Neurotrauma, the EANS and European neurosurgery: a 2025 situation sketch

situation sketch Traumatic brain injury (TBI) has a case fatality rate over 10/ 100,000/year and representstogether with spinal cord injury (SCI) -a major cause of trauma-related permanent disability in young adults and more recentlyincreasingly in older adults (Hyder et al., 2007;Guan et al., 2023).The major breakthroughs that were successful in reducing mortality by the identification, monitoring and management of secondary insults through the joined efforts of neurosurgeons and intensivists lay several decades behind us.Since then, we have been struggling to make further progress, whilst the challenges are numerous: eg. the increasing proportion as well as age-adjusted incidence of TBI and SCI in older adults with little specific guidance available, the absence of appropriate care pathways for mild TBI and management schemes for persistent post-concussion symptoms, the inconsistent access to proper rehabilitation facilities, and the suboptimal access to overall care in low and middle income countries calling for stronger global collaboration to advance equitable neurotrauma care (Maas et al., 2022).Neurosurgeons have traditionally played a major role in the care for patients with neurotrauma, and it has always represented a small to larger, yet significant portion of every neurosurgeon's practice.Epidural and acute subdural hematomas constitute one of the few indications for immediate neurosurgical intervention, for which we are trained to take responsibility.Therefore, neurotrauma care is in the DNA of all neurosurgeons from their early traineeship.It was Europeans that were among the giants on whose shoulders the field was built: Pierre Janny and Nils Lundberg introduced the monitoring of intracranial pressure (Sonig et al.,