French mobile neurosurgical unit: a retrospective analysis of 22 years of mission.

INTRODUCTION: The French mobile neurosurgical unit (MNSU) is used to provide specific support to remote military medicosurgical units deployed in foreign theatres. If a neurosurgical casualty is present, the Role 2 team may request the MNSU to be deployed directly from France. The deployed neurosurgeon can then perform surgery in Role 2 or decide to evacuate the casualty and perform surgery in Role 4 in France. We provide an epidemiological analysis of MNSU missions between 2001 and 2023 and investigate the value of the MNSU for the French Armed Forces. METHODS: We conducted a retrospective case series that included patients managed by the MNSU from 1 January 2001 to 31 January 2023. We collected epidemiological data (eg, age, military or civilian status, delay between transmission and takeoff, origin of the injury and mission location), clinical records (aetiologies of the injury and disease), data on surgical intervention (operator nature and type of surgery) and data on postoperative outcomes recorded at the time of discharge from hospital. RESULTS: 51 patients were managed by the MNSU. 36 (70.5%) and 3 (5.8%) patients underwent surgery on Role 2 and Role 4, respectively. 39 (76.9%) interventions were due to traumatic injury, 4 (7.8%) due to hydrocephalus, 4 (7.8%) due to vascular causes, 3 (5.9%) due to tumour and 1 (2%) due to spine degeneration. In 30 (76.9%) of these cases, the first operator was a neurosurgeon from the MNSU, whereas in the remaining 9 (23.1%) cases, procedures were initially performed by a non-neurosurgeon. CONCLUSION: The MNSU contribution to D1 casualties' strategic evacuation (STRATEVAC) is important. The MNSU provides additional support for STRATEVAC during the reorganisation of French Armed Forces engaged in several fronts. With the return of high-intensity wars, the French MNSU must develop and adjust for the management of massive influxes of casualties.

Evaluation of neurosurgical training of French military surgeons prior to their deployment.

BACKGROUND: A specific training course was formalized in 2007 in order to facilitate the management of cranio-encephalic injuries by French military general surgeons during deployment, within the Advanced Course for Deployment Surgery (ACDS). The objective is to evaluate the neurosurgical pre-deployment training course attended by the military surgeons. METHODS: From June 2019 to September 2019, we conducted a cross-sectional survey in the form of a digital self-completed questionnaire, addressed to all graduated military surgeons working in the French Military Training Hospitals. The survey included: (1) a knowledge assessment; and (2) a self-assessment of the training course. The participating surgeons were classified into two groups according to their participation (group 1) or not (group 2) in the neurosurgical module. The main outcome was the score received on the knowledge assessment. RESULTS: Among the 145 military surgeons currently in service, 76 participated in our study (53%), of which 49 were classified in group 1 (64%) and 27 in group 2 (36%). Group 1 surgeons had a significantly higher score than Group 2 at the knowledge assessment (mean 21.0±7.1 vs. 17.8±6.0, P=0.041). The most successful questions were related to TBI diagnosis and surgical technique, while the least successful questions dealt with "beyond emergency care" and surgical indications. CONCLUSION: The French pre-deployment neurosurgical training course provides a strong neurosurgical background, sufficient to perform life-saving procedures in a modern conflict situation. However, neurosurgical specialized advice should be solicited whenever possible to assist the in-theatre surgeon in surgical decisions.

Update about ventriculoperitoneal shunts: When to combine visceral and neurosurgical management?

Ventriculoperitoneal shunts (VPS) are the treatment of choice for chronic hydrocephalus. However, the rate of abdominal complications is far from negligible. Combined abdominal and neurological surgical management is often necessary. The goal of this study was to describe the abdominal complications related to VPS and their management. This update overviews: (1) acute or chronic abdominal complications after insertion of a VPS, especially those that call for involvement of visceral surgeons; and (2) the particular precautions necessary when neurosurgeons and visceral surgeons have to collaborate in case an abdominal operation is necessary in patients with a VPS.

Superior sagittal sinus reconstruction using a femoral venous graft after total removal of a meningioma. Case report.

OBJECTIVE: Resection of a parasagittal meningioma invading the superior sagittal sinus (SSS) needs the reconstruction of the sinus by a patch or a venous graft depending of sinus invasion degree. METHOD: We present here a case of a 21-year-old man who underwent radical removal of a radio-induced parasagittal meningioma totally invading the posterior third of the sinus. For its reconstruction, we used the patient's left superficial femoral vein without valves as an autograft, by realizing two end-to-end anastomoses between the sinus and the graft after an en-bloc removal of the meningioma and the invaded sinus. RESULTS: Two years after surgery, clinical examination of the patient was strictly normal and the femoral venous graft was still patent on CT angiograms. CONCLUSION: The superficial femoral vein without valves seems to be convenient for SSS reconstruction.