Global neurosurgery: a scoping review detailing the current state of international neurosurgical outreach

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  • 1 Duke University Division of Global Neurosurgery and Neurology;
  • 2 Duke University School of Medicine;
  • 3 Duke University Global Health Institute;
  • 4 Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina;
  • 5 Department of Neurological Surgery, University of Washington, Seattle, Washington;
  • 6 Keck School of Medicine of the University of Southern California, Los Angeles, California; and
  • 7 Paul L. Foster School of Medicine, El Paso, Texas
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OBJECTIVE

Global neurosurgery is a rapidly emerging field that aims to address the worldwide shortages in neurosurgical care. Many published outreach efforts and initiatives exist to address the global disparity in neurosurgical care; however, there is no centralized report detailing these efforts. This scoping review aims to characterize the field of global neurosurgery by identifying partnerships between high-income countries (HICs) and low- and/or middle-income countries (LMICs) that seek to increase neurosurgical capacity.

METHODS

A scoping review was conducted using the Arksey and O’Malley framework. A search was conducted in five electronic databases and the gray literature, defined as literature not published through traditional commercial or academic means, to identify studies describing global neurosurgery partnerships. Study selection and data extraction were performed by four independent reviewers, and any disagreements were settled by the team and ultimately the team lead.

RESULTS

The original database search produced 2221 articles, which was reduced to 183 final articles after applying inclusion and exclusion criteria. These final articles, along with 9 additional gray literature references, captured 169 unique global neurosurgery collaborations between HICs and LMICs. Of this total, 103 (61%) collaborations involved surgical intervention, while local training of medical personnel, research, and education were done in 48%, 38%, and 30% of efforts, respectively. Many of the collaborations (100 [59%]) are ongoing, and 93 (55%) of them resulted in an increase in capacity within the LMIC involved. The largest proportion of efforts began between 2005–2009 (28%) and 2010–2014 (17%). The most frequently involved HICs were the United States, Canada, and France, whereas the most frequently involved LMICs were Uganda, Tanzania, and Kenya.

CONCLUSIONS

This review provides a detailed overview of current global neurosurgery efforts, elucidates gaps in the existing literature, and identifies the LMICs that may benefit from further efforts to improve accessibility to essential neurosurgical care worldwide.

ABBREVIATIONS HIC = high-income country; LMICs = low- and/or middle-income countries.

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Contributor Notes

Correspondence Anthony T. Fuller: Duke University, Durham, NC. anthony.fuller@duke.edu.

INCLUDE WHEN CITING Published online May 8, 2020; DOI: 10.3171/2020.2.JNS192517.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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