Neurosurgical journals influence neurosurgeons and their patients

A compendium of articles in the Journal of Neurosurgery (JNS) provides evidence that specialty medical journals are not only an invaluable resource to physicians and researchers, but to the media and public. Clinical and basic science papers do not have to be published in large, high-impact publications to garner attention, and in fact when it comes to specialized areas of medicine such as neurosurgery, publications devoted to the subspecialty produce many citation classics. "Citation classic" is a term given to articles that have been cited more than 400 times.

Highly Cited Works in Neurosurgery: Part 1. The 100 Top-Cited Papers in Neurosurgical Journals and Part II. The Citation Classics are written by Andres M Lozano, MD, PhD, Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada and Francisco Ponce, MD, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona. The related introduction is authored by JNS Editor-in-Chief John A. Jane Sr., MD, and the editorial by Roberto C. Heros, MD, University of Miami, Florida. The articles are posted online at: http://thejns.org/toc/jns/forthcoming.

While these findings are clearly very important to scholars publishing in the field of neurosurgery, what greater meaning can be extracted? "Identifying the most cited articles in neurosurgical journals is one method of assessing the drivers of progress in neurosurgery, where our field has been, and where it is headed," remarked Dr. Lozano.

The two articles yielded many commonalties, but also elucidated some key differences. In Part I, the authors analyzed all the clinical and basic science articles published in neurosurgical journals. Thirteen neurosurgical journals were included in this review. General medical journals such as the New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), and Lancet were not included. Key findings from this analysis:

~ Among the 100 top-cited papers, there were 79 articles from the JNS, 11 from The Journal of Neurology, Neurosurgery, and Psychiatry (JNNP), and 10 from Neurosurgery.

~ Citation counts ranged from 287 to 1515 with years of publication between 1956 and 2001; 77 of these articles were published between 1976 and 1995, 19 before 1976, and four after 1995.

~ The subspecialty breakdown among the 100-top cited papers: cerebrovascular - 43, trauma - 27, stereotactic and functional - 13, and tumor - 12.

In Part II, the authors analyzed clinical neurosurgery articles from all medical journals that yielded citation classics. There were 106 articles in 28 journals with greater than 400 citations. Key findings from this analysis:

~ More than half of these citation classics appeared in JNS or NEJM.

~ Randomized trials were the highest cited papers, accounting for eight of the 12 articles with greater than 100 citations. Of the 29 randomized trials articles, 86 percent were published in general medical journals.

~ Citation counts ranged from 402 to 4199 with more than half published in the last 20 years.

~ The subspecialty breakdown among the citation classics: cerebrovascular - 38, stereotactic and functional - 21, neuro-oncology - 21, and trauma - 19. Additional totals: non-traumatic spine - 4, cerebrospinal fluid pathologies - 2, and infection - 1.

Interestingly, spine is missing from the top 100, despite comprising a large percentage of most neurosurgical practices. The most recent AANS survey indicates that spine procedures comprise an estimated 62 percent of all neurosurgical procedures performed. The editorial points to a key factor in this mix. "Neurosurgeons have joined the burgeoning field of complex spine instrumentation only over the last 20 years. If this list of most cited articles were developed again in 10 years, the contribution of dedicated spine neurosurgeons would likely be substantive, given that works generate more citations over time," remarked Dr. Heros.

Cerbrovascular articles were the most cited in both studies, yet cerebrovascular surgery represents only a small percentage of the practice of neurosurgery. Both the editorial and article offer the explanation that cerebrovascular surgery is not only risky, but has attracted some of the most scholarly practitioners in the field working at academic settings where research and publishing are held in high regard.

Functional neurosurgery is a rapidly growing subspecialty area. While interest in this waned in the late 1960s due to advances in medical therapy for Parkinson's disease (PD), there has been a resurgence of research into deep brain stimulation (DBS). This technology has proven to be a safe and effective treatment for essential tremor, as well as tremor and involuntary movements associated with PD, dystonia and multiple sclerosis. The applications for DBS therapy are expanding rapidly and include several psychiatric conditions. It is very likely that functional neurosurgery articles will yield future citation classics.

The vast majority of randomized trials were published in non-neurosurgical journals. Randomized trials are clearly very important to both the specialty and general medical community. There is an untapped opportunity for neurosurgeons to impact the field through publishing groundbreaking research in neurosurgical journals.

"It is evident that neurosurgical journals have a considerable influence and should be considered as a primary vehicle to disseminate important findings that impact neurosurgeons and their patients, neurosurgeons-in-training, and the general medical community," concluded Dr. Lozano.

SOURCE Journal of Neurosurgery