Sustained neurosurgical decision support through remote multidisciplinary case conferencing: A six-year LMIC-HIC collaboration.

Introduction: Global disparities in neurosurgical care remain substantial in low- and middle-income countries (LMICs), where limited access to specialist expertise and supporting services can restrict timely treatment. Remote multidisciplinary case conferencing may provide specialist decision support using existing digital infrastructure, but longitudinal descriptions remain limited. Research question: Can a low-cost, clinician-led remote case-conference model provide sustained neurosurgical decision support in a resource-constrained setting? Methods: We conducted a descriptive implementation case study of a collaboration between Haukeland University Hospital, Bergen, and Teaching Hospital Jaffna, Sri Lanka, from September 2019 to December 2025. Routine meeting logs were reviewed for meeting activity, case-discussion volume, imaging review, participants, workflow, and decision-support functions. The model combined asynchronous review of imaging and clinical information with synchronous multidisciplinary videoconferencing; direct remote patient examination was not routine. Results: Across 150 meetings, 1258 case-discussion episodes were recorded, involving review of more than 2700 CT and MRI studies. Some patients were discussed more than once, and the number of unique patients could not be reliably reconstructed. Discussions addressed diagnostic clarification, operative and non-operative management, surgical prioritization, additional investigation, follow-up, and referral or escalation. The model used existing digital infrastructure and professional time without dedicated project funding. Final clinical responsibility remained with the Sri Lankan treating team. Conclusion: This cross-border model was maintained for more than six years and demonstrates the feasibility of longitudinal neurosurgical decision support in a resource-constrained setting. Effects on clinical outcomes, professional development, implementation sustainability, and local capacity require prospective evaluation.