2026 Poster Presentations
P160: SKULL BASE NEUROSURGERY IN LOW-RESOURCE SETTINGS: AN INTERNATIONAL SURVEY TO DEFINE CURRENT CAPACITIES AND CHALLENGES
Syed M Adil1; Claire Karekezi2; Eugene Cho1; Joshua Woo1; Jihad Abdelgadir3; Tanner J Zachem1; Edgar Carrasco4; Ernest Bathélemy5; Andrew F Alalade6; Amos Adeleye7; Syed A Enam8; Traiq K Hashim9; Ali Zomorodi1; Michael M Haglund1; Lucas R Lima10; Daniel Prevedello11; Alvan Ukachukwu1; 1Duke University; 2University of Rwanda; 3University of Utah; 4Caja de Salud de la Banca Privada; 5SUNY Downstate Health Sciences; 6Lancashire Teaching Hospitals NHS Foundation Trust; 7University of Ibadan; 8Aga Khan University; 9North West General Hospital and Research; 10Hospitais Biocor; 11The Ohio State University
Introduction: Skull base pathologies pose a significant unmet burden to patients and health systems in low- and low-middle-income countries (LLMICs) due to the necessity of specialized training, long operative times, significant operating room resources, and diligent perioperative care–all of which are scarce. Nonetheless, some LLMIC neurosurgeons are growing skull base surgery practices, with only limited data available on this experience. An international webinar on this topic hosted through the WFNS drew 109 participants across 5 continents, with a strong interest in deepening analyses.
Objective: We aim to define the current skull base neurosurgery capacity and challenges in LLMICs across the globe.
Methods: This is a digital survey disseminated amongst LLMIC skull base neurosurgeons, focusing on four key areas. Preoperative factors include disease incidence, diagnostic and therapeutic efficiency, and pathology severity. Intraoperative factors include case volumes, use of key surgical tools, and availability of collaborating subspecialists (e.g., ENT). Postoperative factors include ICU availability, rate of follow-up, and surgical outcomes. Finally, systemic factors include rates of international referrals, surgeon training/confidence, use of radiotherapy and or other adjuvants, and barriers to skull base surgical expansion.
Results: Thus far, 70 neurosurgeons across 3 continents and 30 countries have completed the survey. The mean age of respondents was 48 years old, and 87% were male, with 70% working in public hospitals. The mean number of years in practice was 11, and 28% had completed fellowship-level training in skull-base surgery. Across all countries, the median number of fellowship-trained surgeons was estimated at 2.5 with a median case volume of 3 skull base cases per month. Regarding capacity, 51% and 17% of respondents said there were “definitely not” or “probably not” enough surgeons to meet skull base patients’ needs, respectively. Collaboration with ENT was done “rarely” or “never” for 42% of respondents. Severity of patient presentation was rated a median score of 71/100. Mean rates of availability for a microscope were 72% versus 53% for endoscopes, 34% for navigation, and 22% for neuromonitoring. Mean self-reported rates of achieving surgical goals and complications were 68% and 28%, respectively. The mean rates of availability for post-op ICU care and radiation were 60% and 43%, respectively. Looking to the future, 70% said skull base surgery was either a strong priority or one of the highest priorities for growth. The most common barriers to growth were technical skill for support staff and physical resources, though lack of mentorship from / collaboration with high-income countries was also important.
Conclusion: Skull base neurosurgery is resource-intensive but growing in LLMICs. By not only extending survival but also improving quality of life and reducing disability, it may serve as a “high cost, high reward” investment. By understanding local surgeons’ current capacities and challenges, this study lays the foundation for future targeted interventions to expand skull base neurosurgery care in LLMICs.