Letter: Operationalizing Global Neurosurgery Research in Neurosurgical Journals

Traumatic brain injury (TBI) affects roughly 69 million individuals per year, many of who reside in low- and middle-income countries (LMICs).1 While there exist several limitations to treating TBI in LMICs, many can be properly addressed if given the attention and focus required to usher in change. Case in point, the governing body of neurotrauma literature is produced in high-income countries (HICs), which pose additional constraints in settings with limited medical equipment, health infrastructure, and available staff, as seen in several LMICs.1-3 In addition, approximately 23 300 additional neurosurgeons are required to address more than 5 million essential neurosurgical cases that are unmet annually, all of which occur in LMICs.4 We believe operationalizing global neurosurgery research in neurosurgical journals can serve to bridge this gap and provide a space for leaders across the world to share pearls of knowledge toward reducing the global burden of neurological diseases and disorders, including TBI.

Fortunately, there is a growing movement to ensure the provision of timely, safe, and affordable neurosurgical care to all individuals who require it. In 2015, the Lancet commission on surgery published an article that brought attention to the need for neurosurgical enhancement on a global scale.5 This group offered targets focusing on increasing access to surgery and expanding knowledge of barriers to equitable care in LMICs by the year 2030. Still, inequities in access to neurosurgical care remain rampant, stressing a need for targeted efforts as potential remedy.

Global Neurosurgery has gained significant momentum as evident by the upward trend of peer-reviewed abstracts and articles submitted and published in neurosurgical journals. A PubMed search of the phrase “global neurosurgery” displays an ascending trend with 3 published articles in 2015, 42 articles in 2018, and 82 in the year 2020.6 This positive trend speaks to the impact of efforts made by communities such as The Lancet, the World Federation of Neurosurgical Societies (WFNS), Global Neurosurgery Committee (GNC), American Association of Neurological Surgeons (AANS), and many other organizations aimed at strengthening neurosurgery globally. Global neurosurgery conferences provide additional unique opportunities to connect partners in LMICs and HICs to develop education, advocacy, and policy. Importantly, the rise in the digital world amid the COVID-19 pandemic has enabled participants—particularly from LMICs—to overcome barriers such as visa acquisition, funding for travel and lodging, and time away from school and/or work.7,8

Global Neurosurgery: the role of WFNS Foundation

The World Federation of Neurosurgical Societies (WFNS) is the largest neurosurgical organization gathering more than 49.000 neurosurgeons belonging to almost all existing neurosurgical societies worldwide, created in 1955 to promote neurosurgery camaraderie among neurosurgeons. In 90’s beginnings, the visionary leadership of professor “Pepe” Martin-Rodriguez and professor Madjid Samii made possible the creation of the WFNS Foundation; its mission can be defined as an improvement of neurosurgical care in developing countries (education, training and, intraoperative neurosurgical technology), with the vision to become the worldwide leader neurosurgical organization in the promotion of education and neurosurgical care in that countries. It is essential to mention the name of professor Armando Basso, who exemplarily created the modern and current Foundation structure that nowadays is helping thousands of patients and neurosurgeons.

The Executive Board governs the WFNS Foundation (seven persons, three of them being the President, Secretary, and Treasurer of WFNS). Also, it has the support of the Advisory Board, composed of a group of neurosurgeons who enthusiastically contribute to WFNS Foundation goals. A few years ago, a strategic plan was devised considering the Foundation’s activity based on three pillars: Education, the development of a network of training centers, and the provision of neurosurgical equipment to developing countries. Recent publications (1–6) have pointed out the current unmet needs in developing countries, hence the interest of WFNS Foundation to comply with the context and definition of Global Neurosurgery (“the clinical and public health practice of neurosurgery with the primary purpose of ensuring timely, safe, and affordable neurosurgical care to all who need it”).

Global Neurosurgery: The Unmet Need

Globally, the lack of access to basic surgical care causes 3 times as much deaths as HIV/AIDS, tuberculosis, and malaria combined. The magnitude of this unmet need has been described recently, and the numbers are startling. Major shifts in global health agenda have highlighted access to essential and emergency surgery as a high priority. A broad examination of the current global neurosurgical efforts to improve access has revealed some strengths, particularly in the realm of training; however, the demand grossly outstrips the supply; most people in low-income countries do not have access to basic surgical care, either due to lack of availability or affordability. Projects that help create a robust and resilient health system within low- and middle-income countries require urgent implementation. In this context, concurrent scale-up of human resources, investments in capacity building, local data collection, and analysis for accurate assessment are essential. In addition, through process of collaboration and consensus building within the neurosurgical community, a unified voice of neurosurgery is necessary to effectively advocate for all those who need neurosurgical care wherever, whenever.