Geographical neurosurgery.

Disparities in manpower and facilities notwithstanding, neuroepidemiology might explain the observed differences in the mix of neurosurgical caseload in different parts of the world. The highest incidence rate of primary intracranial 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 Africa. The lowest rates of childhood brain tumors were in South America, Africa and Asia. Stroke rates were very high in Finland and China. Blacks, Japanese and Chinese had more intracranial vascular occlusive disease while whites 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 aneurysm: AVM ratio. Highest incidence rates of neural tube defects occurred in countries where consanguineous marriages are common. Brain abscess, tuberculoma and other granulomas from infestations were preponderant in developing countries. Head injuries accounted for up to 40% of all neurosurgical admissions in some developing countries. Outside the USA and South Africa, civilian gunshot injuries were uncommon.