Defying Deprivation: Neurosurgical Outcomes and 75% 6-Month Survival in 96 Primary Brain Tumor Cases Amid Yemen's Humanitarian Crisis.
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BACKGROUND: Yemen's protracted humanitarian crisis has devastated healthcare infrastructure, creating profound challenges for the management of primary brain tumors under severe resource constraints. This study characterizes patient profiles, surgical approaches, and 6-month outcomes at a tertiary neurosurgical center in Sana'a (2023-2024). METHODS: A retrospective cohort of 96 consecutive patients undergoing surgery for primary brain tumors was analyzed. Data extraction included demographics, clinical presentation, imaging findings, tumor location and histopathology (World Health Organization Central Nervous System 5, 2021 classification), extent of resection, complications, adjuvant therapies, and 6-month survival status. Statistical analyses employed χ2 tests, Kaplan-Meier survival estimates, and Cox proportional hazards regression. RESULTS: The median patient age was 35 years (range: 0.5-80), and 60.4% were male. Supratentorial tumors (78%) were most common, with meningioma (19.8%) and glioblastoma (14.6%) representing the predominant histologies. Gross total resection was achieved in 61.5% of cases. The overall complication rate was 28%, including cerebrospinal fluid leak (7%) and surgical site infection (5%). Adjuvant therapy was received by 38.5% of patients. The overall 6-month survival rate was 75%. Survival was significantly superior in gross total resection compared to subtotal resection or biopsy (83.0% vs. 65.6%, P = 0.01) and in those with World Health Organization grade I-II tumors compared to grade III-IV tumors (94.4% vs. 51.5%, P < 0.001). CONCLUSIONS: Despite operating amid chronic power outages and critical supply shortages, the implementation of strategic adaptive protocols enabled the achievement of neurosurgical outcomes comparable to those reported in other low-resource settings. Prioritizing reliable imaging, minimizing complications, and improving access to adjuvant therapies are crucial for further improving prognosis for brain tumor patients in Yemen.