Molecular neuropathology practices and challenges in central nervous system tumor care across Saudi Arabia

The 2021 World Health Organization Classification of Tumors of the Central Nervous System (WHO CNS5) increasingly integrates molecular information into CNS tumor diagnosis, but the availability of molecular neuropathology services in Saudi Arabia is incompletely characterized. This cross-sectional online survey assessed respondent-reported practices, infrastructure, molecular testing, WHO CNS5 implementation, precision medicine, and development priorities among healthcare professionals involved in CNS tumor care across Saudi Arabia from 12 February to 31 May 2026. Among 131 respondents, histopathology/cytopathology services were reported by 98.5%, whereas molecular pathology/genetic services, neuro-oncology teams, and molecular neuropathologists were reported by 27.5%, 23.7%, and 13.0%, respectively. Among 48 pathology respondents, 14.6% reported routine integrated WHO CNS5 histological-molecular reporting, while 54.2% reported conditional implementation depending on test availability. Precision medicine was considered relevant by 95.8% but reported as implemented by only 16.7%. Respondents strongly supported further research, precision medicine, and streamlined referral pathways. These findings identify substantial respondent-reported gaps in molecular diagnostic capacity and WHO CNS5 implementation. Because convenience sampling was used and institution identifiers were not collected, the findings should not be interpreted as institution-level national prevalence estimates.