LAUSR

BACKGROUND The need for neurosurgical care across the globe remains a public health issue. The creation of sustainable neurological surgery departments and training programs is indispensable in alleviating the burden of neurological disease in LMICs. METHODS We reviewed the history of the neurological surgery department and residency program of Santarém in the state of Pará, Brazil since 1999 to present day. We describe epidemiology unique to the region, and provide evidence of a sustainable practice in a LMIC. Challenges, limitations, and resources are explored. RESULTS We provide a historical vignette on 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 assess the neurological surgery burden and epidemiology unique to its region, with emphasis on community and indigenous health in this remote area. We explore future directions of this example impacting the international neurological surgery community. CONCLUSION A sustainable neurosurgery practice and training program is possible in a LMIC. Training neurosurgeons in developing regions of LMICs is a sustainable way to decrease morbidity and mortality of neurological diseases, as well as, prevent mis-distribution of physicians in a country. We encourage adaptation of sustainable neurological surgery practices in similar regions across the world in order to increase access to necessary neurosurgical care.