Top 5 Most Cited Articles in Neurosurgery

In a multinational data synthesis and workforce analysis Dewan et al. from the Harvard Medical School (Boston), Vanderbilt University Medical Center (Nashville), University of Cape Town (Cape Town), Carlos Haya University Hospital (Malaga), Humanitas University (Milan), University of Tennessee (Memphis), WHO (Geneva), Boston Children’s Hospital (Boston), CURE Children’s Hospital of Uganda (Mbale) published in the Journal of Neurosurgery to quantify the global burden of neurosurgical disease and estimate the deficit in workforce capacity required to deliver essential neurosurgical care worldwide. The study estimates that 13.8 million people annually require neurosurgical intervention, with over 5 million cases left untreated due to a shortage of approximately 23,300 neurosurgeons—primarily in low- and middle-income countries (LMICs). Traumatic brain injuries and stroke-related conditions dominate the burden. Urgent workforce scaling is required to close care gaps, especially in Africa and Southeast Asia ¹⁾.

Content Accuracy: The study draws on a synthesis of country registries, meta-analyses, and practitioner surveys to estimate global neurosurgical demand. While the methodology is sound in intent, it suffers from inevitable limitations inherent in the use of third-party modeled data and extrapolated disease volumes. The disease burden and workforce numbers are estimative rather than empirical, making the findings foundational but not definitive.

Utility to Neurosurgeons: For policy-focused neurosurgeons or global health advocates, this paper offers critical framing. However, for practicing neurosurgeons, especially in high-income settings, the clinical utility is limited. It lacks operational strategies for addressing workforce imbalances and is essentially a macro-level epidemiological overview rather than a roadmap for intervention.

Tone and Structure: The tone is more humanitarian than scientific, with strong advocacy undercurrents. While the executive summary format ensures digestibility, it truncates nuanced methodological discussion, particularly around regional modeling assumptions, case classification criteria, and survey representativeness. It should have been accompanied by an appendix or supplementary data to support transparency.

Weaknesses: - No standardized case definitions or ICD codes referenced. - Overreliance on modeled rather than real-world hospital-based data. - Workforce projections omit variables such as training duration, attrition rates, and regional practice differences. - Practitioner's survey responses are not validated or stratified by training level or setting.

Strengths: - Sets a global baseline for neurosurgical burden discussions. - Integrates diverse data sources to triangulate estimates. - Strong international authorship lends it institutional credibility.

Takeaway for Neurosurgeons: While not clinically actionable, this paper establishes a necessary conceptual framework for global neurosurgical equity. It is a call to action for workforce development rather than a guide for practice. Bottom Line: An important but broad-strokes paper that effectively highlights global neurosurgical disparities, but lacks the methodological rigor and granularity needed for direct implementation planning. Rating: 6.5 / 10

Corresponding Author Email: kbpark@partners.org

Dewan MC, Rattani A, Fieggen G, et al. Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change. Journal of Neurosurgery. 2019;130(4):1055–1064. DOI: https://doi.org/10.3171/2018.10.JNS181640

Yaşargil MG. A legacy of microneurosurgery: memoirs, lessons, and axioms. Neurosurgery. 1999;45(5):1025–1091. DOI: https://doi.org/10.1097/00006123-199911000-00014

Multiple highly cited papers led by various authors in this field, often published in Journal of Neurosurgery during the 1990s–2000s. No single paper dominates; citations range from 600–1,000+. Focus: long-term outcomes of stereotactic radiosurgery for meningiomas.

Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. Journal of Neurosurgery. 1953;10(2):154–168. DOI: https://doi.org/10.3171/jns.1953.10.2.0154

Cloward RB. The anterior approach for removal of ruptured cervical disks. Journal of Neurosurgery. 1958;15(6):602–617. DOI: https://doi.org/10.3171/jns.1958.15.6.0602

Reviewed: June 2025