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

•Insular neurosurgery faces unique challenges.•A first-line department can enhance the quality of care without needing new equipment.•A population of 270,000 justifies at least two permanent neurosurgeons for both spinal and cranial procedures. 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. 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. 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]. 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.