The Top 100 Most Cited Journal Articles in Pediatric Neurosurgery

With the many papers published in the field of pediatric neurosurgery, it is often difficult to recognize those that have the most impact on future papers, i.e., citable papers. However, citation analysis allows one to better understand which papers are impacting the field the most. Therefore, the current study aimed to evaluate this literature. The Journal Citation Report database was searched for publications with the words “pediatric neurosurgery” or “pediatric neuro” in the title. Using the Web of Science Core Collection, the top 100 journal articles in pediatric neurosurgery from the selected journals were identified and citation analysis was used to identify the most impactful articles. A search was performed on Web of Science Core Collection by searching for each journal under “Publication Name” and using the Boolean “OR” function to separate fields. The results were ordered by the “Times Cited” category, which provided a list of all the articles from the eight journals appearing in the most cited order. The timeline used was from 1976 to 2021. The top 100 most cited articles were extracted from this list for analysis. The following variables were collected from each scientific article: publication journal, impact factor of journal, title, number of citations, year and month of publication, and type of article. Eight journals were identified on the basis of our search criteria and the articles were sorted by most cited; 1609 pediatric neurosurgery journal articles were screened to select the 100 most cited since 1976. This compilation could serve to help clinicians and researchers to familiarize themselves with the journal articles included in terms of study type, study field, journal of publication, and recurring authors.


Introduction And Background
There are many journal articles published on pediatric neurosurgery; a way to analyse and compare these publications is using citation analysis. The first scientific database for citation tracking was developed by the Institute for Scientific Information in 1962, later combined with the Social Sciences Citation Index in 1973 and the Arts and Humanities Citation Index in 1978. In 1997, this database was presented online under the name Web of Science. Later, it was rebranded under the name Web of Science Core Collection and was supplemented by many more citation indexes to maintain continual systematic updating of citation counts for journal articles [1]. The massive growth of medical and biological publications during this information era has led to new ways of assessing and systematically reviewing the impact of individual publications on a field of interest [2,3]. Thus, within the past two decades, there has been an influx of articles using citation index methods to evaluate the most relevant work within specific fields such as neurosurgery [1,4], plastic surgery [5], dermatology [6], orthopedic surgery [7], and others [8,9]. This review presents the 100 most highly cited journal articles in pediatric neurosurgery selected from eight journals using citation data accessed from the Web of Science Core Collection.

Review Methods
The focus of this study was to identify journal articles specifically dedicated to pediatric neurosurgery. Using similar methods as used by Ponce and Lozano, we identified eight journals by searching the Journal Citation Report database for publications with the words "pediatric neurosurgery" or "pediatric neuro" in the title [1,4]. The chosen journals were Child's Brain, Pediatric Neurosurgery, Child's Nervous System, Journal of Pediatrics, Journal of Neurosurgery , Journal of Neurosurgery-Pediatrics , Neuropediatrics, and Neurosurgery. A search was then performed on the Web of Science Core Collection database by searching for each journal under "Publication Name" and using the Boolean "OR" function to separate fields. The results were ordered by the "Times Cited" category, which provided a list of all the articles from the eight journals appearing in the most cited order. The timeline used was from 1976 to 2021. The top 100 most cited articles were extracted from this list for analysis. The following variables were collected from each scientific article: publication journal, impact factor of journal, title, number of citations, year and month of publication, and type of article. Articles were excluded if they included basic science research, or animal studies, or were not purely pediatric or related to neurosurgery (i.e., they included adults or were not related to pediatric neurosurgery). The pediatric population was defined as ages 0-18 years as referenced in the articles. There were two exceptions to the age limit in the articles selected for review: in the study by Grant et al., the age limit was 21 (range 6 months to 21 years, with a mean of 10.4 ± 0.5 years), and in that by Tubbs et al., the age of patients ranged from 2 months to 20 years with a mean of 11 years [10,11].

Sources and citations
Eight journals were identified on the basis of the criteria described in Methods and the articles were sorted by most cited; 1609 pediatric neurosurgery journal articles were screened to select the 100 most cited articles since 1976 ( Table 1)   The field of study with most publications in pediatric neurosurgery was tumor-related (n=33), followed by hydrocephalus (n=16), trauma (n=14), congenital (n=9), functional (n=6), vascular (n=5), spinal (n=4), and other (n=5). Gliomas were the most commonly discussed tumors in the pediatric population, contributing to six of the 33 total journal articles. There were four articles related to each tumor type: craniopharyngioma, medulloblastomas, and ependymomas. Other tumor-related articles were of origins such as spine and neuroepithelial. Hydrocephalus was the second most discussed topic, with findings related to shunt design, malfunctions, and improvements. Among the 14 articles describing trauma in the pediatric population, severe traumatic brain injury (n=5) and concussion (n=4) were the most common topics. The reviewed articles from the vascular field were related to abnormal cerebral blood flow, intraventricular hemorrhage, and revascularization. Topics that did not fit the listed categories were listed as "Other" and included articles related to magnetic resonance imaging (MRI) findings for non-traumatic brain injury, craniectomy, and neurological problems associated with preterm infants.

Type of study
The articles were also categorized by time of study, based on the information from the article or the category assigned by PubMed ( Table 3). The 100 selected journal articles comprised 34 original articles, 33 reviews, 12 clinical trials, 11 comparative studies, and 8 case report/reviews; there was also one cross-sectional and one multi-center study. Over two-thirds of the most cited pediatric neurosurgical articles were either original (prospective, non-review) or review (retrospective with regard to data collection and analysis). Clinical trials were most common in articles related to tumors (n=7), hydrocephalus (n=2), trauma (n=2), and vascular (n=1). Although hydrocephalus and trauma were the second and third most commonly studied fields, they each had four comparative studies, the rest of the comparative studies being congenital (n=1), trauma (n=1), and vascular (n=1). Case reports were most common in the vascular field (n=3), followed by tumor-related (n=2), trauma (n=1), functional (n=1), and congenital (n=1). Both the cross-sectional and multi-center studies were related to hydrocephalus.

Discussion
In this literature review, we present the top 100 most cited articles in pediatric neurosurgery since 1976. Our research was conducted similarly to other reviews of the most relevant articles within their respective fields [1,[4][5][6][7][8][9]. To keep this article focused solely on clinical neurosurgery in the pediatric population, we excluded basic science research, animal studies, and any articles that included an adult population. This article contributes significantly to neurosurgery, as pediatric neurosurgery is a specific and more recent subspecialty that requires its own analysis. Although Ponce and Lozano [1,4] published two articles on the most cited work in neurosurgery, only three of their 100 are consistent with pediatric neurosurgical findings, regarding neuroepithelial tumors and the positive effects of surgical resection [13], randomized trial for treatment of medulloblastoma [14], and findings concerning shaken baby syndrome [15]. Furthermore, in 2013, Wilcox et al. compiled and categorized the most cited work in pediatric neurosurgery; however, they only evaluated four clinical pediatric neurosurgical journals and included basic science research within the criteria for relevance [16]. This work was continued by Khan et al. in 2013, in Part 2, with a focus on nonpediatric journals only, excluding basic science, imaging, histology, pathology and pharmacology-related articles from their selection of the top 100 [12].
Overall, the present study contributes to the field of pediatric neurosurgery by compiling pediatric neurosurgical articles in a single review, with a specific focus on pediatric clinical neurosurgical studies from pediatric and non-pediatric surgical journals and non-surgical journals. Furthermore, by grouping the 100 most cited pediatric neurosurgical articles in the field within one table, we hope to eliminate the time burden for other physicians, residents, and others interested in learning about the pediatric neurosurgery field.

Limitations
Several limitations are associated with the citation analysis and the impact of journal articles. There is still a debate about correlating the number of citations with the importance of an article [3]. The journals selected do not encompass all those in which highly cited articles in pediatric neurosurgery can be published, so seminal articles could have been missed. Owing to the time frame of the literature search, more recent articles that could have a high impact might not yet have had time to accumulate the citations necessary to be included in the rankings [17]. The limitations of the Web of Science database must also be considered as it only includes citation data from 1976 to 2021, so older journal articles, or very new ones, will not necessarily be well represented. Other databases such as Google Scholar (2,689,809) or Microsoft Academic (1,840,702) also contain more citations than the Web of Science Core Collection (1,503,657) [2].

Conclusions
Using the Web of Science Core Collection database, the top 100 articles in pediatric neurosurgery from the selected journals were identified and citation analysis was used to identify the most impactful articles. The compilation could help clinicians and researchers to familiarize themselves with the journal articles included in terms of study type, study field, journal of publication, and recurring authors. Although there might not be a direct impact of such an article on clinical practice, a review of this nature is of archival value and shows pediatric neurosurgeons in the field what papers are of most value to others who have cited their works.

Conflicts of interest:
In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.