Timing Matters: Optimizing Oncology Involvement in Pediatric Neuro-Oncology Pathways in Saudi Arabia.

Objective: To explore current practices and barriers in pediatric neuro-oncology care coordination, and to identify opportunities to optimize care pathways. Timely coordination between pediatric neurosurgery and oncology is critical for optimal outcomes in children with central nervous system (CNS) tumors. However, in many centers, pediatric oncologists are not involved until after surgery, which contributes to treatment delays and repeated procedures. Methods: A cross-sectional survey was conducted among neurosurgeons and pediatric oncologists in Saudi Arabia. The questionnaire addressed the timing of oncological involvement, neuroimaging practices, cerebrospinal fluid (CSF) cytology collection, and opinions on care coordination solutions. Results: A total of 62 responses were obtained. Only 29% of the participants reported presurgical oncology involvement in their typical practice, whereas 58% indicated that involvement occurred only after the final pathology results were obtained. Neuroimaging protocols varied: only 56.5% always performed dedicated CNS tumor magnetic resonance imaging (MRI) protocols before surgery, and spinal MRI was often delayed. CSF cytology practices were inconsistent, and major barriers included the lack of multidisciplinary tumor boards and the belief that oncology input before pathology is unnecessary. Over 88% of the respondents supported the use of presurgical tumor boards as a solution. Conclusion: There is substantial heterogeneity in pediatric neuro-oncology coordination practices. Efforts to promote early oncology consultations, standardized imaging protocols, and integrated care discussions may bridge critical gaps in care delivery.