La transition de l’enfant à l’adulte en neurochirurgie : exposition du problème

Abstract The transition from childhood to adulthood is a difficult period for neurosurgical patients, who are at risk of interrupted follow-up, causing delayed diagnosis of complications and compromised outcome. Many of these patients harbor chronic diseases that have an impact on their adult life, may present new developments and sometimes decompensate suddenly. The authors review their experience with 601 patients treated for hydrocephalus, myelomeningocele, or tumors, and followed after their 20th birthday. Mortality, morbidity and socioprofessional outcome statistics are provided, showing the magnitude of the health problem in this population. The authors then review the obstacles to the transition from childhood to adulthood and propose possible solutions. Some problems stem from the patient's lack of information, remedied by early education. Others involve physicians, whose skills may be fragmented and who lack clinical data; this requires greater awareness of this entity, inclusion of lectures on this topic in the medical curriculum and increased clinical research in this field. Finally, obstacles in hospital organization and healthcare financing require that patient support groups and medical societies unite to lobby for improvements. The problems related to the transition from childhood to adulthood in neurosurgery is a complex one, requiring all participants to be involved in the possible solutions. This endeavor should be regarded as an integral part of the duties of both pediatric and adult neurosurgeons.