Postoperative Complications in Pediatric Brain Tumor Surgery in Latin America: A Systematic Review and Meta-Analysis

Abstract

Introduction

Pediatric brain tumors are one of the most common causes of cancer-related death in children. Surgical resection is the primary treatment of choice; however, postoperative complications can impact outcomes, particularly in low- and middle-income countries. The current systematic review and meta-analysis estimated the burden and evaluated the risk factors related to the postoperative complications of pediatric brain tumor surgery in Latin America, and compared the outcomes to those of European cohorts.

Materials and Methods

Following the 2020 Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (PROSPERO ID: CRD420251124110), we conducted searches on the PubMed, Scopus, Web of Science, Embase, SciELO, and LILACS databases for studies published f from inception until June 30, 2025 on the postoperative complications of patients aged ≤ 18 years undergoing brain tumor resection in Latin America. The studies included had to have a sample size ≥ 30 individuals and report at least one of the following outcomes: surgical site infection, hemorrhage, new neurological deficit, or mortality. The secondary outcomes included altered sodium levels after surgery. Pooled data were analyzed using DerSimonian-Laird random-effects models, and indirect comparisons were made with contemporary studies from Europe and the United States.

Results

A total of 26 studies (from 10 countries and including 3,472 patients) met the inclusion criteria, and 21 were included in the current meta-analysis. The pooled complication rates were as follows: infection – 12.8% (95%CI: 10.1–15.7%); hemorrhage – 6.4% (95%CI:4.5–8.6%); neurological deficits – 18.5% 95%CI: 14.7–22.6%; and 30-day mortality – 4.2% (95%CI: 2.8–5.8%). Alterations in sodium levels were noted in 7.6% (95%CI: 5.0–10.5%) due to hyponatremia, and in 4.3% (95%CI: 2.5–6.5%) due hypernatremia, often in the context of posterior fossa and suprasellar tumors. Regarding regional benchmarks, the lowest complication rates in Latin America were found in Uruguay, and the highest, in Bolivia, Venezuela, and Honduras (risk ratio [RR] of up to 2.25). The risk factors included: age < 3 years, tumor size > 5cm, operative time > 5 hours, and limited access to pediatric intensive care in countries with few specialized pediatric surgical centers.

Conclusion

The postoperative infection and mortality rates following pediatric brain tumor surgery are significantly higher in Latin America than in Europe and the United States; this reflects disparities in the perioperative infrastructure and in the ability to deliver specialized care. Strengthen infection control, facilitate access to pediatric intensive care, and the standardization of sodium monitoring protocols should be priorities to improve the outcomes.

Keywords

pediatric - brain tumors - postoperative complications - neurosurgery

Introduction

Pediatric brain tumors are a significant global health concern, accounting for the most common solid tumors of childhood and the second leading cause of cancer-related deaths among children.[1] Despite advances in neuroimaging, neurosurgical techniques, anesthetic management, and perioperative care, which have improved outcomes in recent decades in high-income countries, those gains have not been uniform. Many children in low- and middle-income countries (LMICs) remain vulnerable to poorly-timed diagnoses, low access to problem-based care, and greater rates of complications.[2] [3] [4]

Surgical resection is usually the primary treatment of choice for most pediatric brain tumors, aiming at maximal safe tumor resection while preserving neurological function.[5] But complications in the postoperative period (such as neurological deficits, infections, cerebrospinal fluid [CSF] abnormalities, and hemodynamic instability) remain commonplace, and they can have a serious impact on prognosis, length of hospital stay, and functional outcomes upon discharge.[6] [7] The impact of these complications is notably higher in resource-limited situations, in which the recommendations (multidisciplinary team: pediatric neuro-oncologists and neurosurgeons, anesthesiologists, intensivists, specialized nurses etc.), intraoperative neurophysiological monitoring (IONM), and access to pediatric intensive care cannot be entirely (or sometimes are only partially) fulfilled.[3] [8]

Pediatric neurosurgical care in Latin America is subjected to structural and systemic challenges,[4] [9] which can manifest as prolonged diagnostic intervals and delays in referral to pediatric oncology care, the low number of centers equipped to perform complex surgeries, such as pediatric neuro-oncological procedures, as well as a lack of access to IONM and inconsistent levels of postoperative intensive care. These four considerations indicate a context in which children have an increased risk of morbidity after surgery.[9] [10] Other challenges arise from unequal training, unequal access to acquiring technology and research infrastructure; thus, the lack of robust region-specific evidence on clinical practice.[11] [12] Although some single-center studies that describe local experiences have been conducted, there is still a lack of comprehensive, regionally-pooled data to assess patterns of interest and to inform regional policy through the aggregation of evidence.

By knowing the incidence, type, and predictors of postoperative complications in this population, it becomes possible to guide potential evidence-based perioperative protocols, to strengthen health system planning, and to find ways to reduce disparities in pediatric neurosurgery. Therefore, the present systematic review and meta-analysis provides current data from Latin America on postoperative complications after pediatric brain tumor surgery, with the objectives of estimating the burden of complications and exploring the risk factors and indications for system-level changes in Latin America. We hypothesized that the postoperative complication rates would be higher in Latin America than in high-income regions, due to disparities in perioperative infrastructure and access to specialized care.

Materials and Methods

Study Design and Registration

We conducted a systematic review and meta-analysis according to guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement ([Fig. 1]). The study protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD420251124110).[13] [14]

Fig. 1 2020 guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Eligibility Criteria

We included observational studies (cohort studies [prospective and retrospective], case-control studies, and cross-sectional studies) and clinical trials reporting postoperative complications among pediatric patients (aged < 18 years) who underwent surgical resection for brain tumors in Latin America. The studies included were required to provide postoperative complications rates, mortality or functioning outcomes, and include sufficient detail to extract or calculate an effect estimate. Studies that focused solely on the adult population, non-surgical management, or extracranial tumors were excluded.

Information Sources and Search Strategy

We performed a systematic search on the MEDLINE (via PubMed), Embase, Scopus, Web of Science, SciELO, and LILACS for articles published from inception until June 30, 2025; and we used a combination of controlled vocabulary (MeSH, Emtree) and free-text terms (such as pediatric, brain tumor, and postoperative complications). No language restrictions were applied. The grey literature was searched using the ProQuest Dissertations and Theses database, conference abstracts, and through a review of the reference lists of key articles.

Study Selection

Two reviewers independently screened the titles and abstracts and then performed a full-text assessment. Disagreements were solved through consensus, or through the identification of a third reviewer for consultation. Studies were excluded during the full-text assessment if they did not meet the eligibility criteria or if we were not able to disaggregate data for the pediatric population.

Data Extraction

Data were independently extracted by two reviewers using a prepiloted data extraction form on the following:

• Study characteristics: year, country, study design, sample size, recruitment period, and setting (such as tertiary care center, regional hospital etc.).

• Patient characteristics: age, sex, tumor type and location, and comorbidities.

• Surgical characteristics: surgical approach, extent of resection, and intraoperative monitoring.

• Postoperative outcomes: total complication rate, type of complication (such as neurological, infectious, hemorrhagic, metabolic etc.); length of hospital stay, reoperation, mortality, and functional status (assessed through the modified Rankin Scale and the Pediatric Cerebral Performance Category, for example).

Risk of Bias Assessment

We used the Newcastle–Ottawa Scale (NOS) for observational studies, and the Cochrane Risk of Bias 2 (RoB 2, The Cochrane Collaboration) tool for randomized trials to evaluate the methodological quality. Each study was assessed independently by two reviewers, with all disputes resolved by consensus.[15] [16] For observational studies, quality was graded as high (NOS score ≥ 7), moderate (NOS score: 5–6), or low (NOS score < 5). Sensitivity analyses were performed excluding studies rated as low quality.

Statistical Evaluation

For postoperative complications, we pooled prevalence rates through the random-effects model (DerSimonian–Laird) with 95%CIs. Heterogeneity was quantified by the I² statistics and interpreted according to Cochrane values. Subgroup analyses were performed for differences regarding tumor type, surgical approach, and income based on country classification. Publication bias was assessed with funnel plots and the Egger's regression test. All statistical analyses were performed in the R (R Foundation for Statistical Computing) software, version 4.3.1, with the meta and metafor packages.[17] [18] [19] [20]

We assessed the certainty of the evidence for each pooled outcome (infection, hemorrhage, neurological deficits, mortality, and alterations in sodium levels) using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, considering risk of bias, inconsistency, indirectness, imprecision, and publication bias. The evidence was categorized as high, moderate, low, or very low certainty.

Results

Study Selection and Characteristics

Our initial search yielded 1,509 records, and after removing 312 duplicates, we screened the titles and abstracts of 1,197 records. We assessed 112 full-text articles for eligibility. Of these, 26 studies were included, representing 3,472 pediatric patients across 12 Latin-American countries ([Table 1]). The PRISMA flow diagram is shown in [Fig. 1]. The studies included were published between 2000 and 2024: most were retrospective cohorts (n = 20), and a minority (n = 6), prospective studies. The sample sizes ranged from 34 to 482 patients, and follow-up, from 30 days to 5 years.

Table 1 Characteristics of pediatric brain tumor surgery according to Latin American country

Country	Type of health system	High-complexity centers (n)	Surgeries in high-complexity centers (%)	Reported complication rate (%)
Argentina	Public and private	5–7	60–70	12–18
Brazil	Public and private	> 10	65–75	10–15
Mexico	Public and private	6–8	55–65	15–20
Chile	Public and private	4–6	70–80	9–12
Colombia	Public and private	4–5	50–60	14–18
Peru	Public and private	4–6	50–65	13–17
Uruguay	Public and private	2–3	80–90	8–12
Venezuela	Public and private	3–5	45–55	18–22
Paraguay	Public and private	2–4	50–60	14–18
Ecuador	Public and private	3–5	60–70	12–16
Bolivia	Public and private	1–2	30–40	20–25
Honduras	Public and private	1–3	35–45	18–22

Characteristics of the Patients and Tumors

The median age at surgery was of 9. (range: 0.2–18) years, with a slight male predominance (54%). Tumor location was predominantly infratentorial (58%), followed by supratentorial hemispheric (26%), in the suprasellar/optic pathway (9%), and in the brainstem (7%). The most common histological subtypes were medulloblastoma (28%), pilocytic astrocytoma (22%), and ependymoma (18%), followed by craniopharyngioma (10%), diffuse midline glioma (8%), and other rare entities (14%).

The surgical approach and the extent of resection varied substantially according to tumor type and location. Cerebellar and hemispheric tumors typically underwent resection with an attempt at gross total removal, which was achieved in approximately 60% of cases. In contrast, brainstem tumors and optic pathway gliomas were primarily managed with biopsy or subtotal resection due to safety considerations. These differences in surgical strategies likely influenced the operative time, the perioperative risk, and the incidence of postoperative complications.[21]

Primary Postoperative Complications

The pooled incidence of surgical site infections was of 12.8% (95%CI: 10.1–15.7%; I² = 68%); the incidence demonstrated significant heterogeneity among studies, with the highest incidence rates reported in multicenter studies and in settings without dedicated pediatric intensive care units (PICUs).[4] [9] [22] [23] The incidence of postoperative hemorrhage was of 6.4% (95%CI: 4.5–8.6%; I² = 44%); this was more frequent in patients undergoing surgery for infratentorial tumors (risk ratio [RR]: 1.8). New neurological deficits were encountered in 18.5% of the patients (95%CI: 14.7–22.6%; I² = 72%); the incidence was significantly greater regarding tumors adjacent to the brainstem and cases managed without IONM (RR: 1.9).[10] [24] In terms of regional benchmarks, the lowest complication rates in Latin America were found in Uruguay, and the highest, in Bolivia, Venezuela, and Honduras (RR of up to 2.25) ([Table 2]). The 30-day postoperative mortality rate was of 4.2% (95%CI: 2.8–5.8%; I² = 39%); the incidence of mortality was significantly greater in centers that did not routinely manage postoperative patients in the intensive care unit (RR: 2.7).[4] [22] [23]

Table 2 Difference between the relative risk (RR) and absolute risk regarding surgical complications using Uruguay as a reference

Country	Average complication rate (%)	RR versus Uruguay	AR versus Uruguay (%)
Uruguay	10.0	1.00	0.0
Chile	10.5	1.05	+0.5
Brazil	12.5	1.25	+2.5
Ecuador	14.0	1.40	+4.0
Argentina	15.0	1.50	+5.0
Peru	15.0	1.50	+5.0
Colombia	16.0	1.60	+6.0
Paraguay	16.0	1.60	+6.0
Mexico	17.5	1.75	+7.5
Venezuela	20.0	2.00	+10.0
Honduras	20.0	2.00	+10.0
Bolivia	22.5	2.25	+12.5

Notes: The data for Chile is almost identical to those for Uruguay (only 5% higher relative risk). Brazil and Ecuador show a 25 to 40% higher relative risk. Mexico, Venezuela, Honduras, and Bolivia carry the highest burden, with 1.7 to 2.25 times the risk of complications compared to Uruguay, and absolute differences pf up to +12.5%.

Risk Factors for Complications

Five factors were identified, each correlating to an increase in complications after surgery. These included age < 3 years, tumor size > 5 cm, tumor location in the posterior fossa, operative time > 5 hours, and limited access to specialized neurosurgical centers ([Table 3]).[10]

Table 3 Risk factors for postoperative complications and postoperative sodium alterations in pediatric brain tumor patients

Risk factor	Description
Age < 3 years	Higher risk of severe complications
Large tumor size (> 5 cm)	Greater risk of hemorrhage and deficits
Prolonged operative time (> 5 hours)	Increased infection and complications
Posterior fossa location	The complex anatomy increases the risk
Limited healthcare access	Limited access to specialized centers
Sodium imbalance	Common associated complications
Hyponatremia	Inadequate secretion of antidiuretic hormone, excessive fluid therapy, cerebral edema, seizures, and neurological decline; percentage: 7.6
Hypernatremia	Fluid loss, renal insufficiency, intracranial hemorrhage, confusion, and renal injury; percentage: 4.3
Severe hyponatremia	Syndrome of inappropriate antidiuretic hormone secretion, use of diuretics, coma, and multiorgan dysfunction; percentage: 2

Secondary Outcomes: Alterations in Sodium Levels

The rate of patients with hyponatremia was of 7.6% (95%CI: 5.0–10.5%; I²= 55%), and these cases were almost all transient, mainly in posterior fossa and suprasellar surgeries. Hypernatremia was reported in 4.3% (95%CI: 2.5–6.5%; I²= 32%). Several studies[25] [26] [27] [28] attributed this sodium imbalance to longer lengths of hospital stay and poorer neurological recovery, demonstrating the need for standardized protocols for monitoring ([Table 3]).

Comparative Assessment with Cohorts from Europe

An indirect comparison with contemporary pediatric neurosurgical series from Europe demonstrated significantly-higher incidences of infection (12.8% versus 6.4% respectively; RR: 2.0) and mortality (4.2% versus 1.9% respectively; RR 2.2) than in Latin America, while hemorrhage and neurological deficits were similar between regions ([Table 4]).[29] [30] [31]

Table 4 Comparison of postoperative complication rates in Latin America and Europe

Complication	Latin America (% range)	Europe (% range)	Risk factors/comments
Surgical site infection	12.8–21.4	5–7.5	Hygiene, antibiotic protocols
Postoperative hemorrhage	5–8.7	2–4.5	Large tumors, prolonged surgery
Neurological deficits	14.8–18.5	5–10.2	Tumor location, surgical extent
Motor deficits	8–18	5–12	Surgery near motor areas
Speech disorders	5–10	2–6	Tumors near language centers
Postoperative mortality	2–4.2	1–1.9	Age, comorbidities

Comparative Assessment with Cohorts from the United States

When compared with United States cohorts, the complication rates in Latin America were consistently higher. Data from the American College of Surgeons National Surgical Quality Improvement Program-Pediatrics (NSQIP-Peds) registry (2012–2014) report 30-day mortality for pediatric neurosurgical procedures between 0.1 and 1.2%, with a composite morbidity ranging from 10.2 to 38.8%, depending on the type of procedure.[32] In a large single-center series from the United States,[33] 30-day mortality was of 1.26%, and long-term neurological deficits were only observed in 8.4% of the cases. In contrast, our pooled analysis in Latin America documents mortality rates of up to 4.2% and neurological deficits of up to 18.5%, nearly doubling the United States figures and underscoring the structural and resource disparities between high- and middle-income regions ([Table 4]).

Publication Bias and Sensitivity Analysis

The asymmetry of the funnel plots suggested a publication bias for the outcomes of infection (Egger's test p = 0.04). Sensitivity analysis excluding studies of low quality did not lead to materially-different estimates of pooled outcomes.[19] After the exclusion of low-quality studies (NOS score < 5; n = 3), the pooled estimates remained largely unchanged (infection: 12.2% versus 12.8%; mortality: 3.9% versus 4.2%), supporting the robustness of the findings.

Discussion

The current systematic review and meta-analysis provides an important overview of the burden and determinants of postoperative complications after neurosurgery for pediatric brain tumors in Latin America, which uncovered a significant disparity of burden regarding high-income countries. Nevertheless, postoperative complications (such as neurological deficits, infection, CSF disorders, and hemodynamic instability) occur frequently and may have meaningful impacts on prognosis, length of hospital stay, and quality of life of the patients.[6] [7]

Our pooled estimates demonstrate that the rates of surgical site infection and mortality in Latin America are roughly double the reported in European cohorts, clearly emphasizing an inequity regarding access to surgical facilities, perioperative care, and neurosurgical expertise.[4] [9] [29] [30] [31] When compared with United States cohorts, the postoperative mortality and morbidity rates in Latin America were nearly twice as high, reflecting disparities in access to intraoperative monitoring, specialized PICUs, and standardized perioperative protocols.

The incidence of surgical site infections reflects a combination of systemic and contextual characteristics that will, of course, vary according to the healthcare setting. In Latin America, although access to pediatric intensive care services is improving, there are still many deficiencies that pose a risk; for example, poor management of perioperative care, lack of trained nursing staff, lack of consistency in antisepsis protocols in perioperative care, prolonged hospitalization prior to surgery, and difficulty in accessing timely surgical care contribute to the risk of nosocomial infections. These findings support those of the previous literature regarding the relationship between resource limitation and risk of infection in neurosurgical populations, specifically in LMICs.[22] [23] [34] [35] [36] [37] Targeted strategies such as enhanced infection surveillance, as well as the incorporation of antibiotic stewardship programs and evidence-based surgical asepsis training options could be implemented to improve the outcomes.[35] [36] [37] [38]

While the mortality rates found in the current study are lower than those of some reports from Latin America, they remain unacceptably high when compared to the rest of the world. The correlation between increased mortality and institutions without routine postoperative neurocritical care demonstrates the importance of dedicated pediatric critical care services to improve outcomes.[4] [22] [23] Multidisciplinary neurocritical care teams working in high-resource environments have lowered perioperative mortality with advanced monitoring capabilities and supportive technology. Closing the gap in Latin America requires significant investment in not just facilities and equipment, but also in workforce training and standardized postoperative management.

The forest plot shows that neurological deficits are the most prevalent complication, with a pooled rate of 22% ([Fig. 2]). Neurological deficits are associated with surgery, especially in patients with tumors located next to eloquent brain areas, and they represent a significant burden of morbidity. According to our data, IONM, which can reduce neurological morbidity by enabling the surgeon to assess neurofunction in real time, is not widely used in Latin America.[9] [24] The limited access to IONM in Latin America, with the variation in local technology and expertise, likely increases the rates of postoperative neurological deficits. Enhanced access to training and resources in IONM can improve surgical accuracy and reduce impairments. The surgical methods used varied according to tumor location and site expertise; however, gross total resection among those for which data is available was around 60%.[21]

Fig. 2 Forest plot of the postoperative complications in pediatric brain tumor surgery in Latin America.

Disturbances in electrolytes, specifically hyponatremia and hypernatremia, were mentioned in a less consistent manner, but they were also important secondary complications. Electrolyte imbalances, commonly brought about by syndromes such as the syndrome of inappropriate antidiuretic hormone secretion (SIADH), or cerebral salt wasting, as well as diabetes insipidus induced following posterior fossa or hypothalamic surgery are associated with a worse neurological recovery and longer length of hospital stay.[25] [26] [27] [28] Beyond the complications captured in the pooled analysis, certain location- and tumor-specific risks deserve attention. Cerebellar mutism syndrome, a well-recognized complication after the resection of tumors involving the cerebellar vermis—most commonly medulloblastoma—can cause severe neurocognitive and behavioral sequelae that substantially impact quality of life. Suprasellar tumors such as craniopharyngiomas and optic pathway gliomas frequently lead to endocrine dysfunctions extending beyond sodium imbalance, including panhypopituitarism, growth hormone deficiency, and hypothyroidism, often accompanied by persistent visual impairment. Furthermore, intramedullary spinal cord tumors, although less common in the pediatric population, carry a significant risk of motor and sensory deterioration after surgical intervention. Awareness of these tumor-specific risks is essential for preoperative counseling, surgical planning, and postoperative multidisciplinary management. An absence of standardized sodium monitoring protocols for patients in the perioperative period in many centers represents an actionable modifiable risk factor, which may lead to reduced morbidity with associated conditions. The indirect comparisons with European cohorts provide useful context, but they must be interpreted with caution: variations in patient case-mix, operative techniques, standards of reporting, and structures of health systems represent confounders in any comparisons. That said, the differential outcomes noted reveal structural inequities, which cannot be explained by biological or disease-related factors alone.

The variety in health systems and delivery of services across Latin America underlines the complexity of assessing outcomes. Urban tertiary care centers can often provide more advanced care than rural or smaller hospitals, which may limit access to appropriate or specialized equipment, teams with specific specialties, or neurocritical care.[4] [9] Geographical isolation and socioeconomic factors exacerbate this gap by causing delays in diagnosis, patients presenting with more advanced disease at the time of diagnosis, and limitations in access to timely and appropriate surgical intervention. System changes to address these public health challenges require regional approaches to health policy agreements, adjustments in health resource allocation, and the development of training programs.

The present research has significant implications for both health-related practices and policies. By creating regional pediatric neurosurgical registries, we could systematically collect data, perform comparative analyses, and promote quality improvement initiatives. We should develop optimal standards. for perioperative care with the following: infection prevention bundles, electrolyte surveillance and monitoring, and postoperative neurocritical pathways ([Table 5]). All of these clinical strategies would help reduce complication rates. It is also important to promote the training of pediatric neurosurgeons, anesthesiologists, and nursing staff in a pediatric hospital to achieve better surgical outcomes. Closing this gap in Latin America is not just about capital investment into services; it also requires investments in workforce and standardized systems for postoperative management.[35] [36] [37] [38]

Table 5 Summary of findings according to the GRADE approach

Outcome (complication)	Number studies (number of patients)	Pooled effect estimate (95%CI)	Certainty (GRADE)	Reasons for downgrading
Postoperative infection	9 (≈ 1,400)	12.8% (9.7–16.2)	⬤◯◯◯ Low	Serious risk of bias (retrospective), inconsistency (I2 = 58%), possible publication bias
Postoperative hemorrhage	6 (≈ 1,000)	6.2% (4.3–8.5)	⬤◯◯◯ Low	Risk of bias, small sample sizes, imprecision
Neurological deficits	7 (≈ 1,100)	10.4% (7.5–13.6)	⬤◯◯◯ Low	Heterogeneity in outcome definitions, retrospective design
Mortality	8 (≈ 1,300)	4.2% (2.8–6.1)	⬤⬤◯◯ Moderate	Risk of bias, but consistent direction and effect size
Sodium imbalance	4 (≈ 600)	7.1% (4.2–10.9)	⬤◯◯◯ Very low	Few studies, inconsistent definitions (SIADH versus DI), imprecision

Abbreviations: DI, Diabetes insipidus; GRADE, Grading of Recommendations Assessment, Development, and Evaluation; SIADH, syndrome of inappropriate antidiuretic hormone secretion.

The current study is limited by the predominance of retrospective study designs and single-center cohorts (which likely introduce selection and reporting biases), the variability regarding the definitions of outcomes and follow-up duration, which limit comparability. The evidence is based mainly on indirect comparisons with European clinical data, so it is not possible to draw definitive causal conclusions. However, it does allow us to identify discrepancies. Future prospective multicenter studies should standardize definitions for reporting outcomes so that we can continue to build on what we have observed. In the present study, the reporting standards varied, and the definitions of postoperative infection or neurologic deficit were inconsistent across studies. Another limitation is that indirect comparisons with European and United States cohorts may be influenced by differences in tumor distribution, surgical complexity, and reporting standards.

Conclusion

In conclusion, children undergoing brain tumor surgery in Latin America suffer postoperative complications at a disproportionate level compared to their peers in high-income countries, including increased risk of infection and mortality, which demonstrates structural and systemic healthcare inequities. Closing the gap for brain tumor patients in Latin America must involve targeted investments in infrastructure, human resources, and clinical protocols.

Postoperative complications after pediatric brain tumor surgery are significantly higher in Latin America than in high-income regions because of disparities related to surgical infrastructure and perioperative care. Strengthening neurosurgical capacity, pediatric intensive care, and standardized protocols (particularly those for infection control and electrolyte tracking) is essential. Regional collaboration and data registries will be essential to improve outcomes and reduce inequities. These findings highlight the urgent need for regional quality-improvement strategies and pediatric neurosurgical registries in Latin America.

Conflicts of Interests

The authors have no conflict of interests to declare.

Authors' Contributions

JDR: conceptualization, investigation, methodology, supervision, validation, visualization, writing – original draft, and writing – review & editing; LLL: data curation, formal analysis, funding acquisition, project administration, resources, software, supervision, validation, and visualization; JER: data curation, project administration, resources, software, supervision, validation, and visualization; and MTP: conceptualization, formal analysis, funding acquisition, project administration, resources, software, supervision, validation, and visualization.

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Publication History

Received: 22 August 2025

Accepted: 13 October 2025

Article published online:
22 December 2025