在155例手术中，107例（69.0%）为急诊手术，48例（31.0%）为择期手术。急诊手术最常见的适应证是创伤性脑损伤（TBI）（47/107 - 43.9%）、脑脊液疾病（24/107 - 22.4%）和自发性颅内感染（13/107 - 12.1%）。在择期手术中，31例为肿瘤切除术（31/48 - 64.5%），12例为异体颅骨成形术（12/48 - 25.0%）。93.8%的择期手术术后病程良好。在107例急诊手术中，14例（14/107 - 13.1%）需要再次手术（4例术后感染、2例术后血肿、1例术后颅内高压、2例慢性硬膜下血肿复发和5例伤口感染）。
我们的经验证实，即使没有所有的技术工具，大多数神经外科病例也可以在现场安全处理，尽管将高复杂性病例转运至配备先进手术设备的中心的可能性仍然起着至关重要的作用。在无法在四小时内转运至三级中心的偏远地区，这样一个单元的存在不仅安全，而且对于提高医疗服务质量至关重要。农村单元中有常驻神经外科医生也有助于减少因能够现场处理术后并发症而进行二次转诊的需求。
