Recommendations of the EANS Global and Humanitarian Neurosurgery Committee for sustainable neurosurgical partnerships in low-resource settings.

Background: Despite growing interest in global neurosurgery, equitable access to neurosurgical care in low- and middle income countries (LMICs) remains limited. European-led collaborations have received little attention, and practical guidance for initiating and maintaining partnerships is lacking. Research question: This study aimed to develop a set of consensus recommendations to guide sustainable neurosurgical partnerships between European institutions and partners in LMICs. Material and methods: Following a prospective qualitative study involving 14 neurosurgeons- seven from European institutions and seven from LMIC partners, key factors for successful institutional partnerships were identified. Evidence was synthesized into an initial list of 31 recommendations. Following consensus discussions at the 2024 EANS Congress and additional expert validation, 22 final recommendations were established. Results: Recommendations were organized into three phases: initiation, development, and maintenance. Key elements for initiation include building mutual trust, avoiding paternalistic dynamics, engaging local institutions, and defining shared goals. Development-focused recommendations highlight the importance of context-adapted, in-person training, bidirectional knowledge exchange, and inclusive program design. Long-term maintenance emphasizes self-sufficiency, equipment sustainability, continuous communication, and equity. A structured rating process ensured that each recommendation achieved at least 70% consensus among experts. Implementation insights were included as a supplement. Discussion and conclusions: This study presents the first structured, evidence-based recommendations tailored explicitly to European-LMIC neurosurgical collaborations. Emphasizing equity, sustainability, and local ownership, these guidelines offer a framework for future partnerships and may be relevant across other global health disciplines. Future validation in real-world settings will help refine their applicability and broaden their impact.