Neurosurgical practice remains highly dependent on the incomes of each country. [1] Some disparities have been already described about the neurosurgical workforce, with a various neurosurgeon’s density varying from 0.12 to 2.44 per 100,000 people respectively in low-income countries to high-income countries (HIC) [1]. This ratio mainly depends on the health care system, but the access to these neurosurgeons depends also on the geographical limitations. Even in the United States, a huge differences exists in neurosurgery access depending on the population density [2]. The American neurosurgeons are mostly in the major cities, and some people in low-density regions do not have the same access [2].

In resources-constrained regions, the lack of neurosurgeons is not the only reason of medical care disparities. The growing role of recent technologies in the operating room such as neuronavigation, optical microscope, or augmented-reality, may have increased these disparities [3], [4], [5].

A reduced number of neurosurgeons in a defined region leads to the decreasing of the subspecialization [3], [4], [5]. This might concern the rural regions of some HIC, or some countries with a low density of neurosurgeons. Then, these neurosurgeons are likely less subspecialized than surgeons practicing in tertiary centers since they must manage all types of neurosurgical pathologies [3], [4], [5].

The neurosurgery access seems to depend on the income of the countries, the geospatial distribution of the neurosurgical units, the funding of each unit, and likely the transport ways to access such units [3], [4], [5].

This predominance of new technologies aims to lower the potential complications, the invasive nature of the surgery, and often the duration of the hospital stay. Due to economic and politic considerations, some neurosurgical units lack these technologies. Due to geographical, historical reasons, some departments must manage all the patients presenting neurosurgical pathologies, with or without the capacity to transfer the patient in a center equipped with advanced surgical devices [6], [7], [8]. The aim of this work is to define what kind of pathologies may be effectively and safely managed in such units, with limited surgical technologies.