DISP-08. Pediatric brain tumors in a global context: socioeconomic determinants, systemic disparities, and opportunities for neurosurgical collaboration and advancement

Abstract BACKGROUND Brain tumors are the most common solid malignancies in children, presenting with a dismal prognosis. Socioeconomic barriers, lack of public awareness and healthcare policy, and inconsistent resources exacerbate the global burden of pediatric brain tumors (PBTs). This review aims to inform the collaboration, innovation, and resource-sharing of neurosurgeons and researchers internationally with the goal of improving care for pediatric CNS tumors and beyond. Objective: Identify and analyze historical advancements, key obstacles to optimal care, and future directions in the treatment of PBTs in various global regions, especially in the context of socioeconomic, cultural, or infrastructural challenges, to inform future international efforts and partnerships. METHODS We reviewed literature published from the last 15 years regarding the epidemiology, guidelines, and trends surrounding the management, prognosis, and healthcare consequences of PBTs. 108 articles were identified through PRISMA guidelines. RESULTS Low and middle income countries demonstrate worse PBT outcomes due to various barriers to care, all of which can be traced back to the low availability of specialty neuro-oncology and pediatric oncology programs. Insufficient centralization of care leads to lack of multidisciplinary management teams which are equipped to create and employ standardized management guidelines, address perioperative adverse events, and monitor disease progression and treatment sequelae. Various initiatives have shown the benefits of increased technical training and multidisciplinary case reviews in a single-institution or twinning program setting. This leads to the formation of integrative guidelines for diagnosis, referral, risk-stratification, therapy, and follow-up. Such efforts demonstrate numerous training and specialty paradigms which can support the aim of offering reliable, equitable, and affordable medical care. CONCLUSIONS Mutually beneficial and longitudinal relationships within the international pediatric neurosurgery community are needed to improve the global outcome of PBTs. These initiatives can include sustainable pediatric neurosurgeon training, thorough tumor management protocols and documentation, and resource-efficient multidisciplinary practices.