Cerebrovascular surgery training stands at a critical juncture, facing a dual challenge of profound global disparities and a fundamental paradigm shift from open microsurgical techniques to endovascular interventions. This review analyses the current global landscape of training programmes to identify gaps and propose strategic solutions. We synthesised data from recent global workforce mapping studies (2024), systematic reviews and fellowship outcome analyses across 192 countries. The dataset encompasses 1261 neurosurgery training programmes and 10,546 trainees worldwide, alongside specific case volume trends and equipment availability metrics. Analysis reveals a 20-fold disparity in neurosurgeon density between high-income countries (2.44 per 100,000) and low-income countries (0.12 per 100,000). While 91% of training programmes report endovascular exposure, only 26% of residents achieve core competency during residency, creating a critical skills gap. Over the past decade, open cerebrovascular case volumes have declined by 15%–20%, while endovascular procedures have risen by 25%–30%. Currently, there are only 12 active open cerebrovascular fellowships in the U. S., contrasted with a rapid 300% expansion in neuroendovascular fellowship programmes. The sustainability of comprehensive cerebrovascular care is threatened by widening global inequities and a training model that lags behind technological evolution. Urgent restructuring is required through the implementation of longitudinal dual-pathway curricula, widespread integration of simulation technology, expanded international fellowship collaborations and targeted infrastructure investment in low-resource settings.
Paspala et al. (Tue,) studied this question.