The Boston Declaration 2025: Plan and Pledges for Progress in Global Neurosurgery.

Global neurosurgery has been described as the clinical and public health practice of neurosurgery with the primary purpose of ensuring timely, safe, and affordable neurosurgical care to all who need it. Global neurosurgery activities in the form of mission trips, educational partnerships, and research collaborations have been in place for decades. Still, there have been no central organizing efforts to improve the harmonization of these endeavors until recently. The 2016 Bogotà Declaration on Global Neurosurgery was the first meeting of global neurosurgery practitioners from low- and middle-income countries (LMICs) and high-income countries (HICs) to organize a consensus statement around the global gaps in neurosurgery care and goals for its future development. Since then, interest in global neurosurgery has grown dramatically among neurosurgeons, trainees, nurses, and allied professionals. Global neurosurgery has emerged as a distinct academic subspecialty within neurosurgery. However, recent evidence demonstrates that wide gaps remain in access to safe, timely, and affordable neurosurgical care. Quite as important is the current dominance of global neurosurgery discourse by HIC actors. The Boston Declaration seeks to further define a unified vision of progress as global neurosurgery continues to grow and evolve. This ambitious initiative will review existing evidence, employ on-the-ground expert experience, and seek broad inclusivity and transparency to formulate a new set of goals for global neurosurgery and a structure that shifts the agency to LMIC actors. We propose a path to developing a new consensus statement and action plan, the 2025 Boston Declaration for Global Neurosurgery.