IntroductionTelemedicine has evolved into an integral component of neurosurgical care, especially in expanding access to specialized services in remote or resource-limited areas. This systematic review summarizes worldwide evidence on the implementation, outcomes, and barriers of tele-neurosurgery in emergency and outpatient settings.MethodsFollowing PRISMA guidelines, a comprehensive PubMed/MEDLINE search (2000-2025) identified English-language studies on telemedicine applications in neurosurgery. Eligible studies included emergency cases (trauma, stroke, intracerebral hemorrhage) and outpatient settings. Data on design, interventions, outcomes, and limitations were extracted and analyzed qualitatively.ResultsThirty-six studies met inclusion criteria, covering programs within high-, middle-, and low-income regions. Emergency networks using teleradiology and teleconsultation achieved significant reductions in time-to-specialist evaluation-from about 160 to 38 min-and prevented up to 44% of potential patient transfers, with low failure rates among locally managed cases. Outpatient programs reported patient satisfaction above 80%, surgical decision agreement comparable to in-person visits, and notable travel and cost savings, especially in pediatric teleclinics. Across various settings, telemedicine improved access, workflow efficiency, and cost-effectiveness, though challenges remained regarding connectivity, imaging interoperability, licensure differences, and digital inequality.ConclusionTele-neurosurgery is a safe, effective, and cost-efficient addition to traditional neurosurgical care. It enhances response times, improves triage, and maintains high patient satisfaction across various health systems. Overcoming infrastructural and regulatory barriers through standardized digital networks and equitable access programs will be essential for consolidating telemedicine as a core element of global neurosurgical practice.
Palmiero et al. (Thu,) studied this question.