CERG-04 ADULT NEUROONCOLOGY MANAGEMENT IN RESOURCE-LIMITED SETTINGS: A MULTICENTER SURGICAL REVIEW OF 220 CASES AND SYSTEMIC CHALLENGES

Abstract

Abstract Background and Aims Neuro-oncological care in low-resource environments is often hindered by limited diagnostic tools, delayed pathology, and poor access to adjuvant therapies. This multicenter retrospective review highlights our collective experience managing adult intracranial and spinal tumors across two established neurosurgical units in Zambia. Methods We reviewed all adult patients (≥18 years) who underwent surgery for cranial or spinal tumors between January 2021 and October 2024. Data were collected on demographics, tumor type and location, imaging modality used, access to histopathology, surgical outcomes, and challenges faced during care delivery. Results A total of 220 adult patients were operated on across the two institutions. The first center managed 100 cases, with the most common tumors being meningiomas (n = 50), glioblastomas (n = 13), astrocytoma (n = 7), and teratomas (n = 7). The second center contributed 120 cases, including 55 pituitary adenomas, 10 meningiomas, 30 gliomas, 15 spinal tumors, 5 posterior fossa tumors, 2 intraventricular tumors, 1 pineoblastoma, and 1 intrinsic pontine tumor. Approximately 54% of all patients underwent surgery based only on CT imaging due to limited MRI availability and high costs. Imaging wait times averaged 1-2 weeks, and histopathology reports were delayed by 1–3 months. Histological subclassification and timely initiation of adjuvant therapy were frequently compromised. Loss to follow-up was notable, especially among patients requiring radiotherapy or chemotherapy postoperatively. Conclusions Despite constrained resources, safe tumor resection is achievable across both centers. Meningiomas and gliomas were the most common pathologies. However, limitations in advanced imaging, histopathological subclassification, and access to adjuvant therapy hinder comprehensive neuro-oncology care. Investment in diagnostic infrastructure and patient tracking systems is vital to improving long-term outcomes in low-income settings.