Infrastructural Barriers to Neurosurgical Care of Brain Tumors in Low- and Middle-Income Countries: A Systematic Review

BACKGROUND: Appropriate surgical infrastructure is important for improving patient outcomes. However, low- and middle-income countries (LMICs) often struggle to provide adequate brain tumor surgery due to fractured infrastructure. This study aims to identify and evaluate barriers to surgical care infrastructure for brain tumors in LMICs. METHODS: A comprehensive literature search was conducted from inception to October 20, 2022, using PubMed, Scopus, CINAHL, and Google Scholar. Inclusion criteria were studies that focused on surgical care of brain tumors in terms of infrastructure in low-resource settings. Studies were excluded if they did not focus on surgical care or were not conducted in LMIC. Data was extracted and analyzed qualitatively. RESULTS: A final analysis of 39 studies showed significant barriers: 66% had poor operating room infrastructure, 32% lacked specialized care centers and imaging facilities, 26% faced long-distance travel issues, 13% had poor public health infrastructure, and 11% had poor referral pathways and lacked advanced diagnostic facilities. Additionally, 3% had an uneven distribution of quality centers and inadequate ward capacity. Proposed strategies include cross- border collaboration (29%), optimizing existing resources (29%), improving referral pathways (7%), resource sharing within hospitals, and acquiring surgical devices through donations (7%). CONCLUSIONS: The review highlights key barriers in infrastructure while providing effective neurosurgical care to brain tumors in LMICs. To overcome these challenges, targeted strategies need to be implemented by stakeholders, policymakers, and health ministries.