Geographical neurosurgery

Disparities in manpower and facilities notwithstanding, neuroepidemiology m ight explain the observed differences in the mix of neurosurgical caseload in different parts of the world. The highest incidence rate of primary intr acranial tumor was in Europe and the lowest rate in Africa. Glioma was more common in the West, teratoma in Japan and the Far East and meningioma in A frica. The lowest rates of childhood brain tumors were in South America, Af rica and Asia. Stroke rates were very high in Finland and China. Blacks, Ja panese and Chinese had more intracranial vascular occlusive disease while w hites had more extracranial disease. Finland had a very high SAH incidence rate but the Middle East and Africa had low rates and a reversal of the ane urysm :AVM ratio. Highest incidence rates of neural tube defects occurred i n countries where consanguineous marriages are common. Brain abscess, tuber culoma and other granulomas from infestations were preponderant in developi ng countries. Head injuries accounted for up to 40% of all neurosurgical ad missions in some developing countries. Outside the USA and South Africa, ci vilian gunshot injuries were uncommon.