Gaps In Neurosurgical Care Leave Northeast Critically Underserved: Experts

This is far below India’s national average of 1 neurosurgeon per million, and significantly lower than several Latin American low- and middle-income countries, which have close to 2 specialists per million. The region’s neurosurgical availability is only slightly better than that of Sub-Saharan Africa (0.1 per million), a stark comparison that highlights the urgent need for targeted investments and systemic strengthening.

Presenting a dismal picture of neurological care in the region, the team of neurosurgeons from Government hospitals has highlighted that the distribution of specialists is even more skewed than the overall numbers suggest. Of the 55 neurosurgeons currently practising, 37 are based in Guwahati alone.

Large parts of Arunachal Pradesh, Manipur, Nagaland and Tripura still function without a single full-time neurosurgeon. Mizoram, despite its improving medical infrastructure, continues to have no neurosurgeon at all.

Most other districts depend on visiting consultants, and during emergencies, patients are often forced to travel for hours — delays that can prove critical in conditions where every minute counts, said the authors in their correspondence titled, “Neurosurgical Disparities in Northeast India: Present Scenario and Necessary Steps Suggested to Build Sustainable Neurosurgery Centers,” published in the ‘Neurology India.’

Although the number of specialists has risen from 30 to 55 in the last six years, this increase has not matched the rising disease burden. Road traffic injuries, strokes, congenital disorders and late-presenting brain tumours have all grown in incidence, placing severe strain on the existing system, pointed out lead author and neurosurgeon Dr. Binoy Kumar Singh from Department of Neurosurgery, AIIMS, Raipur, Chhattisgarh.

A major cause of concern is the almost total absence of neurosurgical subspecialties across the region. No dedicated paediatric neurosurgeon is available, forcing children with congenital conditions or deformities to seek treatment outside the Northeast. Similarly, there are no dedicated neuro-oncology centres, even though cancer prevalence in the region remains comparatively high, pointed out neurosurgeon Dr. Amrit Kumar Saikia, Department of Neurosurgery, Jorhat Medical College, Jorhat, Assam.

Similarly, functional neurosurgery—including deep brain stimulation (DBS) for Parkinson’s disease—has not yet begun. Epilepsy surgery remains severely limited. Modern vascular neurosurgery is unavailable, and the region lacks endovascular specialists who are essential for managing aneurysms and acute strokes. Most complex cases are referred out of State, often delaying treatment when minutes matter most.

The experts noted that these gaps mirror trends in LMICs but emphasise that the Northeast’s geography makes the lack of subspecialties especially dangerous.

Infrastructure limitations remain a serious bottleneck. Only five hospitals—Guwahati Medical College Hospital, Assam Medical College Dibrugarh, NEIGRIHMS Shillong, Regional Institute of Medical Sciences Imphal and Jorhat Medical College—have advanced neurosurgical tools, including operating microscopes and neuronavigation systems.

Assam, despite having 13 medical colleges, has only three centres equipped for high-end neurosurgical procedures. Many institutions lack even basic neurosurgical facilities, meaning patients with emergencies such as traumatic brain injury or intracranial bleeds are stabilised and transferred, often losing critical time, said the neurosurgeons.

Another significant deficiency is the absence of dedicated neuro-intensive care units. Currently, neurosurgical patients are managed in general ICUs, which often lack the monitoring capabilities and specialised personnel required for brain and spine emergencies. Stroke care also remains fragmented. No dedicated stroke units exist, and thrombolysis is available only in parts of Guwahati, with door-to-needle times frequently exceeding recommended limits.

Countries like Brazil and Mexico—also in the LMIC bracket—have built successful regional stroke networks, offering a workable model. The Northeast has yet to take similar steps.

The neurosurgeons stressed that poor public awareness significantly worsens outcomes. In many rural areas, early warning signs of stroke, traumatic brain injury or tumour-related symptoms often go unrecognised. Doctors have recommended increasing public education efforts to help reduce delays in accessing care and inspire young students to consider neurosurgery as a career—addressing the long-term workforce gap.

While government schemes such as Ayushman Bharat have reduced financial barriers for many, access under the scheme remains limited to a few tertiary hospitals. Programmes like the National Rural Health Mission have improved maternal and child healthcare outcomes in the Northeast, but, said co-author Dr. Tamajyoti Ghosh, from Department of Neurosurgery, NEIGRIHMS, Shillong, Meghalaya, neurological disorders now require similar prioritisation.

A dedicated national programme targeting neurosurgical diseases—similar to existing programmes on cancer, dialysis or deafness—may be necessary.

Initiatives like PM-DevINE are expected to strengthen cancer care, but neurosurgical infrastructure still awaits comparable attention. Public–private partnerships, targeted fellowships, incentives for specialists to serve in underserved districts and long-term investment in neurocritical care are among the suggestions put forward.

The persistent gaps in neurosurgical services pose a serious and growing public-health concern for the Northeast. The combination of specialist shortages, infrastructural deficits, lack of subspecialties, weak stroke systems and low awareness creates a fragile ecosystem unable to meet the region’s rising neurological disease burden, said the other co-author Dr Bineta Singh, from Department of Pharmacology, JIET Medical College, Jodhpur, Rajasthan.