{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:48:55Z","timestamp":1785890935909,"version":"3.56.0"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:p>Neuro-oncology neurosurgeons (NONs) manage patients with progressive neurological decline, make high-stakes decisions, and face repeated exposure to death. While burnout has been recognized as a significant concern, grief and psychological strain remain underexplored as related, partly overlapping phenomena. To address this gap, we convened an exploratory international cohort of NONs to develop a dialogue-informed perspective on grief. Insights from semistructured roundtable discussions were used to explore how grief and psychological strain are experienced, their key triggers, coping approaches, cultural influences, and perceived institutional and evidence gaps. Informed by these discussions\u2014recorded, transcribed, and analyzed with a rapid thematic analysis\u2014findings were synthesized into six themes: 1) The perception of grief and impact. We collectively view grief and psychological strain among NONs as arising not only from patient death, but also from iatrogenic neurological deficits and complications, reexposure to the patient\u2019s decline during follow-up, and the long relational trajectories characteristic of lower-grade glioma care. 2) Patterns in experiences of grief in NONs. Such experiences are understood to contribute to rumination, emotional blunting, social withdrawal, and exhaustion associated with sustaining realism while preserving hope. 3) NONs\u2019 coping with grief. Coping is similarly viewed as encompassing exercise and other \"reset\" routines, restoration of mastery through reflection and case review, reframing and meaning-making, selective peer support, compartmentalization, and graduated reexposure to lower-risk cases following adverse events. Career stage is regarded as a double-edged aspect, including a \"lonelier at the top\" experience. 4) Cultural differences in grief experiences. Grief is universal, but its expression and management vary via spiritual frameworks, end-of-life expectations, resources, medicolegal climate, and team psychological safety. 5) Lack of formal training and the hidden curriculum of grief and coping. NONs navigated these challenges largely by \"learning by doing,\" with minimal formal guidance. 6) Institutional support, evidence gaps, and unintended harms. Institutional support is perceived as limited, with morbidity and mortality conferences variably buffering or intensifying distress depending on the degree of psychological safety. In this context, the cohort represented here emphasized the need for implementation of routine check-ins, mentorship structures, and psychologically safe debriefing after adverse events. Together, these reflections frame grief as a shared and discussable reality of neuro-oncology surgery practice; explicitly distinguish grief-related strain from burnout, describing significant burden even without burnout; and point toward actionable recommendations to support psychological safety and professional sustainability.<\/jats:p>","DOI":"10.3171\/2026.5.focus26135","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:01:18Z","timestamp":1785283278000},"page":"E13","source":"Crossref","is-referenced-by-count":0,"title":["Silent burdens: global perspectives on grief and psychological strain among neuro-oncology neurosurgeons"],"prefix":"10.3171","volume":"61","author":[{"given":"Juan","family":"Baquero-Rodriguez","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Hospital Universitario Marqu\u00e9s de Valdecilla, Santander;"},{"name":"Valdecilla Health Research Institute (IDIVAL), Santander, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Piil","sequence":"additional","affiliation":[{"name":"Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital\u2014Rigshospitalet, Copenhagen;"},{"name":"Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark;"},{"name":"School of Nursing, Curtin University, Perth, Western Australia, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Mansouri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asgeir S.","family":"Jakola","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg;"},{"name":"Section of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Karekezi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rwanda Military Referral and Teaching Hospital, Kigali, Rwanda;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirokazu","family":"Takami","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Balogun","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan, Nigeria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine","family":"Drummond","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal Melbourne Hospital, Parkville, Victoria;"},{"name":"Department of Surgery, University of Melbourne, Parkville, Victoria, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen Joy O.","family":"Khu","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Alverne Freitas de Albuquerque","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, General Hospital of Fortaleza, Cear\u00e1, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirjam","family":"Renovanz","sequence":"additional","affiliation":[{"name":"Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital T\u00fcbingen, Hertie Institute for Clinical Brain Research, T\u00fcbingen;"},{"name":"Department of Neurosurgery, University Hospital T\u00fcbingen, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florien","family":"Boele","sequence":"additional","affiliation":[{"name":"Leeds Institute of Medical Research at St. James\u2019s and Leeds Institute of Health Sciences, School of Medicine, University of Leeds, United Kingdom;"},{"name":"Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Vel\u00e1squez","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Hospital Universitario Marqu\u00e9s de Valdecilla, Santander;"},{"name":"Valdecilla Health Research Institute (IDIVAL), Santander, Spain;"},{"name":"Department of Anatomy and Cell Biology, Universidad de Cantabria, Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Ann Fam Med","first-page":"375","article-title":"Disenfranchised grief and physician burnout","volume":"15","author":"Lathrop D","year":"2017","unstructured":"Lathrop D. 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