Literature Review
Assessing the Relevancy of Highly Cited Works in Neurosurgery. Part I: The 100 Most
Relevant Papers in Neurosurgical Journals
Michael A. Bohl and Francisco A. Ponce
Key words
- Bibliometric
- Neurosurgical journal
- Relevancy
Department of Neurosurgery, Barrow Neurological Institute,
St. Joseph’s Hospital and Medical Center, Phoenix, Arizona,
USA
To whom correspondence should be addressed:
Francisco A. Ponce, M.D.
[E-mail: Neuropub@dignityhealth.org]
Citation: World Neurosurg. (2017).
http://dx.doi.org/10.1016/j.wneu.2017.03.149
Journal homepage: www.WORLDNEUROSURGERY.org
Available online: www.sciencedirect.com
1878-8750/$ - see front matter ª 2017 Elsevier Inc. All
rights reserved.
INTRODUCTION
Since 1962, the Institute for Scientific
Information has maintained ongoing
citation counts for academic journals in
the Science Citation Index. The informa-
tion contained in the Science Citation In-
dex is accessible via the Web-based
bibliometric database Web of Science. As
the functionality of online research data-
bases such as Web of Science continues to
grow, so too does our ability to access and
process these data to perform meaningful
bibliometric analyses of the published
literature. Previous publications have
analyzed the neurosurgical literature by
ranking articles in neurosurgical journals
according to total citation counts.1,2
Analyses such as these enable us to
objectively identify seminal contributions
to neurosurgery, to better understand
what it takes to make an impact in our
field, and to identify those classic neuro-
surgical articles on which many of our
guiding principles were founded.1-3
Although appraisals based on total
citation count alone are valuable, they
come with many limitations. Older pub-
lications are given an advantage over
newer and potentially more relevant
studies, and older studies cannot be
assessed for their impact over time or
their continued relevance in modern
WORLD NEUROSURGERY -: ---, MONTH 2017
- BACKGROUND: Bibliometric analyses based on total citation count come
with many limitations, which investigators in other fields have overcome using
the average number of citations per year since publication.
- METHOD: The following study is presented in 2 parts. In this first part, the 100
most relevant articles in neurosurgical journals were identified and ranked by
total citations per year since publication. We queried the Web of Science
database for the 1000 most-cited articles in neurosurgical journals. The number
of citations per year was calculated for these 1000 articles, and the top 100 were
identified.
- RESULTS: Among the top 100 most relevant articles, 63 were from the Journal
of Neurosurgery, 26 from Neurosurgery, 7 from the Journal of Neurology,
Neurosurgery, and Psychiatry, 3 from Acta Neurochirurgica, and 1 from Surgical
Neurology. The average year of publication for the 100 most relevant articles is
1995, compared with 1984 for the list of most-cited articles published by Ponce
and Lozano in 2010 (P < 0.001).
- CONCLUSION: These results suggest that ranking articles based on rele-
vancy rather than historical popularity results in a list of more recently pub-
lished articles and includes more studies addressing topics of surgical
management and outcomes. The ability to appraise the literature in this fashion
is worthwhile to those seeking a better understanding of the science underlying
modern clinical practice and is thus a highly valuable tool for neurosurgical
residents, program directors, and neuroscientists as they acquire an under-
standing of modern neurosurgery and its scientific foundation.
practice. Moreover, well-established spe- This study is presented in 2 parts. In
cialties are overrepresented compared this first part, we have identified and
with relatively newer specialties, creating ranked the 100 most relevant articles in
an out-of-date picture of modern clinical neurosurgical journals according to total
practice. Investigators in other fields have citations per year since publication. In the
overcome the bias of total citation counts second part, we reevaluate a previously
by using an alternative measure of the published list of neurosurgical classics2 by
impact of an article: the average number charting the number of citations for each
of citations per year since publication.4-8 article as a function of time. This
Because this metric takes into account analysis enables us to identify those
the length of time since an article was neurosurgical articles that have a steady
published, it provides not only a measure or an increasing number of citations per
of the popularity of the article but, more year (the working definition of a
importantly, its relevance in modern foundational article).
practice. By further applying this metric
to articles considered classics, one can
identify those classics that have main- METHODS
tained their relevance over time and In the first part of this study, we identified
continue to guide modern practice: the 100 most relevant articles in neuro-
so-called foundational studies.4 surgical journals. We began by using a
www.WORLDNEUROSURGERY.org 1

MICHAEL A. BOHL AND FRANCISCO A. PONCE
method similar to that described in 2010
by Ponce and Lozano1 in their report on
the 100 most-cited articles in neurosur-
gical journals. Because Web of Science
does not yet enable users to order results
by the number of citations per year since
publication, we made the assumption that
the 100 articles with the highest number of
citations per year would be captured in a
list of the 1000 articles with the highest
total citation counts. Limiting ourselves to
the same journals searched by Ponce and
Lozano,1 and 1 additional journal (World
Neurosurgery, which began publishing in
2010), we queried the Web of Science
database for the 1000 most-cited articles
in neurosurgical journals (citation range,
3308e157). This task was performed by
searching for each journal under “Publi-
cation Name” and using the “OR” Boolean
function to separate fields. The results
were then ordered by “times cited.”
The number of citations per year was
calculated for these 1000 articles using the
following method. First, the number of
days since publication was calculated by
subtracting the publication month and
year from the current month and year
(calculated in April 2014). Any article
without a month of publication was
assumed to have been published in June,
and all articles were assumed to have been
published on the first of the month. The
number of days since publication was then
converted back to years by dividing by
365.25. The total number of citations of
each article was then divided by the years
since publication to give an average
number of citations per year. The resulting
list was then searched for articles pub-
lished in Journal of Neurology, Neurosurgery,
and Psychiatry that were on non-
neurosurgical topics; 35 articles pertaining
only to neurology and psychiatry were
found within the top 135 articles and were
subsequently deleted to create a list of the
100 most relevant neurosurgical articles
published in neurosurgical journals.
To allow for a more meaningful com-
parison between these results and those of
Ponce and Lozano,1 we used their
methodology for selecting neurosurgical
journals to include in the search. The
database for this study was compiled in
April 2014, and the results reflect the
relevancy scores for neurosurgical articles
published at that time. Since Ponce and
Lozano compiled their database in 2010,
2 www.SCIENCEDIRECT.com
THE 100 MOST RELEVANT PAPERS IN NEUROSURGICAL JOURNALS
the Web of Science has begun restricting
the timescale of searches to include only
those articles published since 1965.
Because Ponce and Lozano1 compiled
their list more than 5 years ago, a new list
of the 100 most-cited articles was created
using Ponce and Lozano’s1 method, and
the average year of publication for this list
was compared both with the list of 100
most-cited articles in 2010 and with the
current list of the 100 most relevant articles
presented in this article.
RESULTS
Fourteen neurosurgical journals were iden-
tified (Table 1). All 14 journals were
searched and the 100 most relevant
neurosurgical articles published since 1965
were identified (Table 2). Among these
articles were 63 from Journal of Neurosurgery,
26 from Neurosurgery, 7 from Journal of
Neurology, Neurosurgery, and Psychiatry, 3
from Acta Neurochirurgica, and 1 from
Surgical Neurology. The number of citations
per year ranged from 59.56 to 17.26. The
publication dates ranged from June 1968 to
April 2009, with 40 articles being
published since 2000, 43 from 1990e1999,
15 from 1980e1989, and 2 before 1980.
Fields of Study
For ease of comparison, the articles were
categorized into the same categories used
Table 1. List of Neurosurgical Journals
Searched
Acta Neurochirurgica
British Journal of Neurosurgery
Clinical Neurology and Neurosurgery
Journal of Neurology, Neurosurgery, and
Psychiatry
Journal of Neurosurgery
Minimally Invasive Neurosurgery
Neurosurgery
Neurosurgery Clinics of North America
Neurosurgical Review
Neurosurgery Quarterly
Pediatric Neurosurgery
Stereotactic and Functional Neurosurgery
Surgical Neurology
World Neurosurgery
WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2017.03.149
LITERATURE REVIEW
by Ponce and Lozano,1 specifically,
cerebrovascular, tumor, trauma, and
functional neurosurgery. The trauma
category included both cranial and spine
trauma, and the functional category
included all articles on stereotaxy,
epilepsy, deep brain stimulation, and
pain. Ninety-five articles fit into 1 of
these categories, with the other 5 articles
pertaining to infection and flow dysregu-
lation of cerebrospinal fluid (numbers 9,
26, 67, 75, and 80).
The best-represented field was cere-
brovascular surgery, with 37 articles
(Table 3). Reports of endovascular
treatments and outcomes were the
highest represented subtopic (n ¼ 11),
followed by studies of cerebral flood flow
and ischemia (n ¼ 9).
There were 27 tumor studies, 14 of
which related to gliomas, particularly
extent of resection and other factors that
influence survival (n ¼ 6). Other tumor
topics included sellar/parasellar tumors,
meningiomas, and intraoperative mag-
netic resonance imaging.
Nineteen studies addressed various as-
pects of neurologic trauma, of which 3
addressed spinal trauma and injury. The
16 studies on brain injury addressed mild
traumatic brain injury (n ¼ 6), severe
traumatic brain injury (n ¼ 6), animal
models (n ¼ 2), epidemiology (n ¼ 1), and
a computed tomographyebased classifi-
cation system (n ¼ 1).
There were 12 articles in functional
neurosurgery. Most of these articles
addressed deep brain stimulation (n ¼ 8),
with other prominent subtopics including
treatments for Parkinson disease (n ¼ 6)
and the implantation of biological agents
(n ¼ 2).
Other topics not classified by these
categories included syringomyelia in
Chiari I malformation, neurologic mani-
festations of AIDS, shunt design, and
endoscopic third ventriculostomy
outcomes.
Type of Study
Articles were further categorized into 1 of
6 study types: surgical management
strategies, nonsurgical management
strategies, natural history of a disease,
classification scheme for a disease, topic
reviews, and laboratory studies. Surgical
management articles included endovas-
cular and radiation therapies, as well as
 LITERATURE REVIEW
MICHAEL A. BOHL AND FRANCISCO A. PONCE THE 100 MOST RELEVANT PAPERS IN NEUROSURGICAL JOURNALS

Table 2. The 100 Most Relevant Articles in Neurosurgical Journals

Total Rank by
Rank Article Year Citations Citations/Year Total Citations

1 Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, et al. A multivariate 2001 757 59.56 11
analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and
survival. J Neurosurg. 2001;95:190-198.
2 Aaslid R, Markwalder TM, Nornes H. Noninvasive transcranial Doppler ultrasound recording of 1982 1703 53.42 2
flow velocity in basal cerebral arteries. J Neurosurg. 1982;57:769-774.
3 Kassell NF, Torner JC, Jane JA, Haley EC Jr., Adams HP. The International Cooperative Study 1990 1139 47.86 4
on the Timing of Aneurysm Surgery. Part 2: Surgical results. J Neurosurg. 1990;73:37-47.
4 Lylyk P, Miranda C, Ceratto R, Ferrario A, Scrivano E, Luna HR, et al. Curative endovascular 2009 238 47.19 74
reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires
experience. Neurosurgery. 2009;64:632-642 [discussion 642-633; quiz N636].
5 Sanai N, Berger MS. Glioma extent of resection and its impact on patient outcome. 2008 284 47.00 63
Neurosurgery. 2008;62:753-764 [discussion 264-756].
6 Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage 1980 1577 46.55 3
visualized by computerized tomographic scanning. Neurosurgery. 1980;6:1-9.
7 Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial 1968 1785 38.90 1
aneurysms. J Neurosurg. 1968;28:14-20.
8 Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, et al. Guglielmi detachable 2003 408 37.21 42
coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg. 2003;98:959-966.
9 Levy RM, Bredesen DE, Rosenblum ML. Neurological manifestations of the acquired 1985 1039 35.98 6
immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature.
J Neurosurg. 1985;62:475-495.
10 Stummer W, Reulen HJ, Meinel T, Pichlmeier U, Schumacher W, Tonn JC, et al. Extent of 2008 220 35.90 78
resection and survival in glioblastoma multiforme: identification of and adjustment for bias.
Neurosurgery. 2008;62:564-576 [discussion 564-576].
11 Vinuela F, Duckwiler G, Mawad M. Guglielmi detachable coil embolization of acute intracranial 1997 608 35.49 17
aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg.
1997;86:475-482.
12 Laitinen LV, Bergenheim AT, Hariz MI. Leksell’s posteroventral pallidotomy in the treatment of 1992 758 34.00 9
Parkinson’s disease. J Neurosurg. 1992;76:53-61.
13 Guglielmi G, Vinuela F, Dion J, Duckwiler G. Electrothrombosis of saccular aneurysms via 1991 758 33.25 10
endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg. 1991;75:8-14.
14 Benabid AL, Pollak P, Gao D, Hoffmann D, Limousin P, Gay E, et al. Chronic electrical 1996 604 33.17 18
stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement
disorders. J Neurosurg. 1996;84:203-214.
15 Siesjo BK. Pathophysiology and treatment of focal cerebral ischemia. Part I: Pathophysiology. 1992 718 33.07 13
J Neurosurg. 1992;77:169-184.
16 Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. 1986 880 31.95 7
J Neurosurg. 1986;65:476-483.
17 Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J. A systematic review of brain injury 2006 258 31.73 69
epidemiology in Europe. Acta Neurochir (Wien). 2006;148:255-268 [discussion 268].
18 Ojemann G, Ojemann J, Lettich E, Berger M. Cortical language localization in left, dominant 1989 768 31.18 8
hemisphere. An electrical stimulation mapping investigation in 117 patients. J Neurosurg.
1989;71:316-326.
19 de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ. Incidence of subarachnoid 2007 196 30.73 84
haemorrhage: a systematic review with emphasis on region, age, gender and time trends.
J Neurol Neurosurg Psychiatry. 2007;78:1365-1372.

Continues

WORLD NEUROSURGERY -: ---, MONTH 2017 www.WORLDNEUROSURGERY.org 3

 LITERATURE REVIEW
MICHAEL A. BOHL AND FRANCISCO A. PONCE THE 100 MOST RELEVANT PAPERS IN NEUROSURGICAL JOURNALS

Table 2. Continued
Total Rank by
Rank Article Year Citations Citations/Year Total Citations
20 Walker MD, Alexander E Jr., Hunt WE, MacCarty CS, Mahaley MS Jr., Mealey J Jr., et al. 1978 1091 30.40 5
Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative
clinical trial. J Neurosurg. 1978;49:333-343.
21 Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord trauma with 1991 693 30.40 14
emphasis on vascular mechanisms. J Neurosurg. 1991;75:15-26.
22 Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Cantu RC, Randolph C, et al. Association 2005 257 30.08 70
between recurrent concussion and late-life cognitive impairment in retired professional
football players. Neurosurgery. 2005;57:719-726 [discussion 719-726].
23 Rosner MJ, Rosner SD, Johnson AH. Cerebral perfusion pressure: management protocol and 1995 520 28.29 28
clinical results. J Neurosurg. 1995;83:949-962.
24 Huang J, Upadhyay UM, Tamargo RJ. Inflammation in stroke and focal cerebral ischemia. Surg 2006 211 27.67 79
Neurol. 2006;66:232-245.
25 Ogden AT, Waziri AE, Lochhead RA, Fusco D, Lopez K, Ellis JA, et al. Identification of 2008 171 27.55 93
A2B5þCD133-tumor-initiating cells in adult human gliomas. Neurosurgery. 2008;62:505-514
[discussion 514-505].
26 Milhorat TH, Chou MW, Trinidad EM, Kula RW, Mandell M, Wolpert C, et al. Chiari I 1999 410 27.40 41
malformation redefined: clinical and radiographic findings for 364 symptomatic patients.
Neurosurgery. 1999;44:1005-1017.
27 Katayama Y, Becker DP, Tamura T, Hovda DA. Massive increases in extracellular potassium and 1990 638 27.29 15
the indiscriminate release of glutamate following concussive brain injury. J Neurosurg.
1990;73:889-900.
28 Black PM, Moriarty T, Alexander E, 3rd, Stieg P, Woodard EJ, Gleason PL, et al. Development 1997 447 27.02 36
and implementation of intraoperative magnetic resonance imaging and its neurosurgical
applications. Neurosurgery. 1997;41:831-842 [discussion 842-835].
29 Siesjo BK. Pathophysiology and treatment of focal cerebral ischemia. Part II: Mechanisms of 1992 579 26.77 21
damage and treatment. J Neurosurg. 1992;77:337-354.
30 Fourney DR, Schomer DF, Nader R, Chlan-Fourney J, Suki D, Ahrar K, et al. Percutaneous 2003 299 26.48 57
vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients.
J Neurosurg. 2003;98:21-30.
31 Guglielmi G, Vinuela F, Sepetka I, Macellari V. Electrothrombosis of saccular aneurysms via 1991 586 25.70 20
endovascular approach. Part 1: Electrochemical basis, technique, and experimental results.
J Neurosurg. 1991;75:1-7.
32 Laws ER, Parney IF, Huang W, Anderson F, Morris AM, Asher A, et al. Survival following 2003 273 25.69 65
surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma
Outcomes Project. J Neurosurg. 2003;99:467-473.
33 Funkiewiez A, Ardouin C, Caputo E, Krack P, Fraix V, Klinger H, et al. Long term effects of 2004 248 25.11 72
bilateral subthalamic nucleus stimulation on cognitive function, mood, and behaviour in
Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2004;75:834-839.
34 Biondi A, Janardhan V, Katz JM, Salvaggio K, Riina HA, Gobin YP. Neuroform stent-assisted 2007 165 24.90 96
coil embolization of wide-neck intracranial aneurysms: strategies in stent deployment and
midterm follow-up. Neurosurgery. 2007;61:460-468 [discussion 468-469].
35 Marmarou A, Foda MA, van den Brink W, Campbell J, Kita H, Demetriadou K. A new model of 1994 498 24.64 31
diffuse brain injury in rats. Part I: Pathophysiology and biomechanics. J Neurosurg.
1994;80:291-300.
36 Aarabi B, Hesdorffer DC, Ahn ES, Aresco C, Scalea TM, Eisenberg HM. Outcome following 2006 196 24.36 85
decompressive craniectomy for malignant swelling due to severe head injury. J Neurosurg.
2006;104:469-479.

Continues

4 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2017.03.149

 LITERATURE REVIEW
MICHAEL A. BOHL AND FRANCISCO A. PONCE THE 100 MOST RELEVANT PAPERS IN NEUROSURGICAL JOURNALS

Table 2. Continued
Total Rank by
Rank Article Year Citations Citations/Year Total Citations
37 Muizelaar JP, Marmarou A, Ward JD, Kontos HA, Choi SC, Becker DP, et al. Adverse effects of 1991 528 23.50 27
prolonged hyperventilation in patients with severe head injury: a randomized clinical trial.
J Neurosurg. 1991;75:731-739.
38 Kassell NF, Torner JC, Haley EC Jr., Jane JA, Adams HP, Kongable GL. The International 1990 559 23.49 23
Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results.
J Neurosurg. 1990;73:18-36.
39 Ciric I, Ragin A, Baumgartner C, Pierce D. Complications of transsphenoidal surgery: results of 1997 403 23.42 45
a national survey, review of the literature, and personal experience. Neurosurgery.
1997;40:225-236 [discussion 236-227].
40 Slevin JT, Gerhardt GA, Smith CD, Gash DM, Kryscio R, Young B. Improvement of bilateral 2005 210 22.81 80
motor functions in patients with Parkinson disease through the unilateral intraputaminal
infusion of glial cell line-derived neurotrophic factor. J Neurosurg. 2005;102:216-222.
41 Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. A prospective study of acute 1990 550 22.64 24
cerebrovascular disease in the community: the Oxfordshire Community Stroke Project–1981-86.
2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary
intracerebral and subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 1990;53:16-22.
42 Jones TH, Morawetz RB, Crowell RM, Marcoux FW, FitzGibbon SJ, DeGirolami U, et al. 1981 742 22.56 12
Thresholds of focal cerebral ischemia in awake monkeys. J Neurosurg. 1981;54:773-782.
43 Dixon CE, Lyeth BG, Povlishock JT, Findling RL, Hamm RJ, Marmarou A, et al. A fluid 1987 601 22.42 19
percussion model of experimental brain injury in the rat. J Neurosurg. 1987;67:110-119.
44 Houeto JL, Mesnage V, Mallet L, Pillon B, Gargiulo M, du Moncel ST, et al. Behavioural 2002 265 22.31 67
disorders, Parkinson’s disease and subthalamic stimulation. J Neurol Neurosurg Psychiatry.
2002;72:701-707.
45 Stummer W, Novotny A, Stepp H, Goetz C, Bise K, Reulen HJ. Fluorescence-guided resection of 2000 298 22.28 59
glioblastoma multiforme by using 5-aminolevulinic acid-induced porphyrins: a prospective
study in 52 consecutive patients. J Neurosurg. 2000;93:1003-1013.
46 Schupbach WM, Chastan N, Welter ML, Houeto JL, Mesnage V, Bonnet AM, et al. Stimulation 2005 185 22.08 88
of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up. J Neurol Neurosurg
Psychiatry. 2005;76:1640-1644.
47 Robinson JR, Awad IA, Little JR. Natural history of the cavernous angioma. J Neurosurg. 1991 494 21.99 33
1991;75:709-714.
48 Dumont AS, Dumont RJ, Chow MM, Lin CL, Calisaneller T, Ley KF, et al. Cerebral vasospasm 2003 234 21.67 75
after subarachnoid hemorrhage: putative role of inflammation. Neurosurgery. 2003;53:123-133
[discussion 133-125].
49 Ondra SL, Troupp H, George ED, Schwab K. The natural history of symptomatic arteriovenous 1990 510 21.58 30
malformations of the brain: a 24-year follow-up assessment. J Neurosurg. 1990;73:387-391.
50 Inglese M, Makani S, Johnson G, Cohen BA, Silver JA, Gonen O, et al. Diffuse axonal injury in 2005 188 21.58 86
mild traumatic brain injury: a diffusion tensor imaging study. J Neurosurg. 2005;103:298-303.
51 Byrne JV, Sohn MJ, Molyneux AJ, Chir B. Five-year experience in using coil embolization for 1999 324 21.53 53
ruptured intracranial aneurysms: outcomes and incidence of late rebleeding. J Neurosurg.
1999;90:656-663.
52 Benitez RP, Silva MT, Klem J, Veznedaroglu E, Rosenwasser RH. Endovascular occlusion of 2004 208 21.06 81
wide-necked aneurysms with a new intracranial microstent (Neuroform) and detachable coils.
Neurosurgery. 2004;54:1359-1367 [discussion 1368].
53 Raabe A, Nakaji P, Beck J, Kim LJ, Hsu FP, Kamerman JD, et al. Prospective evaluation of 2005 171 20.41 94
surgical microscope-integrated intraoperative near-infrared indocyanine green
videoangiography during aneurysm surgery. J Neurosurg. 2005;103:982-989.

Continues

WORLD NEUROSURGERY -: ---, MONTH 2017 www.WORLDNEUROSURGERY.org 5

 LITERATURE REVIEW
MICHAEL A. BOHL AND FRANCISCO A. PONCE THE 100 MOST RELEVANT PAPERS IN NEUROSURGICAL JOURNALS

Table 2. Continued
Total Rank by
Rank Article Year Citations Citations/Year Total Citations
54 Simpkins JW, Rajakumar G, Zhang YQ, Simpkins CE, Greenwald D, Yu CJ, et al. Estrogens may 1997 334 20.29 52
reduce mortality and ischemic damage caused by middle cerebral artery occlusion in the
female rat. J Neurosurg. 1997;87:724-730.
55 Westphal M, Ram Z, Riddle V, Hilt D, Bortey E. Gliadel wafer in initial surgery for malignant 2006 164 20.17 97
glioma: long-term follow-up of a multicenter controlled trial. Acta Neurochir (Wien).
2006;148:269-275 [discussion 275].
56 Raabe A, Beck J, Gerlach R, Zimmermann M, Seifert V. Near-infrared indocyanine green video 2003 224 19.83 76
angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery.
2003;52:132-139 [discussion 139].
57 Fiorella D, Albuquerque FC, Deshmukh VR, McDougall CG. Usefulness of the Neuroform stent 2005 176 19.82 91
for the treatment of cerebral aneurysms: results at initial (3-6-mo) follow-up. Neurosurgery.
2005;56:1191-1201 [discussion 1201-1192].
58 Guglielmi G, Vinuela F, Duckwiler G, Dion J, Lylyk P, Berenstein A, et al. Endovascular treatment 1992 427 19.82 38
of posterior circulation aneurysms by electrothrombosis using electrically detachable coils.
J Neurosurg. 1992;77:515-524.
59 Hochberg FH, Miller DC. Primary central nervous system lymphoma. J Neurosurg. 1988 512 19.78 29
1988;68:835-853.
60 Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M. Surgical treatment of 1999 299 19.66 58
craniopharyngiomas: experience with 168 patients. J Neurosurg. 1999;90:237-250.
61 Duffau H, Lopes M, Arthuis F, Bitar A, Sichez JP, Van Effenterre R, et al. Contribution of 2005 174 19.60 92
intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study
between two series without (1985-96) and with (1996-2003) functional mapping in the same
institution. J Neurol Neurosurg Psychiatry. 2005;76:845-851.
62 Levin HS, Mattis S, Ruff RM, Eisenberg HM, Marshall LF, Tabaddor K, et al. Neurobehavioral 1987 533 19.59 26
outcome following minor head injury: a three-center study. J Neurosurg. 1987;66:234-243.
63 Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T. Variations on the 2004 188 19.53 87
standard transsphenoidal approach to the sellar region, with emphasis on the extended
approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery.
2004;55:539-547 [discussion 547-550].
64 Giller CA, Bowman G, Dyer H, Mootz L, Krippner W. Cerebral arterial diameters during changes 1993 408 19.46 43
in blood pressure and carbon dioxide during craniotomy. Neurosurgery. 1993;32:737-741
[discussion 741-732].
65 Keles GE, Lamborn KR, Berger MS. Low-grade hemispheric gliomas in adults: a critical review 2001 242 19.42 73
of extent of resection as a factor influencing outcome. J Neurosurg. 2001;95:735-745.
66 Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid 1988 497 19.20 32
Hemorrhage Grading Scale. J Neurosurg. 1988;68:985-986.
67 Oldfield EH, Muraszko K, Shawker TH, Patronas NJ. Pathophysiology of syringomyelia 1994 389 19.17 46
associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and
treatment. J Neurosurg. 1994;80:3-15.
68 Stiefel MF, Spiotta A, Gracias VH, Garuffe AM, Guillamondegui O, Maloney-Wilensky E, et al. 2005 162 19.15 98
Reduced mortality rate in patients with severe traumatic brain injury treated with brain tissue
oxygen monitoring. J Neurosurg. 2005;103:805-811.
69 Rorke LB, Packer RJ, Biegel JA. Central nervous system atypical teratoid/rhabdoid tumors of 1996 340 19.10 51
infancy and childhood: definition of an entity. J Neurosurg. 1996;85:56-65.
70 Juvela S, Porras M, Poussa K. Natural history of unruptured intracranial aneurysms: probability 2000 260 19.08 68
of and risk factors for aneurysm rupture. J Neurosurg. 2000;93:379-387.
71 Lunsford LD, Kondziolka D, Flickinger JC, Bissonette DJ, Jungreis CA, Maitz AH, et al. 1991 430 19.07 37
Stereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg.
1991;75:512-524.

Continues

6 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2017.03.149

 LITERATURE REVIEW
MICHAEL A. BOHL AND FRANCISCO A. PONCE THE 100 MOST RELEVANT PAPERS IN NEUROSURGICAL JOURNALS

Table 2. Continued
Total Rank by
Rank Article Year Citations Citations/Year Total Citations
72 Bouma GJ, Muizelaar JP, Choi SC, Newlon PG, Young HF. Cerebral circulation and metabolism 1991 427 19.01 39
after severe traumatic brain injury: the elusive role of ischemia. J Neurosurg. 1991;75:685-693.
73 Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL. Meningioma: analysis of 1985 549 19.01 25
recurrence and progression following neurosurgical resection. J Neurosurg. 1985;62:18-24.
74 Starr PA, Christine CW, Theodosopoulos PV, Lindsey N, Byrd D, Mosley A, et al. Implantation of 2002 222 18.95 77
deep brain stimulators into the subthalamic nucleus: technical approach and magnetic
resonance imaging-verified lead locations. J Neurosurg. 2002;97:370-387.
75 Drake JM, Kestle JR, Milner R, Cinalli G, Boop F, Piatt J Jr., et al. Randomized trial of 1998 296 18.84 60
cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery.
1998;43:294-303 [discussion 303-295].
76 Obrist WD, Langfitt TW, Jaggi JL, Cruz J, Gennarelli TA. Cerebral blood flow and metabolism 1984 560 18.74 22
in comatose patients with acute head injury. Relationship to intracranial hypertension.
J Neurosurg. 1984;61:241-253.
77 Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. 1981 614 18.67 16
Neurosurgery. 1981;9:221-228.
78 Borden JA, Wu JK, Shucart WA. A proposed classification for spinal and cranial dural 1995 357 18.58 49
arteriovenous fistulous malformations and implications for treatment. J Neurosurg.
1995;82:166-179.
79 Jho HD, Carrau RL. Endoscopic endonasal transsphenoidal surgery: experience with 50 1997 312 18.57 54
patients. J Neurosurg. 1997;87:44-51.
80 Hopf NJ, Grunert P, Fries G, Resch KD, Perneczky A. Endoscopic third ventriculostomy: outcome 1999 279 18.54 64
analysis of 100 consecutive procedures. Neurosurgery. 1999;44:795-804 [discussion 804-806].
81 Marshall LF, Marshall SB, Klauber MR, Clark MV, Eisenberg HM, Jane JA, et al. A new 1991 416 18.52 40
classification of head injury based on computerized tomography. J Neurosurg.
1991;75:S14-S20.
82 Nimsky C, Ganslandt O, Cerny S, Hastreiter P, Greiner G, Fahlbusch R. Quantification of, 2000 249 18.50 71
visualization of, and compensation for brain shift using intraoperative magnetic resonance
imaging. Neurosurgery. 2000;47:1070-1079 [discussion 1079-1080].
83 Kroll RA, Neuwelt EA. Outwitting the blood-brain barrier for therapeutic purposes: osmotic 1998 295 18.48 61
opening and other means. Neurosurgery. 1998;42:1083-1099 [discussion 1099-1100].
84 Nuttin BJ, Gabriels LA, Cosyns PR, Meyerson BA, Andreewitch S, Sunaert SG, et al. Long-term 2003 200 18.38 83
electrical capsular stimulation in patients with obsessive-compulsive disorder. Neurosurgery.
2003;52:1263-1272 [discussion 1272-1264].
85 Zabramski JM, Wascher TM, Spetzler RF, Johnson B, Golfinos J, Drayer BP, et al. The natural 1994 370 18.38 47
history of familial cavernous malformations: results of an ongoing study. J Neurosurg.
1994;80:422-432.
86 Lovell MR, Collins MW, Iverson GL, Field M, Maroon JC, Cantu R, et al. Recovery from mild 2003 205 18.29 82
concussion in high school athletes. J Neurosurg. 2003;98:296-301.
87 Coubes P, Cif L, El Fertit H, Hemm S, Vayssiere N, Serrat S, et al. Electrical stimulation of the 2004 177 18.23 90
globus pallidus internus in patients with primary generalized dystonia: long-term results.
J Neurosurg. 2004;101:189-194.
88 Kondziolka D, Steinberg GK, Wechsler L, Meltzer CC, Elder E, Gebel J, et al. 2005 160 18.19 100
Neurotransplantation for patients with subcortical motor stroke: a phase 2 randomized trial.
J Neurosurg. 2005;103:38-45.
89 Lunsford LD, Niranjan A, Flickinger JC, Maitz A, Kondziolka D. Radiosurgery of vestibular 2005 169 18.19 95
schwannomas: summary of experience in 829 cases. J Neurosurg. 2005;102(suppl):195-199.
90 Bracken MB, Shepard MJ, Collins WF Jr., Holford TR, Baskin DS, Eisenberg HM, et al. 1992 404 18.12 44
Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up
data. Results of the second National Acute Spinal Cord Injury Study. J Neurosurg.
1992;76:23-31.

Continues

WORLD NEUROSURGERY -: ---, MONTH 2017 www.WORLDNEUROSURGERY.org 7

 LITERATURE REVIEW
MICHAEL A. BOHL AND FRANCISCO A. PONCE THE 100 MOST RELEVANT PAPERS IN NEUROSURGICAL JOURNALS

Table 2. Continued
Total Rank by
Rank Article Year Citations Citations/Year Total Citations
91 Davis FG, Freels S, Grutsch J, Barlas S, Brem S. Survival rates in patients with primary 1998 294 18.04 62
malignant brain tumors stratified by patient age and tumor histological type: an analysis based
on Surveillance, Epidemiology, and End Results (SEER) data, 1973-1991. J Neurosurg.
1998;88:1-10.
92 Maas AI, Dearden M, Teasdale GM, Braakman R, Cohadon F, Iannotti F, et al. EBIC-guidelines 1997 304 18.01 55
for management of severe head injury in adults. European Brain Injury Consortium. Acta
Neurochir (Wien). 1997;139:286-294.
93 Limousin P, Speelman JD, Gielen F, Janssens M. Multicentre European study of thalamic 1999 270 17.84 66
stimulation in parkinsonian and essential tremor. J Neurol Neurosurg Psychiatry.
1999;66:289-296.
94 Albert FK, Forsting M, Sartor K, Adams HP, Kunze S. Early postoperative magnetic resonance 1994 362 17.84 48
imaging after resection of malignant glioma: objective evaluation of residual tumor and its
influence on regrowth and prognosis. Neurosurgery. 1994;34:45-60 [discussion 60-41].
95 Daumas-Duport C, Scheithauer BW, Chodkiewicz JP, Laws ER Jr., Vedrenne C. 1988 454 17.83 35
Dysembryoplastic neuroepithelial tumor: a surgically curable tumor of young patients with
intractable partial seizures. Report of thirty-nine cases. Neurosurgery. 1988;23:545-556.
96 Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, et al. Primary intracranial 1997 303 17.69 56
germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg.
1997;86:446-455.
97 Fiorella D, Albuquerque FC, Han P, McDougall CG. Preliminary experience using the Neuroform 2004 181 17.58 89
stent for the treatment of cerebral aneurysms. Neurosurgery. 2004;54:6-16 [discussion 16-17].
98 Goldsmith BJ, Wara WM, Wilson CB, Larson DA. Postoperative irradiation for subtotally 1994 352 17.42 50
resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990.
J Neurosurg. 1994;80:195-201.
99 Nimsky C, Ganslandt O, Hastreiter P, Wang R, Benner T, Sorensen AG, et al. Preoperative and 2005 161 17.33 99
intraoperative diffusion tensor imaging-based fiber tracking in glioma surgery. Neurosurgery.
2005;56:130-137 [discussion 138].
100 Kelly PJ, Daumas-Duport C, Kispert DB, Kall BA, Scheithauer BW, Illig JJ. Imaging-based 1987 464 17.26 34
stereotaxic serial biopsies in untreated intracranial glial neoplasms. J Neurosurg.
1987;66:865-874.

procedures performed for diagnostic
purposes.1 Nonsurgical management
included intensive care unit management,
medication-based therapies, and nonsur-
gical diagnostic studies. Natural history
articles included primarily observational
studies of disease and outcomes in the
absence of any diagnostic or therapeutic
procedure. Classification studies described
new systems for classifying diseases and
disease severity, as well as predicted out-
comes based on the new classification
scheme. Laboratory studies included pa-
thology series, animal studies, and basic
science research. Table 4 shows the number
of each type of study pertaining to each field
of study according to these classifications.
Fifty-two articles described surgical
management strategies. Eighteen of these
articles addressed surgical management of
cerebrovascular diseases. Fourteen studies
were of long-term surgical outcomes, 5 of
which addressed outcomes after the sur-
gical treatment of gliomas (numbers 1, 5,
10, 32, and 55). Eleven studies described
functional neurosurgery techniques,
including 1 study of cortical language
localization (number 18) and 2 studies on
the implantation of biological agents into
deep brain targets (numbers 40 and 88).
Topics applicable to tumor surgery were
addressed in 19 articles, including 5 arti-
cles on long-term glioma outcomes
(numbers 1, 5, 10, 32, and 55), 5 articles on
perioperative and intraoperative imaging
of brain tumors (numbers 28, 45, 82, 99,
and 100), and 2 articles on meningioma
outcomes (numbers 73 and 98). There
were also 4 studies on endoscopic/trans-
sphenoidal procedures (numbers 39, 63,
79, and 80). There was 1 study each on the
surgical management of spine fractures
(number 30), assessment of a new shunt
valve used for pediatric hydrocephalus
(number 75), and invasive brain tissue
oxygen monitoring in severe traumatic
brain injury (number 68).
Eighteen articles were reviews, 7 of
which addressed the pathophysiology of
various disease states (numbers 15, 21, 24,
48, 67, 72, and 76). Five studies reviewed
specific diseases and factors affecting pa-
tient outcomes (numbers 9, 44, 59, 65, and
69), and 2 studies were epidemiologic re-
views (numbers 17 and 19).
There were 11 natural history articles,
including 4 articles on outcomes after
head injury that did not focus on a specific
surgical or medical treatment modality
(numbers 22, 62, 77, and 86). There were 5

8 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2017.03.149


MICHAEL A. BOHL AND FRANCISCO A. PONCE
Table 3. The 100 Most Relevant Articles by Topic
Report Topic
Vascular (n ¼ 37)
Intracranial aneurysms and/or subarachnoid hemorrhage (n ¼ 22)
Endovascular techniques and treatment outcomes (n ¼ 11)
Open surgical treatment of aneurysms (n ¼ 4)
Cerebral blood flow and ischemia/stroke (n ¼ 9)
Pathophysiologic studies (n ¼ 5)
Treatment (n ¼ 3)
Use of indocyanine green angiography (n ¼ 1)
Vascular malformations (n ¼ 6)
Cranial arteriovenous malformations (n ¼ 3)
Cavernous malformations (n ¼ 2)
Spinal dural arteriovenous fistulas (n ¼ 1)
Tumor (n ¼ 27)
Gliomas (n ¼ 14)
Extent of resection, factors influencing survival (n ¼ 6)
Other (n ¼ 8)
Transsphenoidal approaches, sellar/parasellar disease (n ¼ 4)
Meningioma: recurrence, postoperative irradiation (n ¼ 2)
Intraoperative magnetic resonance imaging (n ¼ 2)
Other (n ¼ 5)
Primary central nervous system lymphoma (n ¼ 1)
Atypical teratoid rhabdoid tumor (n ¼ 1)
Radiosurgery for acoustic neuroma (n ¼ 1)
Dysembryoplastic neuroepithelial tumor (n ¼ 1)
Germ cell tumors (n ¼ 1)
Trauma (n ¼ 19)
Mild traumatic brain injury: pathophysiology, outcome, treatment
(n ¼ 6)
Severe traumatic brain injury (n ¼ 6)
Intensive care unit management (n ¼ 3)
Cerebral circulation (n ¼ 2)
Surgical management (n ¼ 1)
Spinal cord trauma/injury (n ¼ 3)
Pathophysiology review (n ¼ 1)
Percutaneous kyphoplasty in patients with cancer (n ¼ 1)
Use of methylprednisolone in acute spinal cord injury (n ¼ 1)
*Refers to the article number in Table 2.
WORLD NEUROSURGERY -: ---, MONTH 2017
LITERATURE REVIEW
THE 100 MOST RELEVANT PAPERS IN NEUROSURGICAL JOURNALS
studies on the natural history of various
cerebrovascular diseases, including stroke
Article Number* (number 41), spontaneous and familial
cavernous malformations (numbers 47 and
85), symptomatic arteriovenous malfor-
mations (number 49), and unruptured
aneurysms (number 70). There were also
4, 8, 11, 13, 31, 34, 51, 52, 57, 58,
articles on Chiari I malformations (num-
97
ber 26) and primary malignant brain tu-
3, 7, 38, 53 mors (number 91).
Eight studies were on nonsurgical
management strategies, 3 of which
15, 24, 29, 42, 64
focused on noninvasive diagnostic tests
23, 54, 83 (numbers 2, 50, and 94). One study
56 described methods of penetrating the
blood-brain barrier (number 83), another
addressed the use of methylprednisolone
16, 49, 71 in acute spinal cord injury (number 90),
47, 85 and 1 study offered guidelines on the
78 medical management of severe head injury
in adults (number 92).
There were 6 laboratory studies and 5
classification studies. The laboratory
1, 5, 10, 32, 65, 91 studies included 4 animal model studies: 2
rat models of brain injury (numbers 35 and
20, 25, 45, 55, 61, 94, 99, 100
43), 1 rat study of estrogens used to treat
39, 60, 63, 79 stroke, and 1 monkey model for testing
73, 98 thresholds of focal cerebral ischemia
(number 42). There was also 1 study on
28, 82
tumor-initiating cells in adult human gli-
omas (number 25), and 1 study on cellular
59 pathophysiology in concussive brain injury
(number 27). The classification studies
69
included 2 grading systems for subarach-
89 noid hemorrhage (1 image based and the
95 other clinically based), 1 grading system for
arteriovenous malformations (number 16),
96
1 classification scheme for cranial and
spinal dural arteriovenous fistulas (number
22, 27, 50, 62, 77, 86 78), and 1 computed tomographyebased
classification of head injury (number 81).
37, 68, 92 List Comparisons
Compared with Ponce and Lozano’s1 2010
72, 76
list of most-cited articles, this list of the
36 most relevant articles contains several
important differences. Most (58%) of the
21
articles on the list of most relevant studies
do not appear on the 2010 list of most-
30 cited articles. Of the 42 articles that are
90 common between the lists, 33 are among
the top 50 most-cited articles in 2010. The
list of most relevant articles furthermore
Continues
represents a broader and more even
www.WORLDNEUROSURGERY.org 9
 LITERATURE REVIEW
MICHAEL A. BOHL AND FRANCISCO A. PONCE THE 100 MOST RELEVANT PAPERS IN NEUROSURGICAL JOURNALS

distribution of journals than the 2010 list

Table 3. Continued of most-cited articles (Table 5). Although
Report Topic Article Number* cerebrovascular surgery remains the best-
represented field on both lists, there are
Other (n ¼ 4) more than twice as many articles on
Animal models of brain injury (n ¼ 2) 35, 43 endovascular techniques on the relevancy
Epidemiology of brain injury (n ¼ 1) 17 list than on the 2010 total citations list
(11 vs. 5). There are also more than twice
Computed tomographyebased classification of head injury 81 as many articles on topics related to tumor
(n ¼ 1)
surgery (27 vs. 12). In addition, the rele-
Functional (n ¼ 12) vancy list has fewer trauma studies (19 vs.
Disorders 27) and a similar number of functional
neurosurgery articles (12 vs. 13).
Parkinson disease (n ¼ 6) 12, 33, 40, 44, 46, 93
With regard to the types of studies, the
Other disorders (n ¼ 3) relevancy list has many more studies on
Movement disorders (n ¼ 1) 14 surgical management than does the most-
cited list (54 vs. 37). There were fewer
Obsessive-compulsive disorder (n ¼ 1) 84
laboratory studies (5 vs. 21) and fewer
Dystonia (n ¼ 1) 87 classification articles on the relevancy list
Procedures (5 vs. 11).
Not surprisingly, the list of most rele-
Surgical management (n ¼ 11)
vant articles in neurosurgical journals
Deep brain stimulation (n¼ 8) 14, 33, 44, 46, 74, 84, 87, 93 includes more recently published articles
Implantation of biological agents (n ¼ 2) 40, 88 than the list of most-cited articles. The
Pallidotomy (n ¼ 1) 12
average year of publication for the 100
most relevant articles is 1995, compared
Diagnostic studies (n ¼ 1) with 1984 for the list of most-cited arti-
Cortical language localization via electric stimulation mapping 18 cles published by Ponce and Lozano1 in
Other (n ¼ 5) 2010, and 1984 for the list of 100 most-
cited articles calculated in April 2014.
Syringomyelia (n ¼ 1) 26, 67 The Ponce and Lozano list compiled in
Neurologic manifestations of AIDS (n ¼ 1) 9 2010 included 5 articles published before
Shunt valve design (n ¼ 1) 75 1965 that were excluded from the lists
created in April 2014. The 100 most
Outcome analysis of endoscopic third ventriculostomy (n ¼ 1) 80
relevant articles in 2014 had a signifi-
*Refers to the article number in Table 2. cantly later average date of publication
than either the 2010 list of most-cited
articles (P < 0.001) or the April 2014 list
of most-cited articles (P < 0.001). The
average publication year of the 2010
most-cited articles list was not signifi-
cantly different from the same list created
in April 2014 (P ¼ 0.251).
Table 4. Number of Articles in Each Field by Type of Study
Field of Study DISCUSSION
The creation of relevancy lists will
Study Type Cerebrovascular Tumor Trauma Functional Other Total become ever more important as the total
volume of the neurosurgical literature
Surgical management 18 19 2 11 2 52
continues to increase at a pace that out-
Review 6 5 4 1 3 19 strips the individual resident or new
Natural history 5 1 4 0 0 10 attending physician’s ability to consume
Nonsurgical management 2 1 5 0 0 8
and master a given specialty’s canon of
basic science and clinical research.
Laboratory 2 1 3 0 0 6 Furthermore, such lists could be useful to
Classification 4 0 1 0 0 5 neurosurgery residency programs that are
Total 37 27 19 12 5 100 looking for ways to maximize the amount
of time required for resident reading,

10 www.SCIENCEDIRECT.com WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2017.03.149


MICHAEL A. BOHL AND FRANCISCO A. PONCE
Table 5. Comparison of Journal Distribution Between 2010 List of Most-Cited and 2014 List of Most Relevant Articles
Journal of
List Neurosurgery
2014 list of 100 most relevant studies 63
2010 Ponce and Lozano’s list of 79
most-cited studies
such as in journal club meetings or dur-
ing mandated resident time outside the
hospital.
Similar to what investigators in other
fields have previously reported,4-8 these
results show that ranking neurosurgical
articles based on the total number of ci-
tations received per year since publication
is an easy and reliable method for creating
a list of neurosurgery’s most relevant
studies. In addition, this method could be
applied to specific specialties in neuro-
surgery; for example, to create lists of the
most relevant articles in pediatric, cere-
brovascular, or functional neurosurgery.
Many neurosurgeons have published
most-cited article lists for specific sub-
specialties,9-11 and they include in these
lists the number of citations per year for
each study. However, as shown in our re-
sults, the list of most-cited articles can
differ significantly from the list of articles
with the greatest number of citations per
year. Taking a list of the most highly cited
articles, then reordering them based on
citations per year, is not the same as
searching for and ranking studies based
on the number of citations per year. The
method described earlier, in which we
first created a list of the 1000 most highly
cited articles and then used this list to find
those with the greatest number of cita-
tions per year, is 1 approach to identifying
those studies most relevant to a particular
field.
These results suggest that ranking arti-
cles based on relevancy rather than his-
torical popularity produces a list of more
recently published articles that represent a
more even spectrum of subspecialties, a
wider spectrum of journals, and a greater
number of studies addressing topics of
surgical management and outcomes.
Although 42 of these articles are also
present on Ponce and Lozano’s 2010 list,
the fact that 58 of the most-cited articles in
2010 are missing from the list suggests
that more than one half of the articles on
WORLD NEUROSURGERY -: ---, MONTH 2017
THE 100 MOST RELEVANT PAPERS IN NEUROSURGICAL JOURNALS
Journal of Neurology,
Neurosurgery Neurosurgery, and Psychiatry
26 7 3
10 11
the 2010 list of most-cited articles have
lost some of their relevance to modern-day
practice. Each of these lists possesses
unique usefulness and can be used based
on the reader’s intended goals. For
example, those looking for a more his-
torical perspective on the field, with
greater insight into where the field has
been before arriving at its current state,
might read articles with high total citation
counts. Alternatively, those hoping to
better understand the science underlying
current practice patterns and clinical de-
cision making might find that a list of
articles by average citations per year would
better serve their goals.
Limitations
Considering that this study drew heavily
from the method previously published by
Ponce and Lozano,1 its limitations are
similar to those they cited. By including
only neurosurgical journals, we miss all
publications pertaining to neurosurgery
that were published elsewhere (e.g.,
most landmark studies on carotid
endarterectomy). We also exclude
textbooks, citations made within
textbooks, and articles written in foreign
languages. Therefore, our assessment is
prone to excluding certain landmark
articles with great relevance to modern-
day practice that were not published in
English or in one of these neurosurgical
journals.
In addition, comparisons made between
this list and that presented by Ponce and
Lozano1 are limited by the fact that our
search was limited to articles published
since 1965. Five articles published before
1965 that were included in Ponce and
Lozano’s1 list were therefore excluded
from our analysis, and it remains
unknown how many times per year these
articles were cited. Two of these 5
articles were among the top 10 most-
cited articles in 2010, and so it may be
more likely that these articles would have
www.WORLDNEUROSURGERY.org
LITERATURE REVIEW
Acta Surgical
Neurochirurgica Neurology
1
0 0
appeared on the list of most relevant
studies if their respective citation analyses
could have been conducted.
It is also possible that this list contains
certain studies that were transiently pop-
ular after publication, but have since
stopped receiving citations because they
have lost relevance to modern-day practice
and research. With time, these studies will
fall off the list because the number of ci-
tations received per year since publication
will diminish. Nevertheless, there is likely
a lag time between when a article is no
longer relevant to modern practice and
when that article falls off the list of most
relevant articles.
Another limitation to this list and
methodology is its reliance on citations as
a measure of relevance. The number of
citations a study receives is a function not
only of its quality but also of the impact
factor of the journal in which it is pub-
lished, the referencing practices of col-
leagues in the field, and the possibility
that certain articles become routinely cited
in a given field despite having little
importance to the field. These limitations
are inherent to any study that relies on
citations as a measure of the impact of a
study and should be kept in mind when
interpreting the results.
CONCLUSIONS
In this study, we identified articles by
citations per year rather than total cita-
tion counts. With this methodology, key
differences seen in the list of articles
include greater numbers of endovascular
studies, tumor studies, and studies on
surgical management of various disor-
ders. Ranking the neurosurgical literature
based on the average number of citations
that an article receives per year since it is
published produces a list of the most
relevant studies in the field. The ability to
appraise the literature in this fashion is
worthwhile for those seeking a better
11

MICHAEL A. BOHL AND FRANCISCO A. PONCE
understanding of the science underlying
modern clinical practice, and it is thus a
highly valuable tool for neurosurgical
residents, program directors, and neuro-
scientists as they acquire an understand-
ing of modern neurosurgery and its
scientific foundation. Furthermore, this
method permits dynamic assessments of
the literature because it can be carried
out prospectively in coming years in such
a way that comparisons between lists
could show major trends in clinical
neurosurgery.
ACKNOWLEDGMENTS
The authors thank the Neuroscience Pub-
lications staff for assistance with manu-
script preparation.
REFERENCES
1. Ponce FA, Lozano AM. Highly cited works in
neurosurgery. Part I: the 100 top-cited papers in
12 www.SCIENCEDIRECT.com
THE 100 MOST RELEVANT PAPERS IN NEUROSURGICAL JOURNALS
neurosurgical journals. J Neurosurg. 2010;112:
223-232.
2. Ponce FA, Lozano AM. Highly cited works in
neurosurgery. Part II: the citation classics.
J Neurosurg. 2010;112:233-246.
3. Garfield E. What is a citation classic?. Available at:
http://garfield.library.upenn.edu/classics.html.
Accessed March 29, 2014.
4. Costanza R, Stern D, Fisher B, Lining H,
Chunbo M. Influential publications in ecological
economics: a citation analysis. Ecological Economics.
2004;50:261-292.
5. Loonen MP, Hage JJ, Kon M. Plastic surgery
classics: characteristics of 50 top-cited articles in
four plastic surgery journals since 1946. Plast
Reconstr Surg. 2008;121:320e-327e.
6. Aylward BS, Roberts MC, Colombo J, Steele RG.
Identifying the classics: an examination of articles
published in the Journal of Pediatric Psychology from
1976-2006. J Pediatr Psychol. 2008;33:576-589.
7. Efron N, Brennan NA, Nichols JJ. Citation analysis
of the contact lens field. Optom Vis Sci. 2012;89:
70-79.
WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2017.03.149
LITERATURE REVIEW
8. Namdari S, Baldwin K, Kovatch K, Huffman GR,
Glaser D. Fifty most cited articles in orthopedic
shoulder surgery. J Shoulder Elbow Surg. 2012;21:
1796-1802.
9. Khan NR, Lee SL, Brown M, Reding J, Angotti J,
Lepard J, et al. Highly cited works in skull base
neurosurgery. World Neurosurg. 2015;83:403-418.
10. Khan NR, Auschwitz T, McAbee JH, Boop FA,
Klimo P Jr. Highly cited publications in pediatric
neurosurgery: part 2. Childs Nerv Syst. 2013;29:
2215-2228.
11. Lipsman N, Lozano AM. Measuring impact in
stereotactic and functional neurosurgery: an
analysis of the top 100 most highly cited works
and the citation classics in the field. Stereotact Funct
Neurosurg. 2012;90:201-209.
Received 8 November 2016; accepted 21 March 2017
Citation: World Neurosurg. (2017).
http://dx.doi.org/10.1016/j.wneu.2017.03.149
Journal homepage: www.WORLDNEUROSURGERY.org
Available online: www.sciencedirect.com
1878-8750/$ - see front matter ª 2017 Elsevier Inc. All
rights reserved.