Background: In low- and middle-income countries, resource limitations make the management of central nervous system (CNS) tumors challenging, particularly in Brazil, a country with major socioeconomic and health access disparities. We aimed to evaluate cancer-related neurosurgical procedures in the public health care system. Methods: Based on Brazilian’s public health system database (DATASUS), we collected data for neurosurgical procedures related to CNS tumors performed between January 2008 and November 2013. Information about number of procedures, costs, length of stay and number of inpatient deaths were analyzed for each State and then correlated to State specific population, gross domestic product (GDP) per capita and number of procedures. Results: 57,361 procedures were performed, the majority (45.9%) in the Southeast region. Total cost was $108,363,829.00; average cost per admission was $1,889.00. Average cost in each State, for a fixed number of procedures and population, tended to decrease as GDP per capita increased (OR -0.14; 95% CI -0.4 to -0.1; p=0.001). The mean length of hospital stay was 14.4 days, longer for patients treated at the North of the country (19.9 days). On multivariate analysis, number of procedures, GDP per capita, and population had an independent association with days of hospitalization. A total of 4,079 patients died, translating into an inpatient mortality rate of 7.11%, higher than expected based on US and European data. Northern States had the highest rates (12.76% for the region and 17.6% for the State with the highest mortality). Mortality rates decreased as number of procedures (p<0.001), GDP per capita (p<0.001) or State population increased (p<0.001). On multivariate analysis, only number of procedures (OR 0.93; 95% CI 0.91 to 0.96; p<0.001) and State population (OR 1.25; 95% CI 1.13 to 1.38; p<0.001) had an independent association with mortality. Conclusions: This is the first study to evaluate disparities in CNS tumor surgery in a middle income country, confirming that regional disparities exist and that clinical and economic outcomes correlate with income level, number of procedures and state population.