Identifying Gaps in Bolivian Neurosurgery: A Systematic Review and Proposed Framework for Resource Implementation.

Neurosurgical systems in low- and middle-income countries (LMICs) often face challenges in infrastructure, technology, workforce, and continuity of care. Bolivia, an LMIC in South America, remains underrepresented in global neurosurgical research. Correspondingly, this study aimed to systematically review the neurosurgical literature of Bolivia to identify existing strengths, key gaps, and opportunities for targeted investment and technological implementation. A systematic review was conducted using PubMed, Scopus, and Embase to identify studies reporting original data on neurosurgical care in Bolivia. Data were extracted across the following domains: study design, patient population, surgical volume, institutional capacity, technology access, outcomes, and reported barriers or recommendations. Descriptive statistics and thematic synthesis were used to characterize trends and identify priority areas. Eleven studies met the inclusion criteria, with a heavy research focus on pediatric neurosurgery (98% of study population). Public institutions represented 47% of centers, and 56% of services were urban based. Standard procedures included trauma and hydrocephalus management. Major system gaps included a lack of advanced surgical technology (neuronavigation absent in 46%, microsurgery in 36%), limited imaging access (64%), and high loss to follow-up (21%). Reported barriers spanned infrastructure, workforce, infection control, and delays in referral. Recommendations emphasized imaging expansion, surgical training, telemedicine, and protocol standardization. Neurosurgical care in Bolivia is characterized by concentrated pediatric research, variable infrastructure, and fragmented systems. This review identifies key opportunities for capacity-building and targeted collaboration to strengthen neurosurgical care in Bolivia and similar LMICs.