Outcomes of Congenital Brain Tumors: A Single-Center Experience in a Low- and Middle-Income Country.
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BACKGROUND: Congenital brain tumors (CBTs), defined as intracranial neoplasms initially presented within the first year of life, are rare and biologically heterogeneous, with outcomes largely derived from high-income country data. Evidence from low- and middle-income countries (LMICs) remains sparse, limiting contextual understanding of disease burden and survival. METHODS: We conducted a retrospective single-center cohort study of infants with surgically managed intracranial tumors presenting within the first year of life at a tertiary referral center in Pakistan between January 1, 1988, and July 31, 2025. Vascular and metastatic lesions were excluded. Demographic, clinical, radiological, histopathological, operative, and adjuvant-treatment data were extracted from medical records. Tumors were classified according to WHO 2021 nomenclature where feasible. Overall survival was estimated using Kaplan-Meier methods, and factors associated with survival were explored using Firth-penalized Cox regression because of low event counts. RESULTS: Fifty infants were included; median age at surgery was 420.00 days (interquartile range 198.50-566.00 days), and 26 were male. Supratentorial tumors comprised 20 (40.0%) cases, and 25 (50.0%) were high-grade (WHO grade III-IV). Gross total resection was achieved in 11 (22.0%) patients and subtotal resection in 20 (40.0%). Postoperative complications occurred in 8 (16.0%). Among 33 patients with available survival follow-up, estimated overall survival was 93.9% at 30 days, 82.5% at 6 months, 74.2% at 1 year, and 58.6% at both 5 and 10 years. No clinicopathological variable was independently associated with survival in penalized Cox regression. CONCLUSION: In this single-center LMIC cohort, survival after surgical management of CBTs appeared lower than that generally reported in high-income settings. These findings highlight the need for earlier diagnosis, improved access to specialized pediatric neuro-oncology care, and multicenter collaborative studies to better define prognostic determinants and improve outcomes.