Neurosurgical management of paediatric central nervous system tumours in low, middle and high-income countries: a multi-centre, international, cross-sectional study.

Paediatric central nervous system (CNS) tumours remain a leading cause of cancer-related mortality worldwide. This may partly be because the distribution of vital diagnostic and therapeutic resources is highly uneven across the world. This study characterised paediatric neuro-oncology services across countries of differing economic and development statuses to identify potential sources of disparities in care. This web-based survey was completed by doctors managing CNS tumours at different healthcare facilities internationally. Questions covered participant demographics, institution type, institutional workforce, imaging, surgical, chemotherapy and radiotherapy availability, and multidisciplinary team (MDT) structures. Responses were categorised by World Bank income level, Human Development Index, and Sustainable Development Index. Chi-square and ANOVA tests were used. The participants were 139 clinicians from 122 healthcare facilities across 110 cities/towns in 49 countries: 29 were LMICs. Of 138 respondents reporting their role, 120 (87.0%) were neurosurgical consultants, with 90 (75.0%) being paediatric neurosurgery specialists. Centres in high-income countries were significantly more likely to have a dedicated paediatric neurosurgeon (97.1%, p < 0.001) and MDT services (93.9% vs. 40.0% in low-income settings, p < 0.001). Facilities in high income countries were more likely to have neurosurgical trainees (p = 0.001). Magnetic resonance imaging was readily available in most high-income centres but less so in low-income centres (p < 0.001); positron emission tomography was absent in all low-income settings (p < 0.001). Chemotherapy and radiotherapy availability declined with lower income (p = 0.007 and p = 0.005 respectively). Median one-year follow-up rates were highest in high-income countries (100%) and lowest in low-income settings (34%). These results underscore wide disparities in paediatric neuro-oncology resources, with limited specialist training, imaging technology, and oncology services in lower-income areas. Targeted programmes to bolster local neurosurgical fellowships, telemedicine-based MDT coordination, teleradiology, and sustainable funding for imaging and adjuvant therapies could collectively improve care and follow-up rates for children with CNS tumours globally.