About | Visual Neuro Atlas

About the Visual Neurosurgical Atlas

Just in neurosurgical care alone, there are nearly 13 million people who require care annually.

(Veerappan et al., 2024).

As such, there is tremendous demand for a unified understanding of surgical procedures and approaches that take into account resource availability and accessibility to care. Especially in low resource countries, there is an estimated deficit of 23,000 neurosurgeons given the burden of need (Veerappan et al., 2024). Since training is lengthy and sometimes not available in all geographical areas, student doctors and practicing physicians in high resource settings have begun initiatives to travel to low resource settings and share their surgical knowledge. While this is a wholly positive practice, issues arise when those from high resource settings arrive in lower income areas and realize that they do not have access to the same technologies that they may be used to. This can lead to disruption of education in the surgical setting—especially in neurosurgical procedures that rely on timely and accurate intervention.

Since there is such a discrepancy in the access to neurosurgical care between high resource and middle- and low-resource settings, some educational exchange programs have been initiated in an effort to strengthen global neurosurgical care (Hamzah et. al., 2024). Alongside this rise in collaboration comes an enormous need for education as well. With neurosurgical training varying greatly between countries, establishing physicians who are able to teach surgical practices that are pertinent to the country they are in is essential (Gupta et. al., 2024). Education that is accessible to high income and low income countries has the potential to bridge this gap, providing both parties with a solid understanding of what the interventions are in order to expand upon the surgical practices most effectively.

One such educational exchange program that exists is that between Barrow Neurological Institute (located in Phoenix, AZ) and Mount Kilimanjaro Christian Medical Center (KCMC, located in Moshi, Tanzania). Students, doctors, and other healthcare professionals from the Barrow Global program regularly travel to Tanzania to assist in "system strengthening" educational efforts.

Under the guidance of professional from both Barrow and KCMC for this project, the project began with an effort to define the most relevant surgical interventions to begin with. Careful consideration led to the selection of the highest burden neurosurgical conditions treated by those at KCMC in Moshi, Tanzania—with those conditions being found and detailed in the table below.

Traumatic Brain Injury Intervention

With traumatic brain injuries (TBI) being one of the most common neurosurgical emergencies that are addressed worldwide, it is unsurprising that the intervention varies greatly based on geographic region and resource availability. The intervention and incidence rate also varies tremendously based on the location and severity of the injury to the brain—with lower income countries having “brain injury rates three times higher than high income countries” (Dulf, et. al., 2021). As is analyzed in Tropeano et. al.’s 2019 review of TBI publications to instance ratio in different countries, there is an extremely disproportionate amount of information collected on TBIs in low-income countries, and a much higher incidence rate than that of high-income countries. Unfortunately, the best practice guidelines for timely treatment of TBIs is “not easily reproducible in resource-limited settings” calling for “international TBI guidelines [that] must be adapted to fit local contexts” (Righy, et. al., 2025). If the primary education and intervention being taught is by high income countries based on their population data, there are bound to be discrepancies in care that is possible and most suitable to lower income countries. As such, there must be training that is understood by both high- and low-income country educators, and taught in low resource settings for the most optimal outcomes.

Hydrocephalus Intervention

Hydrocephalus is a developmental defect characterized by an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain (Kantawala, 2023). This fluid accumulation pushes the surrounding brain tissue and skull during development, leading to issues with brain displacement and often enlarged cranium. In order to mitigate complications for the patient and their families, surgical intervention can be taken to place a drain in the ventricle. While the placement of drain is relatively standardized across the globe, the type of drain varies based on resource availability. The difference in drain design leads to different surgical practices for drain placement. Geographical settings where there is higher resource availability may opt for newer shunt technologies that involve endoscopic placement and sophisticated shunt systems (Stagno et. al., 2012). Conversely, in areas where there is much higher incidence of hydrocephalus involving shunt placement—such as “Central and East Africa, Latin America and India”—economic restrictions lead to reliance on more inexpensive and simple shunts—such as the Chhabra shunt system (Stagno et. al., 2012). Since there is a lesser rate of occurrence and wider access to advanced resources in more developed countries, it is no surprise that neurosurgical training in these areas is vastly different from the countries where incidence is higher and technology is restricted (Anele, et. al., 2022). As such, there is a remarkable need for an effort towards “enhancing financial support for neurosurgical education, regionalizing educational opportunities, and facilitating the exchange of expertise with high‐capacity centers...” related to hydrocephalus intervention in low-income countries (Kantawala, 2023).

Spina Bifida Intervention

One of the most disparate surgical interventions examined by my thesis relates to the technology surrounding spina bifida myelomeningocele—more broadly, neural tube defect (NTD)—intervention. NTDs are a class of developmental disorders characterized by a failure of the neural tube to close during early development (Mayaya et. al., 2025). This leads to significant developmental issues, with spina bifida being one that involves outcropping of spinal contents from their standard location (Mayaya et. al., 2025). Surgical intervention is critical in order to correct these malformations; however, the type of intervention varies tremendously based on resource availability. In more developed areas, new technologies enable doctors to preform in utero corrective surgery on these malformations (Sacco et al., 2019). While these interventions have good outcomes, they are incredibly restricted in where they can be preformed due to the risks to the mother and fetus, as well as the requirement for advanced technologies. In low resource settings, the primary intervention remains post-birth open myelomeningocele surgery. Given the high incidence rate of this condition and the sensitivity of the surgery, caregivers in countries with high occurrence rates need to be familiar with the surgical techniques that lead to the best postoperative outcomes (Pattisapu et. al., 2023). While the overall occurrence rate has the potential to be impacted by policy revisions around dietary folic acid fortification for women of childbearing age, there must also be a deeper understanding of the necessary surgical intervention if this initiative is not undertaken (Shlobin et. al., 2024).

If the student doctors are expected to participate in the system strengthening practice of sharing neurosurgical knowledge, it is critical that they are familiar with the ways that common surgical practices differ based on resource availability. If they are expected to teach interventions to those in low resource areas, they must have an accurate understanding of the differences in surgical intervention in the area where they are traveling to teach. As such, it was determined that the narrowed scope of this project would illustrate the most common interventions for these conditions as they are conducted in Tanzania.

About the Artist

My name is Samantha Mack. I am a scientific and medical illustrator based in Cleveland, Ohio.

I studied traditional science in school with the intention of going to medical school, but found a better path for myself at the Cleveland Institute of Art in the Life Science Illustration department. My education has helped teach me the formal skills needed to translate complex scientific information into digestible visual narratives. If you would like to view more of my work, please visit my portfolio at sammack.myportfolio.com.