Introduction: This scoping review investigates telemedicine use in neurosurgery across diverse global contexts, comparing adoption and implementation in high-income countries (HICs) and low- and middle-income countries (LMICs). The study aims to identify barriers specific to LMICs and provide strategic recommendations to foster telemedicine integration.
Methods: A systematic search was conducted across five major databases—PubMed, Scopus, Embase, CINAHL, and IEEE Xplore—yielding 380 studies. After removing duplicates and applying eligibility criteria, seven studies published between 2006 and 2024 were included. Barriers to telemedicine adoption were extracted, including technological, infrastructural, financial, cultural, policy-related, and training-based. A modified Cochrane Risk of Bias tool was applied for preliminary quality assessment.
Results: The analysis identified six main categories of barriers: (1) Technological barriers, such as limited digital literacy and unreliable internet, were the most common in LMICs, severely hindering telemedicine adoption. (2) Infrastructural challenges included inconsistent power supply and inadequate medical equipment, particularly in rural areas. (3) Financial constraints, including high costs for technology and lack of reimbursement models, further restricted telemedicine growth. (4) Policy-related obstacles, such as the absence of regulatory frameworks, raised concerns over data privacy and legal risks. (5) Cultural factors affected acceptance rates, including patient distrust of remote care and preference for in-person consultations. (6) Training deficiencies in telemedicine use among healthcare providers limited effective implementation. Collectively, these barriers were more pronounced in LMICs than in HICs, highlighting a critical gap in equitable access to neurosurgical care.
Conclusion : Telemedicine holds great promise for expanding neurosurgical care in LMICs, where access to resources is limited. However, interventions addressing technology infrastructure, training, and supportive policy reforms are essential to improve telemedicine adoption and ultimately improve access to neurosurgical care in underserved regions worldwide.
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