Neurosurgery in a Pacific archipelago: how to provide optimal care. Experience of the opening of a first-line neurosurgery department

Abstract

Introduction: In the beginning of November 2023, the authors launched a neurosurgery department in Nouméa, New Caledonia. Emergency cranial surgeries are performed by orthopedic surgeons. All other cases are transferred to Australia or mainland France. Opening a neurosurgery department matches the current needs of the population. The department opened 10 inpatient beds on February 1st, 2024.

First neurosurgical experience: During the first 3 months, 108 surgeries were performed: 32 cranial and 76 spinal. Surgical indications were mostly traumatic, degenerative, infectious, tumoral, vascular pathology, and cerebrospinal fluid resorption disorder.

Patient characteristics: There were 93 patients: 58 male, 35 female; median age, 53 years [IQR, 42 ; 65]. Median body mass index was 27.8 [23.4 ; 31.9]. Seven patients were admitted for spontaneous infection (7.5%). Eight (8.6%) were operated on for postoperative infection, including one cranial and one spinal infection initially managed elsewhere. These 15 patients had a median BMI of 31 [24.9 ; 34.4].

Conclusion: The permanent presence of two neurosurgeons seems justified. Some pathologies can be managed on-site, but transfers to centers in Australia or mainland France will remain necessary. We strongly recommend having such a first-line neurosurgery department in this type of isolated territory.

Keywords: Insular neurosurgery; New Caledonia.