Assessing Global Neurosurgical Disease Burden Related To Climate Change: A Scoping Review

IntroductionClimate change is increasingly recognized as a significant threat to global health. Environmental exposures such as air pollution, temperature fluctuations, and extreme weather events may influence the presentation and outcomes of neurosurgical diseases. However, there is limited synthesis of the literature on this intersection. ObjectiveTo systematically map the global literature evaluating the relationship between planetary health and neurosurgical conditions, with a focus on exposure types, disease outcomes, and geographic and economic disparities in research output. MethodsWe conducted a scoping review following PRISMA-ScR guidelines. PubMed, Embase, and Scopus were searched from 1995 to 2024 for English-language, full-text studies reporting primary data on environmental exposures and neurosurgical disease. Studies were categorized by exposure type, outcome, study design, WHO region, and World Bank income classification. ResultsOf 15,658 records screened, 203 studies met inclusion criteria. Most were retrospective (24%, n = 49), prospective (17%, n = 34), or time series analyses (15%, n = 30). Studies originated primarily from high-income countries (62%, n = 126), with fewer from upper-middle-income (31%, n = 63), lower-middle-income (1%, n = 3), and low-income countries (<1%, n = 1). Western Pacific (40%, n = 81) and European (29%, n = 59) regions dominated the research. The most studied exposures were neurotoxic pollutants (30%, n = 61), PM2.5 (28%, n = 57), and temperature fluctuations (10%, n = 21). Ischemic stroke (31%, n = 63) and hemorrhagic stroke (29%, n = 58) were the most common outcomes, with notable links to PM2.5 and heat exposure. Pediatric diseases, epilepsy, and neuroinfectious conditions were underrepresented, as was research on surgical environmental impact. ConclusionThere is increasing evidence linking environmental exposures to neurosurgical disease, particularly stroke. However, global disparities in research persist. Expanding research capacity and integrating planetary health principles into neurosurgery are essential for addressing emerging challenges in neurological health worldwide.