Capacity building in pediatric surgical neuro-oncology: Assessment of clinical collaboration within limited resources in a low-middle-income country

Abstract

Objective: To analyze the impact of a visiting consultant pediatric neuro-oncologist on the outcome of pediatric patients with brain tumors in a health care system with no consultant pediatric neuro-oncologist.

Methodology: This retrospective study was conducted at the Punjab Institute of Neurosciences, Lahore, Pakistan, involving pediatric patients with brain tumors from January 2023 to January 2025. Patients were assessed by a visiting pediatric neuro-oncologist. These patients were followed for one year, and outcomes were observed.

Results: This study included 45 patients who were assessed by a visiting neuro-oncologist; 82.22% (37) underwent craniotomy and excision, and 8.89% (4) had a biopsy. In histopathology, the most common tumor was glioma, with 37.78% (17) of patients, and 24.44% (11) were referred for adjuvant therapy by the visiting neuro-oncologist. After a one-year follow-up, 13 patients were lost to follow-up (LTFU) during their treatment, with an overall LTFU rate of 28.89%. Of those with complete follow-up, 90.63% of patients were healthy without any new neurological deficits.

Conclusion: In countries with limited resources and few specialists, particularly pediatric neuro-oncologists, such a collaboration of shared care can impact the management and outcome of the patients without pouring more resources. However, LTFU remains a major challenge to assess complete disease courses and management outcomes in clinical practice.