Section 8: Neurosurgery

The neurosurgical care activity mentioned in 12° of article R. 6122-25 includes the care of patients with a pathology affecting the brain, the spinal cord, the peripheral nerves, their envelopes (skull, vertebro-discal column, meninges) and their vessels and requiring or likely to require a neurosurgical or radiosurgical procedure under stereotactic conditions.

The authorisation provided for in article L. 6122-1 may only be issued to a health establishment or a health cooperation grouping if it has the following facilities on the same site, possibly by agreement with another establishment located on this site, in a common building or failing that in neighbouring buildings: 1° A full-time inpatient unit and protected operating theatres for neurosurgical patients; 2° An intensive care unit authorised under…

For the neurosurgical treatment of cancerous lesions, the holder of the authorisation to practise neurosurgical care must hold the authorisation mentioned in 18° of article R. 6122-25.

Authorisation to carry out neurosurgical care is not required from a health establishment or a health cooperation group when it holds an authorisation to carry out the surgical care activity mentioned in 2° of article R. 6122-25 and the neurosurgical care activity is limited to lesions of peripheral nerves and lesions of the vertebro-discal and intradural column, excluding the spinal cord.

The authorisation holder may not carry out any of the following practices: 1° Functional cerebral neurosurgery ; 2° Intracranial and extracranial radiosurgery under stereotactic conditions; 3° Paediatric neurosurgery,only if the authorisation to practise neurosurgical care activity expressly mentions it.

Without prejudice to compliance with the provisions of Article R. 6123-98, holders of authorisation for cancer treatment by radiotherapy are not subject to the conditions of thresholds provided for in Article R. 6123-91-4, holders of authorisation for neurosurgery with the practice of intracranial and extracranial radiosurgery in stereotactic conditions, provided that they do not provide other techniques relating to radiotherapy subject to authorisation under 2° of article R. 6123-86-1. However,…

The holder of the authorisation to practise neurosurgery permanently ensures, in liaison with the emergency medical assistance service called SAMU or the emergency structures mentioned in article R. 6123-1, the diagnosis, including by telemedicine, and treatment of patients. This duty may be shared by several authorised neurosurgery sites. In this case, an agreement is drawn up between the authorisation holders for each site.

The holder of the authorisation to practise neurosurgery ensures at all times, where appropriate by agreement with other health establishments or health cooperation groups, that patients have access to : 1° To interventional neuroradiology activities ; 2° A neurology unit with neurovascular activity. When treatment is provided under the terms of an agreement, it must be provided within a timeframe compatible with safety requirements.

Authorisation to carry out neurosurgical care activities may only be granted or renewed if the health establishment or health cooperation group can demonstrate, for neurosurgery, per site, an annual activity, forecast in the case of creation or recorded in the case of renewal, at least equal to a minimum set by order of the Minister for Health. The minimum activity distinguishes, where appropriate, paediatric neurosurgery activity. The annual activity referred…