Characterizing the unmet need for pediatric neurosurgical care.

Background: Specialized pediatric neurosurgical care is often limited or absent in resource-limited countries. This study aims to characterize the unmet need for pediatric neurosurgery by characterizing the burden and outcomes of pediatric neurosurgical disease in children at a high-volume surgical center in Pakistan. Methods: We conducted a retrospective chart review of all pediatric patients admitted for any indication requiring a neurosurgical consultation between 2010 and 2021 at a tertiary care hospital in Karachi, Pakistan. We described the scope and volume of neurosurgical procedures performed, key surgical quality metrics, and the overall outcomes of select pediatric neurosurgical cases. Results: A total of 3,100 patients met criteria, with a male preponderance (n = 2,070, 66.8%). Patients were broadly classified as having neurotrauma (n = 1377, 44%), congenital anomalies (n = 1256, 41%), or central nervous system (CNS) tumors (n = 467, 15%). The most common procedures performed were craniotomies (n = 97, 64.7%), tumor removal (n = 62, 41.3%), ventriculoperitoneal shunt placement (n = 21, 14%), and laminectomies (n = 5, 0.03%). Importantly, there were no cases of kyphoscoliosis, craniosynostosis, or epilepsy surgery in our patient cohort. The outcomes of 268 (19.5%) surgical cases of neurotrauma and 424 (90.8%) congenital anomalies were evaluated further, with high 30-day mortality observed (4.8% and 4.3%, respectively). Conclusion: The scope of pediatric neurosurgical care is limited at our urban healthcare setting in Pakistan, with a limited variety of procedures and poor key quality indicators such as length of stay and operative blood loss. These findings may suggest that training and capacity building to develop specialized pediatric neurosurgical care may address these critical gaps in care provision.