Patients awaiting intracranial tumour resection frequently experience substantial psychological distress that may influence treatment-related decision-making. Although illness perception and psychological distress have been investigated but evidence regarding their association with preoperative decisional conflict remains limited. We aimed to evaluate preoperative illness perception, psychological distress, perceived social support, and decisional conflict in patients undergoing intracranial tumour resection, and to determine the associations between them using validated psychometric instruments.

The initial results of an on-going prospective cross-sectional analytical study being conducted at the Department of Neurosurgery, Unit-1 at Punjab Institute of Neurosciences, Lahore from May to June 2026 are presented. Radiologically confirmed patients, scheduled for elective craniotomy for intracranial tumours with age >18 years were recruited. Informed consent was obtained and in-person interviews using validated psychometric instruments were conducted along with a standardized clinical and demographic data sheet. Descriptive analysis was done using measures of central tendency. With an anticipated prevalence of 21.7%, calculated sample size was 262. As the results submitted in abstract were preliminary, the data collection is ongoing and we have recruited 45 patients till now.

A total of 45 patients between the ages 18-73 years (mean age 44.13 ± 15.51 years,) with 37(82.2%) being married, were included. Participants demonstrated high psychological distress, with mean Hospital Anxiety and Depression Scale of 15.69 ± 2.56 and 14.60 ± 2.73, respectively. The adapted Decision Conflict Scale showed excellent internal consistency (Cronbach's α = 0.956). Spearman's rank correlation was performed to analyze decisional conflict. Illness perception demonstrated a significant negative correlation with decisional conflict (ρ = -0.443, p = 0.002), indicating that stronger illness perceptions were associated with lower decisional conflict. Perceived social support (MOS-SSS) demonstrated a weak negative and non-significant relationship with decision conflict (Spearman's ρ = -0.065, p = .673). When anxiety and depression symptoms were combined into a total HADS score, no significant association was found with decision conflict (Spearman's ρ = -0.155, p = .310).

Among patients undergoing intracranial tumour resection, stronger illness perception was associated with lower preoperative decisional conflict. However, anxiety, depression, perceived social support were not significantly related to decisional conflict.

Outcomes for malignant brain tumours depend on timely access to neurosurgery and specialized oncology, which are concentrated in urban centers. Whether mortality differs along the urban-rural gradient is rarely quantified at population scale. Pakistan, where neurosurgical capacity is heavily urban and national surveillance is absent, lacks such data. We examined United States brain tumour mortality by urbanization, 1999- 2020, as a transferable model.

Serial cross-sectional, ecological analysis was carried out on CDC WONDER with Underlying Cause of Death data (1999-2020, bridged-race) for decedents with ICD-10 C71.Age-adjusted mortality rates (AAMR; 2000 US standard) per 100,000 were computed across thesix-level 2013 NCHS urbanization classification, from Large Central Metro to Noncore(nonmetropolitan) on 29-June-2026. Join point regression (version 6.0.1) estimated APC and AAPC with 95% CIs,and pairwise tests of parallelism and coincidence compared trajectories. Reporting followed STROBE/RECORD.

Across 1999-2020, 315,538 deaths were recorded. Mortality increased along the urban-to-rural gradient: in 1999 AAMR was lowest in Large Central Metro (4.34) and highest innonmetropolitan areas (Noncore 4.81; Micropolitan 4.80), a gradient that persisted to 2020(Large Central Metro 4.08; Noncore 4.71). Most strata showed a significant decline to themid-2000s then a plateau or modest rise (e.g. Large Central Metro: 1999-2006 APC -1.49%,2006-2020 +0.22%; AAPC -0.35%), while Medium Metro and Micropolitan areas stayed essentially flat (0 join points). Trajectories were largely parallel (13 of 15 pairwise comparisons failed to reject parallelism) but differed in level (coincidence rejected, p<0.001), so the urban-rural gap did not close.

US malignant brain tumour mortality followed a persistent urban-to-rural gradient from 1999 to 2020, where it was lowest in large metropolitan cores and highest in nonmetropolitan areas, with parallel trends that left the gap intact. As an ecological analysis, it cannot establish causation. This reproducible CDC WONDER Join point method offers a template for mapping neurosurgical-access disparities in settings such as Pakistan.

A hybrid quantum-classical machine learning framework was proposed to evaluate whether quantum mechanics could extract high-dimensional patterns from small, localized patient registries, bypassing the small-data bottleneck entirely.

An algorithmic pipeline bridging classical preprocessing with quantum state manipulation was designed. Eight core features comprising four structural MRI parameters (tumour volume, oedema index, necrotic core ratio, and perfusion intensity) and four molecular markers were mapped into a low-dimensional Hilbert space using quantum amplitude encoding. A parameterized quantum circuit utilizing entangling layers (CNOT gates) was implemented to capture complex, non-local feature interactions simultaneously. The architecture was evaluated on a simulated retrospective cohort of fifty patients (N=50), computationally derived using open-access anonymized neuro-oncology repositories (The Cancer Imaging Archive / TCGA-GBM database), to mirror local clinical constraints.

While standard classical models (multi-layer perceptrons and random forests) failed to generalize due to severe overfitting on the small training sample, the HQCNN pipeline demonstrated robust convergence. The quantum-enhanced model achieved an evaluation area under the receiver operating characteristic curve (AUCROC) of 0.94 in classifying 1-year survival rates and potential chemotherapy resistance.

This framework demonstrates that shifting the clinical focus from massive data accumulation to quantum-inspired algorithmic efficiency offers a scalable, low-cost path to personalized neuro-oncological care. By deploying such models via cloud-based quantum networks, local institutions across Pakistan can leverage existing, small-scale patient volumes to generate accurate, personalized treatment pathways.

Socioeconomic survival disparities in glioblastoma (GBM) are documented, but whether they operate through differential receipt of surgical resection is unquantified. We estimated the proportion of the county income-based survival disparity in GBM transmitted through receipt of surgical resection, using causal four-way decomposition.

We analysed a population-based SEER 17-registry cohort of adults aged 18-64 with histologically confirmed GBM (ICD-O-3 9440/3) diagnosed from 2007 to 2022. The exposure was county-level median household income, lowest (Q1) versus highest (Q4) quartile. The mediator was receipt of surgical resection versus none or biopsy. The outcome was overall survival. We applied the VanderWeele four-way decomposition with a Cox survival estimator and an exposure-mediator interaction, adjusting for age, sex, diagnosis year, race/ethnicity, marital status, and rurality, with 1000 bootstrap replications. Robustness to unmeasured confounding was assessed using E-values.

Among 19,051 patients, median overall survival rose from 12 months (Q1) to 15 months (Q4), whereas resection rates were near-identical (Q1 66.0%, Q4 68.9%). The lowest-income quartile carried a higher hazard of death than the highest (total-effect HR 1.23, 95% CI 1.17-1.30). Surgery mediated almost none of this gap (proportion mediated 2.6%, 95% CI -2.7 to 7.6%; pure indirect HR 1.00). The controlled direct effect persisted (HR 1.19, 95% CI 1.13-1.25), with a significant income-surgery interaction (proportion eliminated 28.0%, 95% CI 10.9- 44.6%). E-values were 1.58 (total effect) and 1.50 (direct effect).

The income-based survival disparity in GBM is substantial but operates predominantly through nonsurgical pathways; equalizing receipt of surgery alone would not close it. Unmeasured clinical confounders of moderate strength could account for the residual direct effect.

Brain and Central Nervous System (CNS) cancers are rare but highly lethal malignancies associated with substantial neurological morbidity and mortality. In 2019, approximately 246,000 deaths were attributed to these tumours globally. Our study aims to assess Brain and CNS cancer mortality trends in Pakistan from 1980 to 2021.

We utilized mortality data from the Global Burden of Disease (Institute for Health Metrics and Evaluation; https://vizhub.healthdata.org/gbd-results/) to examine mortality trends of brain and other CNS cancers in Pakistan from 1980 to 2021. Age-standardized mortality rates (ASMRs) per 100,000 population were extracted for the overall population and by sex. Temporal trends were analyzed using Joinpoint Regression software, and annual percentage changes (APCs) or average annual percentage changes (AAPC) with 95% confidence intervals were calculated.

Between 1980 and 2021, an estimated 74,235 deaths due to brain and other CNS cancers occurred in Pakistan. Overall, the ASMR increased from 1.16 in 1980 to 1.67 in 2021 (AAPC: 0.98; 95% CI: 0.91 to 1.04). From 1980 to 1994, the ASMR increased greatly from 1.16 to 1.42 (APC: 1.63; 95% CI: 1.47 to 1.81). However, from 1994 to 2018, ASMR growth slowed down and ASMR reached 1.57 from 1.42 (APC: 0.42; 95% CI: 0.31 to 0.49). From 2018 onwards, there was a dramatic increase in ASMR from 1.57 to 1.67 (APC: 2.47; 95% CI: 1.1 to 4.28). Gender stratification showed that male mortality rates were higher than female rates until 2014, after which females showed slightly higher ASMRs. Both sexes demonstrated an upward trend over the study period.

Mortality due to brain and other CNS cancers in Pakistan increased significantly between 1980 and 2021, with a slowing of the upward trend after the mid-1990s followed by renewed acceleration after 2018. These findings underscore the need for improved surveillance, earlier diagnosis, and strengthened neuro-oncology services to reduce the burden of disease.

Skull base meningiomas represent a distinct subgroup of intracranial tumours because of their proximity to cranial nerves, major vascular structures, and the brainstem. Although advances in imaging, neuroanaesthesia, and skull base approaches, marked improvement in illumination devices, provision of improved haemostatic agents, greater availability of more precise surgical instruments, and better modalities for skull base reconstruction have led to an inevitable evolution of safe skull base neurosurgery, complete resection remains technically demanding. This study evaluates operative nuances, intraoperative challenges, and clinical outcomes following microsurgical resection of skull base meningiomas.

A retrospective analysis was performed on 55 patients who underwent microsurgical resection of skull base meningiomas of different location in Bangladesh Medical University from 01st April, 2018 to 30th June 2026. Tumour location, extent of resection, operative strategies, cranial nerve preservation, vascular management, postoperative complications, and functional outcomes were reviewed. Surgical techniques included tailored skull base approaches with microsurgical dissection under high magnification. Outcome was assessed using MRC grading, GOS and House- Brackmann scale where applicable.

Gross total or near-total resection was achieved in the majority of patients. The principal operative challenges included tumour adherence to the internal carotid artery and its branches, encasement of cranial nerves, hypervascularity, and limited surgical corridors in petroclival lesions. Key operative nuances included early devascularization, internal debulking before arachnoid plane dissection, preservation of perforating vessels, and meticulous cranial nerve handling. Postoperative neurological status was stable or improved in most patients. Out of 55 patients 3 patients died due to post-operative complications. Hemiparesis developed in 2 patients. New cranial nerve deficits, tumour bed haematoma and cerebrospinal fluid leakage were the most common complications.

Skull base tumours pose a management challenge given their complex location and, as a result, the tumours and surgery can result in significant morbidity. Careful preoperative planning, individualized skull base approaches, and meticulous microsurgical technique are essential to maximize safe resection while preserving neurological function.

The primary objective of this study was to analyze long-term trends in the age-standardized incidence of brain and CNS cancers in Pakistan utilizing GBD data from 1990 to 2021.

Age-standardized incidence rates (ASIRs) of brain and CNS cancers per 100,000 population were extracted on 29th July 2026 from the Global Burden of Disease database (Institute for Health Metrics and Evaluation; https://vizhub.healthdata.org/gbd-results/) for Pakistan, covering the period 1990-2021. Data were obtained for the overall population and stratified by sex to assess sex-specific patterns. Temporal trends in ASIR were evaluated using Joinpoint Regression software. For each identified segment, the annual percentage change (APC) was calculated, and the average annual percentage change (AAPC) was computed across the full study period to summarize the overall trend. All estimates were reported with 95% confidence intervals (CIs). P value of <0.05 was considered statistically significant.

The ASIR demonstrated a consistent upward trajectory, rising from 1.69 per 100,000 in 1990 to 2.18 per 100,000 in 2021 (AAPC: 0.84; 95% CI: 0.74-0.91). From 1990 to 2018, the ASIR increased gradually from 1.69 to 2.02 (APC: 0.59; 95% CI: 0.52-0.65), followed by a marked acceleration between 2018 and 2021, during which the ASIR climbed from 2.02 to 2.18 (APC: 3.2; 95% CI: 1.7-5.4). Gender-stratified analysis revealed that male ASIRs exceeded female rates during the earlier decades; however, from 2013 onwards, females demonstrated consistently higher ASIRs, reaching 2.30 per 100,000 by 2021 compared to 2.09 per 100,000 in males.

The age-standardized incidence of brain and other CNS cancers in Pakistan increased steadily from 1990 to 2021, with a marked acceleration after 2018 and an emerging female predominance from 2013 onwards. These findings underscore the urgent need for strengthened cancer surveillance infrastructure, enhanced early detection programmes, and expanded neuro-oncology services to effectively address this growing public health burden.

Brain and central nervous system (CNS) cancers represent a significant source of mortality and morbidity worldwide, creating clinical and economic challenges. In Pakistan, the fifth most populous country, CNS tumours are the 13th most frequently diagnosed cancers, yet accurate nationwide data remain scarce, hindering policy-making for early detection and treatment. This study examines trends in incidence, prevalence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) of brain and CNS cancers in Pakistan from 1990 to 2023, along with sex-stratified analyses.

Data on brain and CNS cancers incidence, prevalence, mortality, DALYs, YLLs, and YLDs for Pakistan from 1990 to 2023 were extracted from the Global Burden of Disease 2023 database. The disease burden was quantified using age-standardized rates per 100,000 population. For temporal trends evaluation, we employed Joinpoint regression analysis to calculate the annual percent change (APC) and the average annual percent change (AAPC) with 95% confidence intervals (CIs). Data were stratified by sex to assess demographic disparities..

Between 1990 and 2023, age-standardized incidence, mortality, DALYs, YLDs, and YLLs rates remained relatively stable, with non-significant AAPCs of 0.29, 0.09, 0.21, 0.28, and 0.21, respectively (all p > 0.05). In contrast, age-standardized prevalence increased significantly from 3.59 to 4.49 per 100,000 (AAPC: 0.60; 95 % CI: 0.20-1.00; p = 0.003). Joinpoint analysis showed significant increases during 1990-2006 (APC: 0.18) and 2009-2021 (APC: 1.39), while the increase during 2006-2009 (APC: 2.95) was non-significant. A significant decline occurred during 2021- 2023 (APC: -4.14). Males had higher mortality, DALYs, and YLLs rates, whereas females had slightly higher incidence, prevalence, and YLDs rates..

Despite stable age-standardized incidence, mortality, and disability trends, brain and CNS cancer prevalence increased significantly in Pakistan from 1990 to 2023, highlighting the need for continued surveillance and healthcare planning.

Palliative and hospice care are essential for patients with malignant brain tumours. Pakistan has limited hospice infrastructure and lacks a national end-of-life surveillance system. This study aimed to evaluate temporal trends in the place of death among malignant brain tumour decedents in the United States and provide a reproducible surveillance model applicable to palliative care planning in Pakistan.ia.

A retrospective population-based ecological time-trend study was conducted using the CDC WONDER Underlying Cause of Death database for malignant brain tumour (ICD-10 C71) deaths from 2003 to 2024, on 29. June 2026.. Place of death was categorized into home, hospice, hospital inpatient, nursing home, and other settings. Bridged-race mortality files (2003-2020) and single-race files (2021-2024) were analyzed using Joinpoint regression. Annual Percent Change (APC), Average Annual Percent Change (AAPC), and 95% confidence intervals were calculated. Pairwise tests of parallelism and coincidence assessed differences in temporal trends across care settings. Reporting followed the STROBE guideline.

A total of 335,318 malignant brain tumour deaths were analyzed. Home remained the most common place of death, increasing from 45.1% in 2003 to 53.3% in 2024 (AAPC +0.83%; 95% CI 0.15-1.52), with the steepest increase between 2018 and 2021 (APC +6.56%) before declining from 2021 to 2024 (APC -3.70%). Hospice deaths increased from 0.7% to 13.3%, with the greatest rise occurring between 2003 and 2006 (APC +99.18%). Conversely, hospital inpatient deaths decreased from 22.5% to 13.0% (APC -3.60% through 2021), while nursing home deaths declined from 21.4% to 14.2%. Fourteen of fifteen pairwise comparisons demonstrated significantly different temporal trajectories between care settings (parallelism p=0.0007; coincidence p=0.0002).

The place of death among United States malignant brain tumour decedents has shifted substantially from hospital-based to home- and hospice-based care over the past two decades. This population-level analysis provides a scalable surveillance framework that may support the development of palliative care services, hospice infrastructure, and end-of-life monitoring in countries lacking comprehensive surveillance systems, including Pakistan.

Malignant brain neoplasms and cardiac arrest represent significant causes of mortality with potentially shared pathophysiological mechanisms and disparate population impacts. This study examines trends and disparities in mortality associated with these conditions in the United States from 1999 to 2024.

We obtained data for U.S. adults aged ≥45 using CDC WONDER spanning 1999 to 2024 with ICD-10 codes C71 (malignant brain neoplasms) and I46 (cardiac arrest). Age-adjusted mortality rates (AAMRs) per 100,000 individuals were categorized by overall, sex, race/ethnicity, census region, urbanization level, and age group. Joinpoint regression analysis was performed to calculate annual percent changes (APCs) and average annual percent changes (AAPCs) with 95% confidence intervals (CIs).

A total of 28,117 deaths were identified. Overall AAMR declined from 1.13 in 1999 to 0.74 in 2024, with an overall AAPC of -1.39% (95% CI: -1.81 to -0.96). Males consistently exhibited higher rates (0.85 in 2024) compared to females (0.65 in 2024). Joinpoint analysis revealed a steep decline from 1999-2006 (APC: -3.61%, 95% CI: -4.93 to - 2.26) followed by a slower decline from 2006-2024 (APC: -0.51%, 95% CI: -0.85 to -0.17). Hispanic or Latino populations showed the highest AAMR (1.06 in 2024) while Black or African American populations reported the lowest rates (0.53 in 2024). Geographically, the West had the highest mortality (1.60 in 2024) while the Midwest showed the lowest rates (0.35 in 2024). Mortality was higher in metropolitan areas (0.90 in 2020) compared to nonmetropolitan areas (0.62 in 2020). Crude mortality rate was highest among those aged 85+ (2.04).

This study reveals critical disparities in mortality trends across sex, race, geography, and age. Urgent, equity-focussed place-based prevention strategies are required to dismantle persistent disparities in high-risk populations.