Abstract

Background: Harvey Cushing and collaborators created the first society of neurosurgeons in 1920, in the United States of America, the Society of Neurological Surgeons. In 1955, the World Federation of Neurosurgical Societies (WFNS) was created in Switzerland to improve neurosurgical care globally through the scientific cooperation of members. The performance of neurosurgical associations today is fundamental to discuss diagnostic methods and therapeutic approaches, transforming modern medicine. Although most neurosurgical associations are recognized worldwide, there are some societies that are not recognized internationally due to a lack of regulatory bodies and lack of official digital channels, among other reasons. The main objective of the article is to list the neurosurgical societies and to provide a more integrated view of the interactions between neurosurgical societies in different countries.

Methods: We developed a table summarizing the countries recognized by the United Nations, the continents, capitals, name of the present societies, and social networks. We utilized “Country AND (Neurosurgery OR Neurological Surgery) AND (Society OR Association),” in English, and in the native language of the country. Our search included: PubMed, Scopus, Google, Google Scholar, and the WFNS website, without filters.

Results: We found 189 neurosurgery associations, from 131 countries and territories; 77 countries did not have their own neurosurgical societies.

Conclusion: There is a difference between the number of internationally recognized societies, and the number of societies found in this study. In the future, we should better organize neurosurgical societies in countries that have neurosurgical activity with those without such resources.

Keywords: Associations, List, Neurosurgery, Societies, Worldwide

INTRODUCTION

At the end of the 19^th century, Broca introduced medicine to the brain. In the 20^th century, Victor Horsely and later Harvey Cushing in 1920, created the Society of Neurological Surgeons in the United States of America.[ 6 , 14 ] The “First International Congress of Neurological Surgery” was held in July 1957 in Brussels.[ 9 ] In 1955, the World Federation of Neurosurgical Societies (WFNS) was created in Switzerland.[ 3 ] At present, there is a long list of neurosurgical societies that the WFNS comprises: the American Association of Neurological Surgeons (AANS), the Asian Australasian Society of Neurological Surgeons, the Continental Association of African Neurosurgical Societies, the European Association of Neurosurgical Societies, and the Latin American Federation of Neurosurgical Societies (FLANC), in addition to 119 other national neurosurgical societies, representing more than 49,000 neurosurgeons worldwide.[ 21 ] Here, our aim, utilizing PubMed, Scopus, and Google Scholar, was to list all as many of the present neurosurgical societies, we could identify worldwide, hoping this would foster more avenues of communication between these societies and neurosurgeons in countries without such organizations.

MATERIALS AND METHODS

There is a list of 197 countries recognized by the United Nations (UN). We listed these in alphabetical order, and searched in English the following databases regarding worldwide neurosurgical societies: PubMed, Google, Google Scholar, Scopus, and the WFNS website [ Flowchart 1 ]. Our search was carried out from October of 2021 to January 2022, using the following formula: “Country AND (Neurosurgery OR Neurological Surgery) AND (Society OR Association).” The second step was to use the main and secondary languages of the desired nations in Google with Google Translate to acquire the names of other neurosurgical societies and their electronic addresses [ Table 1 ].

Flowchart 1:

Sequential flowchart of the elaborated research methodology.

Table 1:

List of Neurosurgery Societies with their respective countries or regions and contacts (related website or social network).

RESULTS

We identified 189 neurosurgery societies, associations, or groups worldwide, related to 131 countries or regions. Some countries had more than one association of neurological surgery (i.e., United States, Spain, Germany, and great Britain, among others). Some countries have more than four neurosurgery societies (i.e., Germany and South Korea [four societies], Russia [five societies], Spain [eight societies], and the United States [11 societies]).

Other countries were grouped into larger regions represent different nations (i.e., the African continent with nine neurosurgical groups, or Europe). Of the 197 territories including 77 countries had no individual neurosurgery society (i.e., about 39%).[ 20 ]

DISCUSSION

In 2018, the world had about 49,940 neurosurgeons; in 2023, that number is expected to exceed 50,000. There are 189 neurosurgery societies, associations or groups around the world, involving 131 countries or regions.[ 15 ] The World Federation of Societies of Neurosurgery has 130 members as affiliates. There are also various societies on the African continent and in the United States of America.[ 21 ] There are about 60 neurosurgical associations that are not internationally recognized (i.e., not listed in WFNS portal). This is because some nations have few neurosurgeons, while others are grouped into larger regions (i.e., Europe, Africa, and Central America). Some were found in external links that were outdated (i.e., Neurosurgical Society of Uganda, Estonian Society of Neurologists and Neurosurgeons, and Cameroon Society of Neurosurgery). Other societies were difficult to trace due to their subspecialties (i.e., largely pediatrics, spinal, functional, oncological, and vascular neurosurgical societies).

Distribution of neurosurgeons worldwide

We observed that China, the with the largest population in the world, (i.e., 1.45 billion inhabitants: human development index [HDI] of 0.764), has about 11,000 neurosurgeons (i.e.), followed by India (i.e. 1.4 billion: HDI of 0.633), with approximately 1800 neurosurgeons.[ 4 , 11 , 17 , 22 ] The United States is in 3^rd place (i.e., population of 333 million, HDI of 0.921), with approximately 3500 neurosurgeons.[ 16 ] Notably, the goal of the American College of Surgeons and American Association of Neurological Surgeons is one neurosurgeon/100,000 inhabitants (i.e., also observing a disproportion for their distribution).[ 19 ]

Indonesia, the fourth most populous country in the world has 370 neurosurgeons for a population of 275 million, HDI 0.777,[ 8 ] followed by Pakistan, with 229 million inhabitants and about 100 to 300 neurosurgeons in the country, with an HDI of 0.544.[ 1 ] Nigeria has 216 million people and about 70 to 100 neurosurgeons, HDI of 0.535,[ 18 , 7 ] followed by Brazil, with a population of 214 million and approximately 4145 neurosurgeons, with an HDI of 0.754.[ 2 ]

Bangladesh has a population of 167 million, with 154 neurosurgeons, with an HDI of 0.661,[ 12 ] followed by Russia, with 145 million inhabitants and about 2487 neurosurgeons, with an HDI of 0.829.[ 13 ] Finally, the 10th most populous country in the world, Mexico, with 126 million inhabitants, has only about 1146 neurosurgeons, with an HDI of 0.758.[ 10 ] Of interest, the FLANC documented a ratio of 1.4 neurosurgeons for every 100,000 inhabitants. Interestingly, Japan, the 11^th most populous country (i.e., 124 million inhabitants), has about 7495 neurosurgeons (i.e., largest number in world; HDI of 0.925).[ 15 ] However, they specialize in other areas of clinical neuroscience, so fewer are practicing neurosurgery.

Higher development index correlates with more neurosurgeons

Based on an analysis of the ten most populous countries in the world, countries with a higher concentration of neurosurgeons tend to have higher HDI values. Alternatively, countries with lower HDI tend to have a smaller number of neurosurgeons. Therefore, it has been observed that there is a tendency in most countries that directly correlates a greater number of neurosurgical societies with the number of neurosurgeons. There is also a greater variety of subspecialized societies [ Table 1 ].

77 countries without official neurosurgical associations/ societies

There are 77 countries without official associations or neurosurgical societies; this includes: Guinea-Bissau, Guyana, Jamaica, Iceland, Monaco, the Vatican, and others [ Table 1 ]. The African and European continents bring together different countries that often lead to larger neurosurgical societies that are also influenced by socioeconomic conditions. Finally, some limitations of this article were the difficulty of finding countries that do not have a significant neurosurgical activity. There is also the hypothesis that some societies may be active, but it was not possible for them to be traced, because they are not listed in the research bases used, such as Google, Google Scholar, Scopus, and PubMed, as well related to the difficulty of translating the search terms in local languages.

CONCLUSION

There should be better global standardization and improved official communication between neurosurgical societies worldwide (i.e., websites or social networks). Certainly, the integration and interaction between the multiple neurosurgical societies are critical to the exchange of information between neurosurgeons performing approximately 13.8 million cases/year (i.e., with 80% being done in low/medium income countries). Thus, we cannot emphasize enough the importance of better educating neurosurgical colleagues across the globe as to how deliver better neurosurgical care.[ 5 ]

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Financial support and sponsorship

Publication of this article was made possible by the James I. and Carolyn R. Ausman Educational Foundation.

Conflicts of interest

There are no conflicts of interest.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.

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