• Nicole A Silva, Herison Harrider Silva Vaz, Adriele Feitosa Ribeiro, Harsh Sule, Ziad C Sifri, Anil Nanda, and Erik Leonardo Jennings Simões.
• Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Office of Global Health, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
• World Neurosurg. 2019 Oct 1; 130: 192-200.

BackgroundThe need for neurosurgical care across the globe remains a public health issue. The creation of sustainable neurological surgery departments and training programs will be indispensable in alleviating the burden of neurological disease in low to middle income countries (LMICs).MethodsWe reviewed the history of the neurological surgery department and residency program of Santarém in the state of Pará, Brazil, from 1999 to the present. We have described the epidemiology unique to the region and provided evidence of a sustainable practice in a LMIC. The challenges, limitations, and resources were explored.ResultsWe have provided a historical vignette of the evolution of neurological surgery in the Brazilian Amazon, including the creation of a sustainable neurological surgery practice and accredited residency program. In addition, we assessed the neurological surgery burden and epidemiology unique to the region, with an emphasis on the community and indigenous health in this remote area. We also explored the future directions of this example, which could affect the international neurological surgery community.ConclusionA sustainable neurosurgery practice and training program is possible in a LMIC. Training neurosurgeons in developing regions of LMICs is a sustainable method to decrease the morbidity and mortality of neurological diseases and prevent the misdistribution of physicians in a country. We encourage adaptation of sustainable neurological surgery practices in similar regions across the world to increase access to necessary neurosurgical care.Copyright © 2019 Elsevier Inc. All rights reserved.

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