Education-based Solutions to the Global Burden of Neurosurgical Disease.

OBJECTIVE: Low- and middle-income countries continue to suffer from a lack of access to basic neurosurgical care. The 2015 Lancet Commission on Global Surgery estimated essential surgical care was lacking to 5 billion people and that 143 million essential surgeries were not performed annually. A significant part of this need is neurosurgical care. Countries lacking basic neurosurgical services cannot have a true trauma system, or complete care for tumor, stroke, pain, and congenital defects in children. Episodic service missions from developed countries cannot fill these large gaps. To maximize the impact of global neurosurgery, the framework through which humanitarian neurosurgeons respond to international need should incorporate sustainable practices that empower the recipient population. METHODS: A historical and anecdotal review of global neurosurgery. RESULTS: The success of sustainable, locally championed neurosurgery educational programs will be dependent on the simultaneous, parallel development of anesthesia, critical care, nursing, and biomedical services. Each of these disciplines will reciprocally benefit from these neurosurgical programs. These programs cannot exist in a vacuum. They will require the thoughtful collaboration of all major neurosurgical societies with a humanitarian emphasis while championing the local surgeons in the area of need who must assume leadership to achieve a self-sustaining program. CONCLUSIONS: To meet the global need for neurosurgical care, self-sustaining neurosurgical programs must be locally developed in the countries of need. International support must be built on "Service through Education" rather the service alone.