Clinical Landscape and Perception of Surgical Neuro Oncology among Neurosurgical Resident Trainees of Pakistan: A Nationwide Analysis.

Objective: To assess the neurosurgical residents' perspectives on surgical neuro-oncology specialty training in Pakistan. Methodology: A nationwide survey-based observational study was conducted among neurosurgery residents registered with the accredited residency programs in Pakistan. A structured questionnaire assessing knowledge, training, mentorship, and institutional support in surgical neuro-oncology was disseminated via Google Forms (Google Inc., USA). Data collection took place from January to March, 2025 across both public and private sector training institutes. Responses were analyzed using Statistical Package for the Social Sciences, with categorical variables presented as frequencies and percentages and continuous variables as means with standard deviations. Results: A total five hudnred residents were targeted among whom one hundred residents responded, yielding a response rate of 20%. While 90% (90) rated their knowledge of brain and spinal tumors as good or excellent, only 67% (67) felt confident interpreting imaging studies. Notably, 33% (33) had received no formal training in surgical neuro-oncology. Exposure to spinal cord tumor surgeries was limited, with only 14% (14) having participated in such procedures. Mentorship and interdisciplinary collaboration were inadequate; only 20% (20) reported access to dedicated neuro-oncology mentors, and just 12% (12) rated interdepartmental collaboration as excellent. Resources were considered limited or insufficient by 69% (69) of respondents. Despite these challenges, 84% (84) supported the establishment of a dedicated neuro-oncology fellowship, and 67% (67) expressed definite interest in pursuing such training. Conclusion: This nationwide analysis highlights critical insights into the clinical exposure, training quality, and perceptions of neurosurgical residents in Pakistan regarding surgical neuro-oncology. While the majority of residents demonstrated enthusiasm and self-reported strong theoretical knowledge, substantial gaps were identified in hands-on experience, formal training, mentorship, and access to specialized resources, particularly in spinal neuro-oncology. Limited interdisciplinary collaboration and insufficient institutional support further hinder comprehensive skill development. National-level reforms are essential to align with global standards in neurooncological education and care.