Global Research Trends in Endoscopic Cranial Surgery: A Bibliometric and Visualized Analysis (2015–2025)

Global Research Trends in Endoscopic Cranial Surgery: A Bibliometric and Visualized Analysis (2015–2025) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Global Research Trends in Endoscopic Cranial Surgery: A Bibliometric and Visualized Analysis (2015–2025) Ahmed Najjar, Dena Salem, Abdulmalik Hakeem, Abdulrahman Tasji, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8760930/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Endoscopic cranial surgery (ECS) has undergone rapid expansion over the past decade, driven by advances in visualization, navigation, and minimally invasive surgical strategies. However, the global structure, thematic evolution, and collaborative patterns of ECS research have not been systematically quantified. Methods A bibliometric and visualized analysis was conducted using publications retrieved from the Web of Science Core Collection (2015–2025). VOSviewer and CiteSpace were applied to analyze publication trends, authorship networks, institutional and national contributions, co-cited references, and keyword clusters. Results A total of 729 eligible publications were included. The United States dominated research output and citation impact, with the University of Pittsburgh emerging as the most influential institution. Major research hotspots centered on skull base reconstruction, cerebrospinal fluid (CSF) leak prevention, and technological innovation, including neuronavigation and high-definition endoscopy. Recent trends indicate increasing focus on postoperative management and complication mitigation. Conclusion ECS research is increasingly shaped by technological refinement and complication prevention strategies. These findings provide a structured overview of the evolution of endoscopic cranial surgery and may assist neurosurgeons, trainees, and researchers in identifying established research domains, emerging priorities, and areas requiring higher-level clinical evidence. Endoscopic cranial surgery Skull base surgery Bibliometric analysis Neuroendoscopy Research trends Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction Overview of the procedure Endoscopic cranial surgery (ECS) represents a major advancement in modern neurosurgical practice. Unlike conventional craniotomies that require wide surgical exposures and substantial brain retraction, ECS relies on narrow operative corridors and advanced visualization systems to reach deep intracranial regions. This minimally invasive approach has been associated with reduced surgical trauma, shorter recovery times, lower complication rates, and improved visualization of delicate neurovascular structures [1,2,3,4]. Owing to these advantages, ECS has been increasingly adopted for the treatment of Deep brain structures and base skull lesions, including vascular and intraventricular pathologies[5,6]. Its expanding application reflects a global movement toward minimally invasive neurosurgery, where surgical precision is integrated with improved patient safety and recovery.The development of endoscopic neurosurgery can be traced to the early 20th century, although its initial use was constrained by inadequate illumination and rudimentary devices. Apuzzo and colleagues first reported its application for intraventricular tumors, but outcomes were limited by the technology of the period [1]. Subsequent progress in rigid endoscopes, fiber-optic systems, and video technology allowed safer and more effective procedures [2,3]. In recent decades, the introduction of high-definition imaging, neuronavigation, and refined instruments has transformed ECS from a tool for simple ventricular procedures into a versatile technique for complex cranial and skull base operations [4,5,6] This historical trajectory illustrates the interplay between technological innovation and surgical expertise in shaping modern neurosurgery. Parallel to its clinical adoption, research on ECS has expanded considerably. Numerous studies addressing surgical techniques, patient outcomes, and training models have appeared in leading neurosurgical journals. However, the global distribution of this scholarship is uneven, with certain countries and institutions contributing disproportionately [6]. Despite the growing body of literature, a comprehensive evaluation of publication trends, influential contributors, and evolving research priorities is still lacking. The present work seeks to conduct a systematic bibliometric and visualized analysis of global ECS research. The objectives are to: (1) assess temporal publication trends, (2) identify leading authors, institutions, and journals, (3) evaluate patterns of international collaboration, and (4) highlight emerging research frontiers. By mapping the scientific landscape, this study aims to inform clinical practice, guide future investigations, and encourage collaboration in the continued advancement of endoscopic cranial surgery. Methods Search Strategies and Data Acquisitions A comprehensive search was conducted in the Web of Science Core Collection (WoSCC) database in October 2025 using the following search string: Topic Search (TS) = ((endoscopic) AND (craniotomy OR skull)). The search was limited to studies published in English between September 1, 2015, and September 1, 2025. A total of 866 records were retrieved. Eight authors independently screened the records and excluded documents that did not meet the search criteria. Only original research articles and review papers were included. To ensure data quality, 4 non-English publications and 133 studies with inappropriate methodology were excluded. As a result, 729 publications met the inclusion criteria and were included in the analysis. Bibliometric data such as publication year, journal title, author names, countries of origin, keywords, H-index, and citations were extracted directly from WoSCC. The data were analyzed using VOSviewer, Excel software and Draw.io to generate visualizations and identify trends in the scientific literature. Eligibility Criteria and Screening Process Inclusion criteria were: (1) original research articles or review papers focused on endoscopic cranial or skull base surgery, (2) published in English, and (3) indexed in the Web of Science Core Collection between September 1, 2015 and September 1, 2025. Exclusion criteria included: (1) non-English publications, (2) conference abstracts, editorials, letters, or technical notes without original data, (3) studies unrelated to cranial or skull base endoscopic procedures (e.g., purely sinus or non-cranial endoscopy), and (4) studies with inappropriate methodology, defined as insufficient methodological description, absence of surgical relevance, or lack of analyzable bibliometric data. All records were independently screened by eight authors in two stages (title/abstract screening followed by full-text review). Discrepancies were resolved through consensus discussion. Bibliometric Analysis The data retrieved from WoSCC consisted of publication year, journal title, author names, countries of origin, keywords, co-occurrence, and co-citation. VOSviewer (version 1.6.19), developed by Leiden University, the Netherlands, Microsoft Excel 2016 software, and Draw.io were used for data analysis that was extracted from WoSCC. VOSviewer was applied to perform co-authorship, keyword, co-occurrence, and co-citation analyses. It shows collaboration networks among authors, institutions, and countries, as well as the clustering of research topics. Excel 2016 software was used for descriptive statistics, such as annual publication trends. Draw.io software was utilized to design diagrams and conceptual maps, making the visualization of the overall workflow easier. Co-authorship is defined as the identification of authors, institutions, and countries as collaboration patterns. The number of publications (Np) is used to assess the productive capacity. The number of citations (Nc) is used for assessing the article's impact. H-index is used for assessing the contribution of researchers and forecasting future research findings by excavating the threshold connecting Np and Nc through productive capacity and impact. Our research consists of network visualizations composed of colored nodes and connecting lines, where each node represents a specific topic among our headlines. The size of the node is directly proportional to the number of times this topic is repeated; the nodes of the same color represent a cluster. The lines represent link strength, indicating the number of connections between subtopics. A higher number of lines corresponds to a stronger link, reflecting how frequently a topic is linked alongside others and its overall influence within the network. Results An Overall Literature Findings A total of 866 publications were identified from WoSCC (2015–2025). A total of 729 original and review papers remained for analysis (84.2%) after excluding 4 non-English studies and 133 other studies with inappropriate methodology . For a detailed illustration of the characteristics of desired publications, see Figure 1 The Regional Distribution of Global Publications Output All publications were distributed among 44 countries. The ten most productive countries are shown in Table 1 . Collectively, these top ten countries accounted for 686 publications, representing approximately 79% of the total global output (866 publications). The USA leads with the highest number of publications (38.7% with 336 publications), followed by China (9.81% with 85 Publications), Italy ( 8.1% with 71 publications ), Japan ( 6.1% with 53 publications ), UK (3.2% with 28 publications ), and India (3% with 26 publications ). The international Collaborations network analysis is shown in Figure 3 . The size of the node indicates the number of publications issued in a specific country, and the lines represent the frequency of cooperation between countries. 12 clusters were obtained based on this information, as shown in Figure 3 . The USA is the main force with a high academic reputation in ECS which was characterized by the following characteristics: Number of publications (336), Total number of Citations (4503), and TLS (1286). Canada has the highest number of citations per publication (CPP: 24.6). However, the total number of research publications from other countries, such as China, Italy, Japan, UK, and lastly Saudi Arabia, was overall relatively low. However, their publications output still reflected the considerable progress made by these countries in this field, which was closely related to their collaborations with the USA. Figure 3 illustrates that the United States occupies a central position within the international collaboration network, functioning as the primary hub connecting emerging research regions. Analysis of Institutional Output All publications were distributed among 62 institutions. The ten most productive institutions are shown in Table 2. The leading institutions in Endoscopic cranial surgery publications by descending order, were the University of Pittsburgh (24.8%, with 55 publications), Ohio State University (14.9%, with 33 publications), University of Brescia (9.5%, with 21 publications), Mayo Clinic (9%, with 20 publications), University of California, Irvine (7.6%, with 17 publications), Capital Medical University (7.6%, with 17 publications). The leading institutional output comes mainly from the USA, then Italy, then China, with the University of Pittsburgh taking the leading role in the USA, alongside the University of Brescia in Italy, and Capital Medical University in China. Taking into consideration that the highest CPP is achieved by the University of Insubria (22.1) demonstrates the integral role in which Italy plays in promoting development in this field. Figure 4 demonstrates that a limited number of high-volume academic centers form dense collaboration clusters, underscoring institutional concentration in ECS research. The network visualization map of cooperative institutions related to Endoscopic Cranial Surgery is shown in Figure 4. The nodes represent institutions, and the lines between nodes represent cooperative relationships. As shown in Figure 4, the major institutions that cooperated with the University of Pittsburgh were the University of State Ohio, the University of Brescia, and Stanford University. Seven clusters were obtained from the analysis. For example, cluster 1 (shown in red, 19 items) represents America's most worldwide cooperative institution, The Ohio State University (33 publications, links 51 TLS:149), which cooperated with the University of Brescia, Seoul National University Hospital, University of Turin, University of Barcelona, Medical University of Vienna, and Capital Medical University. Analysis of Journals and Co-cited Journals Table 3 discerns the top ten journals contributing to the publications in the field of ECS. All publications were distributed among a total of 50 journals that published an ECS paper in the topic of ECS ( Figure 5A ). The total number of publications from among the 50 journals was 581, with the top ten publishing journals accounting for 349, representing 60% of published papers in the field of ECS. This indicates the significant impact of these journals on research in this field. “ The Journal of Neurological Surgery: Skull Base” ranked first (84 publications, accounting for 24.07% of the top ten), followed by World Neurosurgery (79 publications; 22.64%) and Journal of Neurosurgery (34 publications; 9.74%). The International Forum of Allergy & Rhinology (32 publications; 9.17%). Together, these journals represent more than half of the total published works, reflecting their strong contribution and influence within the neuroendoscopic research area. Based on Table 3 , the 154 journals collectively received 19,291 citations ( Figure 5B ) , reflecting the overall scientific influence of publications in this field. Among them, the Journal of Neurosurgery , Laryngoscope , and Neurosurgery recorded the highest citation counts (2,080, 1,905, and 1,492 citations, respectively), together accounting for approximately 28% of total citations. Other highly cited journals included World Neurosurgery (1,309 citations) and the “ International Forum of Allergy & Rhinology” (797 citations), highlighting the strong multidisciplinary collaboration between neurosurgery and otolaryngology in skull base research. These findings indicate that the most productive and most cited journals form the core of research activity and scholarly influence in endoscopic cranial surgery, emphasizing their leading role in shaping scientific advancement in this field. Analysis of Authors and Co-cited Authors A total of 666 authors have published papers on Endoscopic Cranial Surgery. The ten most productive authors and the ten top co-cited authors are shown in Table 4. Snyderman, Carl H. (33 publications, 13.8%) published most papers, followed by Gardner, Paul a. (32 publications, 13.4%), Wand, Eric W. (31 publications, 13%), Carrara, Ricardo L. (26 publications, 10.9%), Prevedello, Daniel M. (24 publications, 10%), Schwartz, Theodore H. (22 publications, 9.2%), Fernandez-Miranda, Juan c. (19 publications, 7.9%), Kuan, Edward c (19 publications, 7.9%), Ananda, Vijay K. (16 publications, 6.7%), and Castenlnuovo, Paolo (16 publications, 6.7%). The network visualization map of the co-cited authors is shown in Figure 6. 17 clusters were obtained from the analysis. The largest nodes were associated with the most frequently co-cited authors, including Snyderman, Carl H (812 citations, TLS: 941, Cluster I), Gardner, Paul A. (810 citations, TLS: 889, Cluster 1), Wang, Eric W. (780 citations, TLS: 1,255, Cluster 7), Fernandez-miranda, Juan C. (611 citations, TLS: 659, Cluster 16), and Carrau, Ricardo L. (521 citations, TLS: 516, Cluster 5). Analysis of References Figure 7. demonstrates a network visualization composed of 129 colored nodes and 172 connecting lines, where each node represents a specific reference. The size of the node is directly proportional to the number of times a publication has been cited, and nodes of the same color represent a cluster of related studies. The lines represent link strength, indicating the number of connections between references. A higher number of lines corresponds to a stronger link, reflecting how frequently a publication is cited alongside others and its overall influence within the network. Table 5 summarizes the 35 most cited papers in endoscopic skull base surgery. Wang et al., 2019, with their article “ICAR: Endoscopic Skull-Base Surgery” , is the most cited publication, with 226 citations and a total link strength of 30. Zwagerman et al., 2019 follows with 165 citations and a link strength of 11. Other works include Conger et al., 2019, Fraser et al., 2018, Xu et al., 2018, Jeswani et al., 2016, Marchioni et al., 2015, Cavallo et al., 2019, and Schwartz et al., 2019. Most of the top 35 references are published in Q1–Q2 journals and appeared after 2015. Analysis of the co-citation network revealed research hotspots, such as add deep seated lesions, reconstruction and prevention of CSF leaks (Cluster 7, orange zone) and reconstruction and technological innovation (Cluster 3, dark blue zone), reflecting the field’s focus on improving surgical outcomes and integrating advanced technologies. Analysis of Keywords and Keyword Co-occurrence Clusters A total of 82 keywords, those repeated for 5 times or more within our inclusion criteria, were mentioned in 729 publications. The keyword publication output of the Endoscopic cranial surgery is shown in Figure 8. The analysis was performed using 82 keywords Map of keyword co-occurrence, with 82 items with 8 clusters each item is represented by a node, and the node size indicates the frequency and the corresponding keywords. The larger the node, the more relevant the research around the keyword. The thicker the line between the nodes, the greater the frequency of the keywords in the subject. The keyword analysis can quickly identify the research hotspots in the field. keywords can help quickly identify hot topics while researching the literature. . According to Table 6, the ten most commonly used keywords are: “Skull Base”, “Skull Base Surgery”, “Endoscopic Skull Base Surgery”, “Endoscopic”, “Endoscopic Endonasal Approach”, “Skull Base Reconstruction”, “Endoscopic Surgery”, “Cerebrospinal Fluid Leak”, “Endoscopy”, and Nasoseptal Flap. Discussion The Most-Contributing Authors and the Most-Cited Papers Bibliometric analysis has increasingly been adopted as a robust methodological framework for mapping research evolution, identifying knowledge gaps, and guiding future investigation across surgical disciplines. Recent studies have successfully applied similar approaches to orthopedics [ 42 ], neuro-oncology [ 43 ], and perioperative care [ 44 ], reinforcing bibliometrics as a contemporary gold standard in medical informatics and scientometrics. Within this context, the present study aligns with best practices in quantitatively evaluating the development and direction of ECS research. Advancements in neuroendoscopic technology and its integration into neurosurgical practice have significantly reshaped clinical approaches compared to traditional open techniques. Whereas conventional cranial surgery often requires wide exposures and substantial brain retraction, endoscopic cranial surgery (ECS) employs narrow operative corridors and high-resolution visualization systems to access deep intracranial regions. This minimally invasive approach has been associated with reduced surgical trauma, faster postoperative recovery, fewer complications, and improved visualization of critical neurovascular structures. Consequently, neuroendoscopic techniques are increasingly utilized in the management of a wide range of complex neurosurgical conditions. The objectives of this study are to: (1) analyze publication trends over time, (2) identify the most influential authors, institutions, and journals, (3) characterize patterns of global research collaboration, and (4) uncover emerging research frontiers within the field. From 2015 to 2025, the number of publications on Endoscopic cranial surgeries has been increasing and has shown a sustained increase in academic interest. The USA has the lead in academic influence over research in ECS. The dominance of the United States and select academic centers, particularly the University of Pittsburgh, likely reflects early adoption of endoscopic skull base techniques, high procedural volumes, structured multidisciplinary skull base teams, and sustained investment in surgical innovation and training programs. These centers also function as international referral and training hubs, amplifying their academic output and citation impact. “Journal of Neurological Surgery Part Skull Base” is the most productive journal, and the most cited journal is “Journal of Neurosurgery”, indicating they are the most informative in their fields. Furthermore, ”World Neurosurgery”, “Journal of Neurosurgery”, and “International Forum of Allergy & Rhinology” Are the most influential journals in the field. Snyderman, Carl H. (University of Pittsburgh) is the most productive and co-cited author of Endoscopic cranial surgery ( 33 publications, 13.8%, 812 TLS:941 ); his most co-cited article” A novel reconstructive technique after endoscopic expanded endonasal approaches: Vascular pedicle nasoseptal flap”, innovated a method by which to decrease postoperative cerebrospinal fluid leaks that is still viable to this day. [ 45 ]. Furthermore, “Endoscopic skull base surgery: principles of endonasal oncological surgery” established the foundations for endonasal endoscopic skull base surgery [ 46 ]. Research HotSpots According to Fig. 7 , two major research hotspots have emerged in ECS: reconstruction and prevention of CSF leaks (Cluster 7), and technological innovation and surgical technique optimization (Cluster 3). Reconstruction and CSF Leak Prevention is the most prominent cluster, focusing on reducing postoperative complications through advanced reconstructive techniques. Zwagerman et al. (2019) highlighted the effectiveness of nasoseptal flaps in preventing CSF leaks, while Fraser et al. (2018) and Jeswani et al. (2016) refined multilayer closures and tissue grafting to ensure watertight repairs. Marchioni (2015) and Cavallo et al. (2019) further explored alternative reconstructive approaches, emphasizing safety and long-term durability. The prominence of the complication cluster indicates a transition from descriptive reporting toward evidence synthesis, highlighting the need for high-quality comparative studies and network meta-analyses to rigorously evaluate reconstructive strategies and prevention protocols. Technological Innovation and Surgical Technique Advancement emphasizes the use of modern imaging, navigation, and endoscopic tools to improve surgical precision and minimize morbidity. Wang et al. (2019a) provided standardized international guidelines through the ICAR consensus, and Conger et al. (2019) and Cavallo et al. (2019) demonstrated the benefits of high-definition endoscopes and neuronavigation systems. These innovations reflect the field’s shift toward safer, more precise, and technology-driven interventions. In summary, ECS research is centered on enhancing reconstruction safety and advancing surgical technology, showing a clear trend toward a more standardized, innovative, and patient-focused surgical practice. Research Trends According to Fig. 8 , which times certain keywords were popularized, the research trends include the following: “Neuroendoscopy”, “Neuronavigation”, “Craniofacial Resection”, “Skull Base Defect”, and “Nasal Packing”. Neuroendoscopy has become one of the fundamental components in standard of care procedures in neurosurgical practice. Neuroendoscopic procedures offer several advantages over standard open cranial approaches, including reduced brain retraction, the use of smaller surgical corridors, and superior visualization of otherwise hidden or blind anatomical regions.[ 47 , 48 ] However, neuroendoscopy still poses several issues, including but not limited to: hemostasis, as well as management of large lesions [ 47 ]. Furthermore, Neuroendoscopic outcomes have a proportional link to the surgeon’s experience, with a steep learning curve. Further investigation is warranted, particularly in further education on neuroendoscopic techniques, as well as their integration with up-and-coming AI and AR technologies.. In addition to advances in neuroendoscopy, neuronavigation is yet another emerging technology used in neurosurgical practice that provides anatomical guidance and improves surgery outcomes. [ 46 ] The evolution from early CT-based pointer navigation to high-resolution MRI–guided, augmented reality–integrated neuronavigation represents a major step forward in endoscopic skull base surgery, improving anatomical accuracy and intraoperative orientation. [ 47 ] Neuronavigation improves surgical accuracy and reduces intraoperative deviations from planned trajectories, and enhances outcomes in complex endoscopic skull base cases.[ 49 ] Further research advancement is needed in Neuronavigation in terms of integration of Augmented Reality (AR), cost/availability, especially in resource-limited settings, and integration of Robotics. With the rapid expansion of endoscopic skull base surgery, surgeons are increasingly encountering larger and more complex dural defects, particularly in extended endonasal approaches, where high-flow cerebrospinal fluid (CSF) leaks are common, thereby necessitating advanced reconstruction techniques to ensure watertight closure and prevent postoperative complications[ 51 ]. Consequently, reconstruction of skull base defects has emerged as a major focus of research, with innovations in pedicled vascularized flaps such as the nasoseptal flap, multilayer closure techniques, and the use of sealants and graft materials significantly improving success rates and reducing postoperative CSF leak incidence.[ 52 ] Future directions in skull base reconstruction research focus on developing standardized protocols and evaluating the efficacy of various reconstructive materials, including the combined use of hydroxyapatite and nasoseptal flaps, while also exploring innovations such as 3D-printed scaffolds, bioengineered grafts, and tissue-engineering techniques to optimize long-term sinonasal outcomes and cost-effectiveness. [ 53 ] Beyond technical innovation, the rise of ECS parallels a broader paradigm shift toward perioperative optimization and complication prevention. As a minimally invasive modality, ECS aligns with contemporary goals of reducing surgical stress, hospital length of stay, and postoperative morbidity. The increasing bibliometric emphasis on postoperative management, CSF leak prevention, and sinonasal outcomes suggests that ECS is evolving not merely as a surgical technique, but as a component of comprehensive, system-level patient care. Postoperative management strategies have also undergone substantial transformation. Traditionally, nasal packing was routinely applied after reconstruction to support grafts, prevent cerebrospinal fluid (CSF) leaks, and control bleeding. However, recent evidence has challenged this necessity, demonstrating that effective closure can be achieved without routine packing, thereby improving patient comfort and reducing sinonasal morbidity [ 54 ]. This shift reflects a growing trend in the literature toward minimally invasive postoperative care, as highlighted in recent studies emphasizing the role of tailored management protocols rather than a one-size-fits-all approach [ 55 ]. From a bibliometric perspective, there has been a marked rise in publications addressing “postoperative management,” “nasal packing,” and “sinonasal outcomes,” indicating increasing research interest in optimizing recovery and minimizing complications. Moreover, the trend toward omitting nasal packing aligns with broader improvements in reconstruction techniques, particularly the use of vascularized flaps and multilayer closures that provide stable support without additional packing. Looking forward, future research will likely focus on standardizing postoperative protocols, assessing patient-reported sinonasal function, and performing cost-benefit analyses to determine when nasal packing can be safely avoided, further refining recovery protocols and improving quality of life for patients undergoing endoscopic skull base surgery [ 56 ]. Future perspectives Future ECS research should move beyond descriptive studies toward higher-level evidence generation. Multicenter prospective studies and international collaborative registries are needed to validate surgical outcomes across diverse practice settings. Standardized outcome reporting and comparative effectiveness research, including network meta-analyses, will be essential to determine optimal reconstructive and perioperative strategies. Additionally, emerging technologies such as artificial intelligence, augmented reality, and robotic assistance should be evaluated through structured clinical studies to clarify their real-world impact on surgical precision, safety, and patient outcomes. Strengthening global collaboration—particularly involving underrepresented regions—will be critical to ensuring equitable advancement and generalizability of ECS research. Strengths and Limitations The study assessed the current status of Endoscopic cranial surgery research, research hotspots, and research trends through bibliometric analysis. However there are some limitations in the study: the analysis of this study retrieved content only from the English language publications in the WOSCC database, causing language bias; this study has omitted publications that are not included in the WOSCC database. Furthermore, with an increasing number of publications related to Endoscopic cranial surgery in recent years, some newly published high-quality publications have low citation frequency and are easily missed. Conclusion This bibliometric analysis delineates the global structure, dominant contributors, and evolving research priorities of endoscopic cranial surgery over the past decade. ECS research is primarily driven by technological innovation and complication prevention, with concentrated contributions from high-volume academic centers. These findings provide a strategic framework for future investigation, emphasizing the need for collaborative, high-level evidence to guide the continued maturation of ECS worldwide. Declarations Conflict of interest: The authors do not have any conflict of interest or source of funding to declare Acknowledgement: None Ethical Approval Not applicable No Ethical approval is required in this type of design due to secondary data usage. Funding Not applicable Availability of data and materials All data used in this study were obtained from publicly accessible databases using the search strategy described in the Methods section. No proprietary or patient-level data were generated. The datasets analyzed consist of published articles retrieved through the specified search terms, and these can be reproduced by any researcher who applies the same search strategy. No additional datasets were generated or stored by the authors; therefore, no separate data repository is available. References Apuzzo ML, Heifetz MD, Weiss MH, Kurze T. Surgical considerations in the treatment of intraventricular tumors by neuroendoscopy. Neurosurgery. 1977;1(4):395-401. Hopf NJ, Perneczky A. Endoscopic neurosurgery and endoscope-assisted microneurosurgery for the treatment of colloid cysts of the third ventricle. Neurosurgery. 1998;42(3):697-704. Schroeder HW, Gaab MR. Endoscopic resection of colloid cysts. Neurosurgery. 2002;51(6):1441-1445. 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Assessment of a patient‑specific, 3‑dimensionally printed endoscopic sinus and skull base surgical model. JAMA Otolaryngol Head Neck Surg. 2018;144(7):574‑579. doi:10.1001/jamaoto.2018.0473 Sigler AC, D’Anza B, Lobo BC, Woodard TD, Recinos PF, Sindwani R. Endoscopic skull base reconstruction: an evolution of materials and methods. Otolaryngol Clin North Am. 2017;50(3):643‑653. doi:10.1016/j.otc.2017.01.015. David AP, Jiam NT, Reither JM, Gurrola JG 2nd, Aghi MK, El‑Sayed IH. Endoscopic skull base and transoral surgery during the COVID‑19 pandemic: minimizing droplet spread with a negative‑pressure otolaryngology viral isolation drape. Head Neck. 2020;42(7):1577‑1582. doi:10.1002/hed.26239 Yano S, Hide T, Shinojima N. Efficacy and complications of endoscopic skull base surgery for giant pituitary adenomas. World Neurosurg. 2017;99:533‑542. doi:10.1016/j.wneu.2016.12.068 Li L, Yang J, Chu Y, Wu W, Xue J, et al. A novel augmented reality navigation system for endoscopic sinus and skull base surgery: a feasibility study. PLoS One. 2016;11(1):e0146996. doi:10.1371/journal.pone.0146996 Turri‑Zanoni M, Zocchi J, Lambertoni A, Giovannardi M, Karligkiotis A, Battaglia P, Locatelli D, Castelnuovo P. Endoscopic endonasal reconstruction of anterior skull base defects: what factors really affect the outcomes? World Neurosurg. 2018;116:e436‑e443. doi:10.1016/j.wneu.2018.04.225 Hannan C, Almhanedi H, Al‑Mahfoudh R, et al. Predicting post‑operative cerebrospinal fluid (CSF) leak following endoscopic transnasal pituitary and anterior skull base surgery: a multivariate analysis. Acta Neurochir (Wien). 2020;162(6):1309‑1315. doi:10.1007/s00701-020-04334-5 Kuan EC, Kaufman AC, Lerner D, Kohanski MA, Tong CC L, Tajudeen BA, Parasher AK, Lee JYK, Storm PB, Palmer JN, Adappa ND. Lack of sphenoid pneumatization does not affect endoscopic endonasal pediatric skull base surgery outcomes. Laryngoscope. 2019;129(4):832‑836. doi:10.1002/lary.27600. Hannan CJ, Kelleher E, Javadpour M. Methods of skull base repair following endoscopic endonasal tumor resection: a review. Front Oncol. 2020;10:1614. doi:10.3389/fonc.2020.01614. Wang EW, Gardner PA, Zanation AM, et al. International consensus statement on endoscopic skull‑base surgery: Executive summary. Int Forum Allergy Rhinol. 2019;9(S3):S127‑S144. doi:10.1002/alr.22327 Zheng JP, Li CZ, Chen GQ, Song GD, Zhang YZ. Three‑dimensional printed skull base simulation for transnasal endoscopic surgical training. World Neurosurg. 2018;111:e773‑e782. doi:10.1016/j.wneu.2017.12.169 Zwagerman NT, Zenonos G, Lieber S, et al. Endoscopic transnasal skull base surgery: pushing the boundaries. J Neurooncol. 2016;130(2):319‑330. doi:10.1007/s11060-016-2274-y Rioja E, Bernal‑Sprekelsen M, Enriquez K, et al. Long‑term outcomes of endoscopic endonasal approach for skull base surgery: a prospective study. Eur Arch Otorhinolaryngol. 2016;273(7):1809‑1817. doi:10.1007/s00405-015-3853-9 Battaglia P, Turri-Zanoni M, De Bernardi F, et al. Septal flip flap for anterior skull base reconstruction after endoscopic resection of sinonasal cancers: preliminary outcomes. Septal flip flap per la ricostruzione del basicranio anteriore dopo resezione di tumori nasosinusali: risultati preliminari. Acta Otorhinolaryngol Ital. 2016;36(3):194-198. doi:10.14639/0392-100X-748 Liu, S., Xu, X. & Zhou, J. Bone Morphogenetic Proteins in Orthopedics: A Bibliometric Analysis. JOIO 59, 1487–1504 (2025). https://doi.org/10.1007/s43465-025-01414-5 Liu S, Liang R. Oncolytic Virotherapy for Glioma: A Bibliometric Roadmap for Multidisciplinary Clinical and Research Strategies. J Multidiscip Healthc. 2025;18:6167-6185. Published 2025 Sep 26. doi:10.2147/JMDH.S557248 Liu, S., & Zhou, J. (2025). Trends and development of enhanced recovery after surgery programs in cranial and spinal neurosurgery. Neuro-Chirurgie, 71 5, 101704 . Hadad G, Bassagasteguy L, Carrau RL, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. 2006;116(10):1882-1886. doi:10.1097/01.mlg.0000234933.37779.e4 Snyderman CH, Carrau RL, Kassam AB, Zanation A, Prevedello D, Gardner P, Mintz A. Endoscopic skull base surgery: Principles of endonasal oncological surgery. J Surg Oncol. 2008;97(8):658-664. doi:10.1002/jso.21020 Tosi U, Guadix SW, Souweidane MM. Neuroendoscopy: The state of the art. World Neurosurg. 2023;178:305-310. doi:10.1016/j.wneu.2023.07.125 Tariq F, Jumah F, Ravipati K, Ortiz-Torres M, Carr SB, Chicoine MR. Advances in Cranial Surgery. Mo Med. 2024;121(2):136-141. Rohde V, Behm T, Ludwig H, et al. The role of neuronavigation in intracranial endoscopic procedures. Neurosurg Rev. 2012;35(3):351-358. doi:10.1007/s10143-011-0369-7 Candy NG, Jukes AK, Patel S, et al. Neuronavigation in endoscopic skull base surgery and the accuracy of different MRI sequences. J Clin Neurosci. 2024;123:203-208. doi:10.1016/j.jocn.2024.04.006 Wang D, Zhang H. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024;38(6):463-466. doi:10.13201/j.issn.2096-7993.2024.06.002 Shin DW, Yee GT. Skull base reconstruction using hydroxyapatite and nasoseptal flap versus nasoseptal flap alone: meta-analysis and systematic review. Sci Rep. 2024;14:28433. doi:10.1038/s41598-024-79956-1 El-Sayed IH, Roediger FC, Goldberg AN, Parsa AT, McDermott MW. Endoscopic reconstruction of skull base defects with the nasal septal flap. Skull Base. 2008;18(6):385-394. doi:10.1055/s-0028-1096202 Asmaro K, Yoo F, Yassin-Kassab A, et al. Sinonasal Packing is Not a Requisite for Successful Cerebrospinal Fluid Leak Repair. J Neurol Surg B Skull Base. 2021;83(5):476-484. Published 2021 Dec 17. doi:10.1055/s-0041-1740622 Goshtasbi K, Abiri A, Talati V, et al. Postoperative management following endoscopic skull base reconstruction: A multidisciplinary cross-sectional survey. Head Neck. 2025;47(7):1939-1948. doi:10.1002/hed.28116 Khaleghi M, Shahid AH, Suggala S, et al. Modified graded skull base reconstruction for intraoperative CSF leak repair in endoscopic endonasal surgeries: a single-surgeon experience in initial years of practice and nuances in the early learning curve. Neurosurgical Focus. 2025;58(2):E6-. doi:10.3171/2024.11.FOCUS24733 Tables Table 1. Top Ten Productive Countries. RANK Country Publications Percentage % Citations Citation per publication Total link strength 1 UNITED STATES 336 38.7% 4503 13.4 1286 2 CHINA 85 9.81% 982 11.6 278 3 ITALY 71 8.1% 1352 19.0 501 4 JAPAN 53 6.1% 390 7.4 144 5 UNITED KINGDOM 28 3.2% 571 20.4 215 6 INDIA 26 3% 117 4.5 48 7 SOUTH KOREA 23 2.6% 312 13.6 154 8 CANADA 23 2.6% 565 24.6 232 9 AUSTRALIA 22 2.5% 417 19.0 187 10 SAUDI ARABIA 19 2.1% 138 7.3 82 total 686 8447 12.3 (average) Percentages are calculated relative to the total number of publications (n = 866). Table 2. Top Ten Productive Institutions RANK Institutions Publications Percentage % Citations Citation per publication Total link strength 1 University of Pittsburgh 55 24.8% 985 17.9 367 2 The Ohio State University 33 14.9% 543 16.4 149 3 University of Brescia 21 9.5% 271 12.9 62 4 Mayo Clinic 20 9% 265 13.2 140 5 University of California, Irvine 17 7.6% 131 7.7 48 6 Capital Medical University 17 7.6% 162 9.5 232 7 University of Insubria 15 6.7% 332 22.1 80 8 Stanford University 15 6.7% 163 10.8 46 9 University of Pennsylvania 14 6.3% 204 14.5 118 10 Fudan University 14 6.3% 265 18.9 70 total 221 3321 Table 3. Top Ten Productive and Co-cited Journals RANK Journal Publications Percentage % Total link strength Rank Journal Citations Citation per publication Total link strength 1 Journal of Neurological Surgery Part Skull Base 84 24.07% 247 1 Journal of Neurosurgery 2080 61.18 187257 2 World neurosurgery 79 22.64% 231 2 laryngoscope 1905 61.45 173022 3 Journal of Neurosurgery 34 9.74% 214 3 Neurosurgery 1492 248.67 147861 4 International forum of allergy & rhinology 32 9.17% 229 4 World Neurosurgery 1309 16.57 123794 5 Laryngoscope 31 8.88% 116 5 International Forum of Allergy & Rhinology 797 24.91 90841 6 Acta neurochirurgica 20 5.73% 82 6 Journal of Neurological Surgery Part Skull Base 737 8.77 68323 7 Journal of Craniofacial Surgery 18 5.16% 25 7 Neurosurgical Focus 705 176.25 71484 8 Operative neurosurgery 18 5.16% 52 8 Journal Otolaryngology Head neck 608 121.60 77528 9 Otolaryngologic clinics of north america 17 4.87% 70 9 Journal Acta Neurochirurgica 518 25.90 65838 10 Neurosurgical review 16 4.58% 52 10 American journal of rhinology allergy 373 26.64 40650 total 349 100% 1318 Total 10524 1046598 Table 4. Top Ten Co-cited authors Rank Author Publications percentage % Total link strength Rank Author Citations Total link strength 1 Snyderman, Carl H. 33 13.8% 941 1 Snyderman, Carl H. 812 941 2 Gardner, Paul A. 32 13.4% 889 2 Gardner, Paul A. 810 889 3 Wang, Eric W. 31 13% 1255 3 Wang, Eric W. 780 1255 4 Carrau, Ricardo L. 26 10.9% 516 4 Fernandez-miranda, juan c. 611 659 5 Prevedello, Daniel M. 24 10% 342 5 Carrau, Ricardo L. 521 516 6 Schwartz, Theodore H. 22 9.2% 418 6 Schwartz, Theodore H. 408 418 7 Fernandez-miranda, juan c. 19 7.9% 659 7 Anand, Vijay K. 372 402 8 Kuan, Edward C. 19 7.9% 942 8 Castelnuovo, paolo 316 229 9 Anand, Vijay K. 16 6.7% 402 9 Prevedello, Daniel M. 295 342 10 Castelnuovo, paolo 16 6.7% 229 10 Nicolai, piero 256 276 Total 238 Total Table 5. 35 Most Cited References RANK Articule Citations Total Link Strength 1 Wang (2019a) [7] 226 30 2 Zwagerman (2019) [8] 165 11 3 Conger (2019) [9] 163 8 4 Fraser (2018) [10] 126 7 5 Xu (2018) [11] 114 3 6 Jeswani (2016) [12] 95 5 7 Marchioni (2015) [13] 84 0 8 Cavallo (2019) [14] 77 5 9 Schwartz (2019) [15] 77 10 10 Muskens (2018) [16] 72 6 11 Borg (2016) [17] 70 5 12 Vural (2021) [18] 67 5 13 Maza (2019) [19] 63 0 14 Locateli (2016) [20] 63 5 15 Younus (2021) [21] 62 4 16 De Almeida (2015) [22] 59 3 17 Stapleton (2017) [23] 56 6 18 Bhenswala (2019) [24] 53 5 19 Fu (2019) [25] 53 1 20 Li (2017) [26] 51 1 21 Alqahtani (2016) [27] 51 4 22 Hsieh (2018) [28] 49 0 23 Sigler (2017) [29] 48 1 24 David (2020) [30] 45 0 25 Yano (2017a) [31] 45 0 26 Li (2016) [32] 45 1 27 Turri-zanoni (2018) [33] 44 2 28 Hannan (2020a) [34] 42 3 29 Kuan (2019) [35] 42 0 30 Hannan (2020b) [36] 41 8 31 Wang (2019b) [37] 41 2 32 Zheng (2018) [38] 41 1 33 Zwagerman (2016) [39] 41 5 34 Rioja (2016) [40] 41 1 35 Battaglia (2016) [41] 41 2 Table 6. Top Ten Related Keywords Rank Keywords Occourance Percentage % Total strength 1 Skull base 189 24.5% 402 2 Skull base surgery 84 10.9% 153 3 Endoscopic skull base surgery 74 9.6% 124 4 Endoscopic 70 9.1% 195 5 Endoscopic endonasal approach 68 8.8% 147 6 Skull base reconstruction 63 8.2% 125 7 Endoscopic surgery 61 7.9% 121 8 Cerebrospinal fluid leak 57 7.4% 138 9 Endoscopy 53 6.9% 84 10 Nasoseptal flap 49 6.3% 137 Total 768 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Co-occurrence\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-8760930/v1/139be59d7f370e2689770c5d.png"},{"id":105205659,"identity":"ca07250c-e87e-48e9-aa70-a1087c6478fe","added_by":"auto","created_at":"2026-03-23 12:43:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4698305,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8760930/v1/7c8c8e05-7db9-43b3-b703-42fa0998bfba.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Global Research Trends in Endoscopic Cranial Surgery: A Bibliometric and Visualized Analysis (2015–2025)","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cstrong\u003eOverview of the procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEndoscopic cranial surgery (ECS) represents a major advancement in modern neurosurgical practice. Unlike conventional craniotomies that require wide surgical exposures and substantial brain retraction, ECS relies on narrow operative corridors and advanced visualization systems to reach deep intracranial regions. This minimally invasive approach has been associated with reduced surgical trauma, shorter recovery times, lower complication rates, and improved visualization of delicate neurovascular structures [1,2,3,4]. Owing to these advantages, ECS has been increasingly adopted for the treatment of Deep brain structures and base skull lesions, including vascular and intraventricular pathologies[5,6]. Its expanding application reflects a global movement toward minimally invasive neurosurgery, where surgical precision is integrated with improved patient safety and recovery.The development of endoscopic neurosurgery can be traced to the early 20th century, although its initial use was constrained by inadequate illumination and rudimentary devices. Apuzzo and colleagues first reported its application for intraventricular tumors, but outcomes were limited by the technology of the period [1]. Subsequent progress in rigid endoscopes, fiber-optic systems, and video technology allowed safer and more effective procedures [2,3]. In recent decades, the introduction of high-definition imaging, neuronavigation, and refined instruments has transformed ECS from a tool for simple ventricular procedures into a versatile technique for complex cranial and skull base operations [4,5,6] This historical trajectory illustrates the interplay between technological innovation and surgical expertise in shaping modern neurosurgery. Parallel to its clinical adoption, research on ECS has expanded considerably. Numerous studies addressing surgical techniques, patient outcomes, and training models have appeared in leading neurosurgical journals. However, the global distribution of this scholarship is uneven, with certain countries and institutions contributing disproportionately [6]. Despite the growing body of literature, a comprehensive evaluation of publication trends, influential contributors, and evolving research priorities is still lacking. The present work seeks to conduct a systematic bibliometric and visualized analysis of global ECS research. The objectives are to: (1) assess temporal publication trends, (2) identify leading authors, institutions, and journals, (3) evaluate patterns of international collaboration, and (4) highlight emerging research frontiers. By mapping the scientific landscape, this study aims to inform clinical practice, guide future investigations, and encourage collaboration in the continued advancement of endoscopic cranial surgery.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eSearch Strategies and Data Acquisitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive search was conducted in the Web of Science Core Collection (WoSCC) database in October 2025 using the following search string: Topic Search (TS) = ((endoscopic) AND (craniotomy OR skull)). The search was limited to studies published in English between September 1, 2015, and September 1, 2025. A total of 866 records were retrieved. Eight authors independently screened the records and excluded documents that did not meet the search criteria. Only original research articles and review papers were included. To ensure data quality, 4 non-English publications and 133 studies with inappropriate methodology were excluded. As a result, 729 publications met the inclusion criteria and were included in the analysis. Bibliometric data such as publication year, journal title, author names, countries of origin, keywords, H-index, and citations were extracted directly from WoSCC. The data were analyzed using VOSviewer, Excel software and Draw.io to generate visualizations and identify trends in the scientific literature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility Criteria and Screening Process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInclusion criteria were: (1) original research articles or review papers focused on endoscopic cranial or skull base surgery, (2) published in English, and (3) indexed in the Web of Science Core Collection between September 1, 2015 and September 1, 2025.\u003c/p\u003e\n\u003cp\u003eExclusion criteria included: (1) non-English publications, (2) conference abstracts, editorials, letters, or technical notes without original data, (3) studies unrelated to cranial or skull base endoscopic procedures (e.g., purely sinus or non-cranial endoscopy), and (4) studies with inappropriate methodology, defined as insufficient methodological description, absence of surgical relevance, or lack of analyzable bibliometric data.\u003c/p\u003e\n\u003cp\u003eAll records were independently screened by eight authors in two stages (title/abstract screening followed by full-text review). Discrepancies were resolved through consensus discussion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBibliometric Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data retrieved from WoSCC consisted of publication year, journal title, author names, countries of origin, keywords, co-occurrence, and co-citation. VOSviewer (version 1.6.19), developed by Leiden University, the Netherlands, Microsoft Excel 2016 software, and Draw.io were used for data analysis that was extracted from WoSCC. VOSviewer was applied to perform co-authorship, keyword, co-occurrence, and co-citation analyses. It shows collaboration networks among authors, institutions, and countries, as well as the clustering of research topics. Excel 2016 software was used for descriptive statistics, such as annual publication trends. Draw.io software was utilized to design diagrams and conceptual maps, making the visualization of the overall workflow easier. Co-authorship is defined as the identification of authors, institutions, and countries as collaboration patterns.\u003c/p\u003e\n\u003cp\u003eThe number of publications (Np) is used to assess the productive capacity. The number of citations (Nc) is used for assessing the article\u0026apos;s impact. H-index is used for assessing the contribution of researchers and forecasting future research findings by excavating the threshold connecting Np and Nc through productive capacity and impact.\u003c/p\u003e\n\u003cp\u003eOur research consists of network visualizations composed of colored nodes and connecting lines, where each node represents a specific topic among our headlines. The size of the node is directly proportional to the number of times this topic is repeated; the nodes of the same color represent a cluster. The lines represent link strength, indicating the number of connections between subtopics. A higher number of lines corresponds to a stronger link, reflecting how frequently a topic is linked alongside others and its overall influence within the network.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eAn Overall Literature Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 866 publications were identified from WoSCC (2015\u0026ndash;2025). A total of 729 original and review papers remained for analysis (84.2%) after excluding 4 non-English studies and 133 other studies with inappropriate methodology\u003cstrong\u003e. \u003c/strong\u003eFor a detailed illustration of the characteristics of desired publications, see\u003cstrong\u003eFigure 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Regional Distribution of Global Publications Output\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll publications were distributed among 44 countries. The ten most productive countries are shown in \u003cstrong\u003eTable 1\u003c/strong\u003e. Collectively, these top ten countries accounted for 686 publications, representing approximately 79% of the total global output (866 publications). The USA leads with the highest number of publications (38.7% with 336 publications), followed by China (9.81% with 85 Publications), Italy ( 8.1% with 71 publications ), Japan ( 6.1% with 53 publications ), UK (3.2% with 28 publications ), and India (3% with 26 publications ). The international Collaborations network analysis is shown in \u003cstrong\u003eFigure 3\u003c/strong\u003e. The size of the node indicates the number of publications issued in a specific country, and the lines represent the frequency of cooperation between countries. 12 clusters were obtained based on this information, as shown in \u003cstrong\u003eFigure 3\u003c/strong\u003e. The USA is the main force with a high academic reputation in ECS which was characterized by the following characteristics: Number of publications (336), Total number of Citations (4503), and TLS (1286). Canada has the highest number of citations per publication (CPP: 24.6). However, the total number of research publications from other countries, such as China, Italy, Japan, UK, and lastly Saudi Arabia, was overall relatively low. However, their publications output still reflected the considerable progress made by these countries in this field, which was closely related to their collaborations with the USA. \u003cstrong\u003eFigure 3\u003c/strong\u003e\u003cstrong\u003e illustrates\u003c/strong\u003e that the United States occupies a central position within the international collaboration network, functioning as the primary hub connecting emerging research regions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of Institutional Output\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll publications were distributed among 62 institutions. The ten most productive institutions are shown in Table 2. The leading institutions in Endoscopic cranial surgery publications by descending order, were the University of Pittsburgh (24.8%, with 55 publications), Ohio State University (14.9%, with 33 publications), University of Brescia (9.5%, with 21 publications), Mayo Clinic (9%, with 20 publications), University of California, Irvine (7.6%, with 17 publications), Capital Medical University (7.6%, with 17 publications). The leading institutional output comes mainly from the USA, then Italy, then China, with the University of Pittsburgh taking the leading role in the USA, alongside the University of Brescia in Italy, and Capital Medical University in China. Taking into consideration that the highest CPP is achieved by the University of Insubria (22.1) demonstrates the integral role in which Italy plays in promoting development in this field. \u003cstrong\u003eFigure 4 \u003c/strong\u003e\u003cstrong\u003e demonstrates\u003c/strong\u003e that a limited number of high-volume academic centers form dense collaboration clusters, underscoring institutional concentration in ECS research.\u003c/p\u003e\n\u003cp\u003eThe network visualization map of cooperative institutions related to Endoscopic Cranial Surgery is shown in Figure 4. The nodes represent institutions, and the lines between nodes represent cooperative relationships. As shown in Figure 4, the major institutions that cooperated with the University of Pittsburgh were the University of State Ohio, the University of Brescia, and Stanford University. Seven clusters were obtained from the analysis. For example, cluster 1 (shown in red, 19 items) represents America\u0026apos;s most worldwide cooperative institution, The Ohio State University (33 publications, links 51 TLS:149), which cooperated with the University of Brescia, Seoul National University Hospital, University of Turin, University of Barcelona, Medical University of Vienna, and Capital Medical University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of Journals and Co-cited Journals\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e discerns the top ten journals contributing to the publications in the field of ECS. All publications were distributed among a total of 50 journals that published an ECS paper in the topic of ECS (\u003cstrong\u003eFigure 5A\u003c/strong\u003e). The total number of publications from among the 50 journals was 581, with the top ten publishing journals accounting for 349, representing 60% of published papers in the field of ECS. This indicates the significant impact of these journals on research in this field. \u0026ldquo;\u003cem\u003eThe Journal of Neurological Surgery: Skull Base\u0026rdquo;\u003c/em\u003e ranked first (84 publications, accounting for 24.07% of the top ten), followed by \u003cem\u003eWorld Neurosurgery\u003c/em\u003e (79 publications; 22.64%) and \u003cem\u003eJournal of Neurosurgery\u003c/em\u003e (34 publications; 9.74%). The International Forum of Allergy \u0026amp; Rhinology (32 publications; 9.17%). Together, these journals represent more than half of the total published works, reflecting their strong contribution and influence within the neuroendoscopic research area. \u003c/p\u003e\n\u003cp\u003eBased on\u003cstrong\u003eTable 3\u003c/strong\u003e, the 154 journals collectively received \u003cstrong\u003e19,291 citations (\u003c/strong\u003e\u003cstrong\u003eFigure 5B\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e, reflecting the overall scientific influence of publications in this field. Among them, the \u003cem\u003eJournal of Neurosurgery\u003c/em\u003e, \u003cem\u003eLaryngoscope\u003c/em\u003e, and \u003cem\u003eNeurosurgery\u003c/em\u003e recorded the highest citation counts (2,080, 1,905, and 1,492 citations, respectively), together accounting for approximately \u003cstrong\u003e28%\u003c/strong\u003e of total citations. Other highly cited journals included \u003cem\u003eWorld Neurosurgery\u003c/em\u003e (1,309 citations) and the \u0026ldquo;\u003cem\u003eInternational Forum of Allergy \u0026amp; Rhinology\u0026rdquo;\u003c/em\u003e (797 citations), highlighting the strong multidisciplinary collaboration between neurosurgery and otolaryngology in skull base research. These findings indicate that the most productive and most cited journals form the core of research activity and scholarly influence in endoscopic cranial surgery, emphasizing their leading role in shaping scientific advancement in this field.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of Authors and Co-cited Authors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 666 authors have published papers on Endoscopic Cranial Surgery. The ten most productive authors and the ten top co-cited authors are shown in Table 4. Snyderman, Carl H. (33 publications, 13.8%) published most papers, followed by Gardner, Paul a. (32 publications, 13.4%), Wand, Eric W. (31 publications, 13%), Carrara, Ricardo L. (26 publications, 10.9%), Prevedello, Daniel M. (24 publications, 10%), Schwartz, Theodore H. (22 publications, 9.2%), Fernandez-Miranda, Juan c. (19 publications, 7.9%), Kuan, Edward c (19 publications, 7.9%), Ananda, Vijay K. (16 publications, 6.7%), and Castenlnuovo, Paolo (16 publications, 6.7%). The network visualization map of the co-cited authors is shown in Figure 6. 17 clusters were obtained from the analysis. The largest nodes were associated with the most frequently co-cited authors, including Snyderman, Carl H (812 citations, TLS: 941, Cluster I), Gardner, Paul A. (810 citations, TLS: 889, Cluster 1), Wang, Eric W. (780 citations, TLS: 1,255, Cluster 7), Fernandez-miranda, Juan C. (611 citations, TLS: 659, Cluster 16), and Carrau, Ricardo L. (521 citations, TLS: 516, Cluster 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of References\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 7. demonstrates a network visualization composed of 129 colored nodes and 172 connecting lines, where each node represents a specific reference. The size of the node is directly proportional to the number of times a publication has been cited, and nodes of the same color represent a cluster of related studies. The lines represent link strength, indicating the number of connections between references. A higher number of lines corresponds to a stronger link, reflecting how frequently a publication is cited alongside others and its overall influence within the network.\u003c/p\u003e\n\u003cp\u003eTable 5 summarizes the 35 most cited papers in endoscopic skull base surgery. Wang et al., 2019, with their article \u003cem\u003e\u0026ldquo;ICAR: Endoscopic Skull-Base Surgery\u0026rdquo;\u003c/em\u003e, is the most cited publication, with 226 citations and a total link strength of 30. Zwagerman et al., 2019 follows with 165 citations and a link strength of 11. Other works include Conger et al., 2019, Fraser et al., 2018, Xu et al., 2018, Jeswani et al., 2016, Marchioni et al., 2015, Cavallo et al., 2019, and Schwartz et al., 2019. Most of the top 35 references are published in Q1\u0026ndash;Q2 journals and appeared after 2015.\u003c/p\u003e\n\u003cp\u003eAnalysis of the co-citation network revealed research hotspots, such as add deep seated lesions, reconstruction and prevention of CSF leaks (Cluster 7, orange zone) and reconstruction and technological innovation (Cluster 3, dark blue zone), reflecting the field\u0026rsquo;s focus on improving surgical outcomes and integrating advanced technologies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of Keywords and Keyword Co-occurrence Clusters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 82 keywords, those repeated for 5 times or more within our inclusion criteria, were mentioned in 729 publications. The keyword publication output of the Endoscopic cranial surgery is shown in Figure 8. The analysis was performed using 82 keywords \u003c/p\u003e\n\u003cp\u003eMap of keyword co-occurrence, with 82 items with 8 clusters each item is represented by a node, and the node size indicates the frequency and the corresponding keywords. The larger the node, the more relevant the research around the keyword. The thicker the line between the nodes, the greater the frequency of the keywords in the subject. The keyword analysis can quickly identify the research hotspots in the field. keywords can help quickly identify hot topics while researching the literature. . According to Table 6, the ten most commonly used keywords are: \u0026ldquo;Skull Base\u0026rdquo;, \u0026ldquo;Skull Base Surgery\u0026rdquo;, \u0026ldquo;Endoscopic Skull Base Surgery\u0026rdquo;, \u0026ldquo;Endoscopic\u0026rdquo;, \u0026ldquo;Endoscopic Endonasal Approach\u0026rdquo;, \u0026ldquo;Skull Base Reconstruction\u0026rdquo;, \u0026ldquo;Endoscopic Surgery\u0026rdquo;, \u0026ldquo;Cerebrospinal Fluid Leak\u0026rdquo;, \u0026ldquo;Endoscopy\u0026rdquo;, and Nasoseptal Flap.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eThe Most-Contributing Authors and the Most-Cited Papers\u003c/h2\u003e \u003cp\u003eBibliometric analysis has increasingly been adopted as a robust methodological framework for mapping research evolution, identifying knowledge gaps, and guiding future investigation across surgical disciplines. Recent studies have successfully applied similar approaches to orthopedics [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], neuro-oncology [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], and perioperative care [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], reinforcing bibliometrics as a contemporary gold standard in medical informatics and scientometrics. Within this context, the present study aligns with best practices in quantitatively evaluating the development and direction of ECS research.\u003c/p\u003e \u003cp\u003eAdvancements in neuroendoscopic technology and its integration into neurosurgical practice have significantly reshaped clinical approaches compared to traditional open techniques. Whereas conventional cranial surgery often requires wide exposures and substantial brain retraction, endoscopic cranial surgery (ECS) employs narrow operative corridors and high-resolution visualization systems to access deep intracranial regions. This minimally invasive approach has been associated with reduced surgical trauma, faster postoperative recovery, fewer complications, and improved visualization of critical neurovascular structures. Consequently, neuroendoscopic techniques are increasingly utilized in the management of a wide range of complex neurosurgical conditions.\u003c/p\u003e \u003cp\u003eThe objectives of this study are to: (1) analyze publication trends over time, (2) identify the most influential authors, institutions, and journals, (3) characterize patterns of global research collaboration, and (4) uncover emerging research frontiers within the field.\u003c/p\u003e \u003cp\u003eFrom 2015 to 2025, the number of publications on Endoscopic cranial surgeries has been increasing and has shown a sustained increase in academic interest. The USA has the lead in academic influence over research in ECS. The dominance of the United States and select academic centers, particularly the University of Pittsburgh, likely reflects early adoption of endoscopic skull base techniques, high procedural volumes, structured multidisciplinary skull base teams, and sustained investment in surgical innovation and training programs. These centers also function as international referral and training hubs, amplifying their academic output and citation impact. \u0026ldquo;Journal of Neurological Surgery Part Skull Base\u0026rdquo; is the most productive journal, and the most cited journal is \u0026ldquo;Journal of Neurosurgery\u0026rdquo;, indicating they are the most informative in their fields. Furthermore, \u0026rdquo;World Neurosurgery\u0026rdquo;, \u0026ldquo;Journal of Neurosurgery\u0026rdquo;, and \u0026ldquo;International Forum of Allergy \u0026amp; Rhinology\u0026rdquo; Are the most influential journals in the field.\u003c/p\u003e \u003cp\u003eSnyderman, Carl H. (University of Pittsburgh) is the most productive and co-cited author of Endoscopic cranial surgery ( 33 publications, 13.8%, 812 TLS:941 ); his most co-cited article\u0026rdquo; A novel reconstructive technique after endoscopic expanded endonasal approaches: Vascular pedicle nasoseptal flap\u0026rdquo;, innovated a method by which to decrease postoperative cerebrospinal fluid leaks that is still viable to this day. [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Furthermore, \u0026ldquo;Endoscopic skull base surgery: principles of endonasal oncological surgery\u0026rdquo; established the foundations for endonasal endoscopic skull base surgery [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eResearch HotSpots\u003c/h2\u003e \u003cp\u003eAccording to Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e, two major research hotspots have emerged in ECS: reconstruction and prevention of CSF leaks (Cluster 7), and technological innovation and surgical technique optimization (Cluster 3).\u003c/p\u003e \u003cp\u003eReconstruction and CSF Leak Prevention is the most prominent cluster, focusing on reducing postoperative complications through advanced reconstructive techniques. Zwagerman et al. (2019) highlighted the effectiveness of nasoseptal flaps in preventing CSF leaks, while Fraser et al. (2018) and Jeswani et al. (2016) refined multilayer closures and tissue grafting to ensure watertight repairs. Marchioni (2015) and Cavallo et al. (2019) further explored alternative reconstructive approaches, emphasizing safety and long-term durability. The prominence of the complication cluster indicates a transition from descriptive reporting toward evidence synthesis, highlighting the need for high-quality comparative studies and network meta-analyses to rigorously evaluate reconstructive strategies and prevention protocols.\u003c/p\u003e \u003cp\u003eTechnological Innovation and Surgical Technique Advancement emphasizes the use of modern imaging, navigation, and endoscopic tools to improve surgical precision and minimize morbidity. Wang et al. (2019a) provided standardized international guidelines through the ICAR consensus, and Conger et al. (2019) and Cavallo et al. (2019) demonstrated the benefits of high-definition endoscopes and neuronavigation systems. These innovations reflect the field\u0026rsquo;s shift toward safer, more precise, and technology-driven interventions.\u003c/p\u003e \u003cp\u003eIn summary, ECS research is centered on enhancing reconstruction safety and advancing surgical technology, showing a clear trend toward a more standardized, innovative, and patient-focused surgical practice.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eResearch Trends\u003c/h2\u003e \u003cp\u003eAccording to Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e, which times certain keywords were popularized, the research trends include the following: \u0026ldquo;Neuroendoscopy\u0026rdquo;, \u0026ldquo;Neuronavigation\u0026rdquo;, \u0026ldquo;Craniofacial Resection\u0026rdquo;, \u0026ldquo;Skull Base Defect\u0026rdquo;, and \u0026ldquo;Nasal Packing\u0026rdquo;. Neuroendoscopy has become one of the fundamental components in standard of care procedures in neurosurgical practice. Neuroendoscopic procedures offer several advantages over standard open cranial approaches, including reduced brain retraction, the use of smaller surgical corridors, and superior visualization of otherwise hidden or blind anatomical regions.[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e] However, neuroendoscopy still poses several issues, including but not limited to: hemostasis, as well as management of large lesions [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Furthermore, Neuroendoscopic outcomes have a proportional link to the surgeon\u0026rsquo;s experience, with a steep learning curve. Further investigation is warranted, particularly in further education on neuroendoscopic techniques, as well as their integration with up-and-coming AI and AR technologies..\u003c/p\u003e \u003cp\u003eIn addition to advances in neuroendoscopy, neuronavigation is yet another emerging technology used in neurosurgical practice that provides anatomical guidance and improves surgery outcomes. [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] The evolution from early CT-based pointer navigation to high-resolution MRI\u0026ndash;guided, augmented reality\u0026ndash;integrated neuronavigation represents a major step forward in endoscopic skull base surgery, improving anatomical accuracy and intraoperative orientation. [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e] Neuronavigation improves surgical accuracy and reduces intraoperative deviations from planned trajectories, and enhances outcomes in complex endoscopic skull base cases.[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] Further research advancement is needed in Neuronavigation in terms of integration of Augmented Reality (AR), cost/availability, especially in resource-limited settings, and integration of Robotics.\u003c/p\u003e \u003cp\u003eWith the rapid expansion of endoscopic skull base surgery, surgeons are increasingly encountering larger and more complex dural defects, particularly in extended endonasal approaches, where high-flow cerebrospinal fluid (CSF) leaks are common, thereby necessitating advanced reconstruction techniques to ensure watertight closure and prevent postoperative complications[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Consequently, reconstruction of skull base defects has emerged as a major focus of research, with innovations in pedicled vascularized flaps such as the nasoseptal flap, multilayer closure techniques, and the use of sealants and graft materials significantly improving success rates and reducing postoperative CSF leak incidence.[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e] Future directions in skull base reconstruction research focus on developing standardized protocols and evaluating the efficacy of various reconstructive materials, including the combined use of hydroxyapatite and nasoseptal flaps, while also exploring innovations such as 3D-printed scaffolds, bioengineered grafts, and tissue-engineering techniques to optimize long-term sinonasal outcomes and cost-effectiveness. [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eBeyond technical innovation, the rise of ECS parallels a broader paradigm shift toward perioperative optimization and complication prevention. As a minimally invasive modality, ECS aligns with contemporary goals of reducing surgical stress, hospital length of stay, and postoperative morbidity. The increasing bibliometric emphasis on postoperative management, CSF leak prevention, and sinonasal outcomes suggests that ECS is evolving not merely as a surgical technique, but as a component of comprehensive, system-level patient care.\u003c/p\u003e \u003cp\u003ePostoperative management strategies have also undergone substantial transformation. Traditionally, nasal packing was routinely applied after reconstruction to support grafts, prevent cerebrospinal fluid (CSF) leaks, and control bleeding. However, recent evidence has challenged this necessity, demonstrating that effective closure can be achieved without routine packing, thereby improving patient comfort and reducing sinonasal morbidity [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. This shift reflects a growing trend in the literature toward minimally invasive postoperative care, as highlighted in recent studies emphasizing the role of tailored management protocols rather than a one-size-fits-all approach [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. From a bibliometric perspective, there has been a marked rise in publications addressing \u0026ldquo;postoperative management,\u0026rdquo; \u0026ldquo;nasal packing,\u0026rdquo; and \u0026ldquo;sinonasal outcomes,\u0026rdquo; indicating increasing research interest in optimizing recovery and minimizing complications. Moreover, the trend toward omitting nasal packing aligns with broader improvements in reconstruction techniques, particularly the use of vascularized flaps and multilayer closures that provide stable support without additional packing. Looking forward, future research will likely focus on standardizing postoperative protocols, assessing patient-reported sinonasal function, and performing cost-benefit analyses to determine when nasal packing can be safely avoided, further refining recovery protocols and improving quality of life for patients undergoing endoscopic skull base surgery [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eFuture perspectives\u003c/h2\u003e \u003cp\u003eFuture ECS research should move beyond descriptive studies toward higher-level evidence generation. Multicenter prospective studies and international collaborative registries are needed to validate surgical outcomes across diverse practice settings. Standardized outcome reporting and comparative effectiveness research, including network meta-analyses, will be essential to determine optimal reconstructive and perioperative strategies. Additionally, emerging technologies such as artificial intelligence, augmented reality, and robotic assistance should be evaluated through structured clinical studies to clarify their real-world impact on surgical precision, safety, and patient outcomes. Strengthening global collaboration\u0026mdash;particularly involving underrepresented regions\u0026mdash;will be critical to ensuring equitable advancement and generalizability of ECS research.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThe study assessed the current status of Endoscopic cranial surgery research, research hotspots, and research trends through bibliometric analysis. However there are some limitations in the study: the analysis of this study retrieved content only from the English language publications in the WOSCC database, causing language bias; this study has omitted publications that are not included in the WOSCC database. Furthermore, with an increasing number of publications related to Endoscopic cranial surgery in recent years, some newly published high-quality publications have low citation frequency and are easily missed.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis bibliometric analysis delineates the global structure, dominant contributors, and evolving research priorities of endoscopic cranial surgery over the past decade. ECS research is primarily driven by technological innovation and complication prevention, with concentrated contributions from high-volume academic centers. These findings provide a strategic framework for future investigation, emphasizing the need for collaborative, high-level evidence to guide the continued maturation of ECS worldwide.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of interest:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe authors do not have any conflict of interest or source of funding to declare\u003c/p\u003e\n\u003ch2\u003eAcknowledgement:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003ch2\u003eEthical Approval\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo Ethical approval is required in this type of design due to secondary data usage. \u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eFunding\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eAll data used in this study were obtained from publicly accessible databases using the search strategy described in the Methods section. No proprietary or patient-level data were generated. The datasets analyzed consist of published articles retrieved through the specified search terms, and these can be reproduced by any researcher who applies the same search strategy.\u003c/p\u003e\n\u003cp\u003eNo additional datasets were generated or stored by the authors; therefore, no separate data repository is available.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eApuzzo ML, Heifetz MD, Weiss MH, Kurze T. Surgical considerations in the treatment of intraventricular tumors by neuroendoscopy. Neurosurgery. 1977;1(4):395-401.\u003c/li\u003e\n \u003cli\u003eHopf NJ, Perneczky A. Endoscopic neurosurgery and endoscope-assisted microneurosurgery for the treatment of colloid cysts of the third ventricle. Neurosurgery. 1998;42(3):697-704.\u003c/li\u003e\n \u003cli\u003eSchroeder HW, Gaab MR. Endoscopic resection of colloid cysts. Neurosurgery. 2002;51(6):1441-1445.\u003c/li\u003e\n \u003cli\u003eOertel JM, Baldauf J, Schroeder HW, Gaab MR. Endoscopic resection of colloid cysts: experience with more than 100 patients. Neurosurgery. 2009;64(2):245-252.\u003c/li\u003e\n \u003cli\u003eJane JA Jr, Han J, Prevedello DM, et al. Perspectives on endoscopic transsphenoidal surgery. Neurosurg Focus. 2005;19(6):E2.\u003c/li\u003e\n \u003cli\u003eLaws ER, Cappabianca P. Endoscopic neurosurgery in practice: an international survey. World Neurosurg. 2014;82(5):879-883.\u003c/li\u003e\n \u003cli\u003eWang EW, Zanation AM, Gardner PA, et al. ICAR: Endoscopic skull-base surgery. Int Forum Allergy Rhinol. 2019;9(S3):S145\u0026ndash;S365. doi:10.1002/alr.22326\u003c/li\u003e\n \u003cli\u003eZwagerman NT, Wang EW, Shin SS, et al. Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial. J Neurosurg. 2019;131(4):1172\u0026ndash;1178. doi:10.3171/2018.4.JNS172447\u003c/li\u003e\n \u003cli\u003eConger A, Zhao F, Wang X, et al. Evolution of the graded repair of CSF leaks and skull base defects in endonasal endoscopic tumor surgery: trends in repair failure and meningitis rates in 509 patients. Journal of Neurosurgery JNS. 2019;130(3):861-875. doi:10.3171/2017.11.JNS172141\u003c/li\u003e\n \u003cli\u003eFraser S, Gardner PA, Koutourousiou M, et al. Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery. Journal of Neurosurgery JNS. 2018;128(4):1066-1071. doi:10.3171/2016.12.JNS1694\u003c/li\u003e\n \u003cli\u003eXu X, Chen X, Li F, et al. Effectiveness of endoscopic surgery for supratentorial hypertensive intracerebral hemorrhage: a comparison with craniotomy. Journal of Neurosurgery JNS. 2018;128(2):553-559. doi:10.3171/2016.10.JNS161589\u003c/li\u003e\n \u003cli\u003eJeswani S, Nu\u0026ntilde;o M, Wu A, et al. Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal transsphenoidal resection of craniopharyngioma and related tumors: a single-institution study. Journal of Neurosurgery JNS. 2016;124(3):627-638. doi:10.3171/2015.3.JNS142254\u003c/li\u003e\n \u003cli\u003eMarchioni D, Alicandri-Ciufelli M, Rubini A, Presutti L. Endoscopic transcanal corridors to the lateral skull base: Initial experiences. Laryngoscope. 2015;125(S1):S1-S13. doi:10.1002/lary.25203\u003c/li\u003e\n \u003cli\u003eCavallo LM, Solari D, Somma T, Cappabianca P. The 3F (Fat, Flap, and Flash) technique for skull base reconstruction after endoscopic endonasal suprasellar approach. World Neurosurg. 2019;126:439-446. doi:10.1016/j.wneu.2019.03.125\u003c/li\u003e\n \u003cli\u003eSchwartz TH, Morgenstern PF, Anand VK. Lessons learned in the evolution of endoscopic skull base surgery: JNSPG 75th Anniversary Invited Review Article. Journal of Neurosurgery JNS. 2019;130(2):337-346. doi:10.3171/2018.10.JNS182154\u003ca href=\"https://onlinelibrary.wiley.com/doi/10.1002/alr.22326?utm_source=chatgpt.com\"\u003e\u0026nbsp;\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eMuskens IS, Briceno V, Ouwehand TL, et al. The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas: a meta-analysis. Acta Neurochir (Wien). 2018;160(1):59-75. doi:10.1007/s00701-017-3390-y\u003c/li\u003e\n \u003cli\u003eBorg A, Kirkman MA, Choi D. Endoscopic endonasal anterior skull base surgery: a systematic review of complications during the past 65 years. World Neurosurg. 2016;95:383-391. doi:10.1016/j.wneu.2015.12.105\u003c/li\u003e\n \u003cli\u003eVural A, Carobbio ALC, Ferrari M, et al. Transorbital endoscopic approaches to the skull base: a systematic literature review and anatomical description. Neurosurg Rev. 2021;44(5):2857-2878. doi:10.1007/s10143-020-01470-5\u003c/li\u003e\n \u003cli\u003eMaza G, Li C, Krebs JP, Otto BA, Farag AA, Carrau RL, Zhao K. Computational fluid dynamics after endoscopic endonasal skull base surgery \u0026ndash; possible empty nose syndrome in the context of middle turbinate resection. Int Forum Allergy Rhinol. 2019;9(2):204-211. doi:10.1002/alr.22236\u003c/li\u003e\n \u003cli\u003eLocatelli D, Pozzi F, Turri-Zanoni M, et al. Transorbital endoscopic approaches to the skull base: current concepts and future perspectives. J Neurosurg Sci. 2016;60(4):514-525. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eYounus I, Gerges MM, Uribe-Cardenas R, et al. How long is the tail end of the learning curve? Results from 1000 consecutive endoscopic endonasal skull base cases following the initial 200 cases. Journal of Neurosurgery. 2021;134(3):750-760. doi:10.3171/2019.12.JNS192600\u003c/li\u003e\n \u003cli\u003ede Almeida JR, Carvalho F, Vaz Guimaraes Filho F, et al. Comparison of endoscopic endonasal and bifrontal craniotomy approaches for olfactory groove meningiomas: a matched pair analysis of outcomes and frontal lobe changes on MRI. J Clin Neurosci. 2015;22(11):1733-1741. doi:10.1016/j.jocn.2015.03.056\u003c/li\u003e\n \u003cli\u003eStapleton AL, Tyler-Kabara EC, Gardner PA, Snyderman CH, Wang EW. Risk factors for cerebrospinal fluid leak in pediatric patients undergoing endoscopic endonasal skull base surgery. Int J Pediatr Otorhinolaryngol. 2017;93:163-166. doi:10.1016/j.ijporl.2016.12.019\u003c/li\u003e\n \u003cli\u003eBhenswala PN, Schlosser RJ, Nguyen SA, Munawar S, Rowan NR. Sinonasal quality-of-life outcomes after endoscopic endonasal skull base surgery. Int Forum Allergy Rhinol. 2019;9(10):1105-1118. doi:10.1002/alr.22398 \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFu C, Wang N, Chen B, et al. Surgical management of moderate basal ganglia intracerebral hemorrhage: comparison of safety and efficacy of endoscopic surgery, minimally invasive puncture and drainage, and craniotomy. World Neurosurg. 2019;122:e995-e1001. doi:10.1016/j.wneu.2018.10.192 \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLi Y, Yang R, Li Z, et al. Surgical evacuation of spontaneous supratentorial lobar intracerebral hemorrhage: comparison of safety and efficacy of stereotactic aspiration, endoscopic surgery, and craniotomy. World Neurosurg. 2017;105:332‑340. doi:10.1016/j.wneu.2017.05.134 \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAlQahtani AA, Castelnuovo P, Nicolai P, Prevedello DM, Locatelli D, Carrau RL. Injury of the internal carotid artery during endoscopic skull base surgery: prevention and management protocol. Otolaryngol Clin North Am. 2016;49(1):237‑252. doi:10.1016/j.otc.2015.09.009. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHsieh TY, Cervenka B, Dedhia R, Strong EB, Steele T. Assessment of a patient‑specific, 3‑dimensionally printed endoscopic sinus and skull base surgical model. JAMA Otolaryngol Head Neck Surg. 2018;144(7):574‑579. doi:10.1001/jamaoto.2018.0473\u003c/li\u003e\n \u003cli\u003eSigler AC, D\u0026rsquo;Anza B, Lobo BC, Woodard TD, Recinos PF, Sindwani R. Endoscopic skull base reconstruction: an evolution of materials and methods. Otolaryngol Clin North Am. 2017;50(3):643‑653. doi:10.1016/j.otc.2017.01.015.\u003c/li\u003e\n \u003cli\u003eDavid AP, Jiam NT, Reither JM, Gurrola JG 2nd, Aghi MK, El‑Sayed IH. Endoscopic skull base and transoral surgery during the COVID‑19 pandemic: minimizing droplet spread with a negative‑pressure otolaryngology viral isolation drape. Head Neck. 2020;42(7):1577‑1582. doi:10.1002/hed.26239 \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eYano S, Hide T, Shinojima N. Efficacy and complications of endoscopic skull base surgery for giant pituitary adenomas. World Neurosurg. 2017;99:533‑542. doi:10.1016/j.wneu.2016.12.068 \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLi L, Yang J, Chu Y, Wu W, Xue J, et al. A novel augmented reality navigation system for endoscopic sinus and skull base surgery: a feasibility study. PLoS One. 2016;11(1):e0146996. doi:10.1371/journal.pone.0146996\u003c/li\u003e\n \u003cli\u003eTurri‑Zanoni M, Zocchi J, Lambertoni A, Giovannardi M, Karligkiotis A, Battaglia P, Locatelli D, Castelnuovo P. Endoscopic endonasal reconstruction of anterior skull base defects: what factors really affect the outcomes? World Neurosurg. 2018;116:e436‑e443. doi:10.1016/j.wneu.2018.04.225\u003c/li\u003e\n \u003cli\u003eHannan C, Almhanedi H, Al‑Mahfoudh R, et al. Predicting post‑operative cerebrospinal fluid (CSF) leak following endoscopic transnasal pituitary and anterior skull base surgery: a multivariate analysis. Acta Neurochir (Wien). 2020;162(6):1309‑1315. doi:10.1007/s00701-020-04334-5 \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKuan EC, Kaufman AC, Lerner D, Kohanski MA, Tong CC L, Tajudeen BA, Parasher AK, Lee JYK, Storm PB, Palmer JN, Adappa ND. Lack of sphenoid pneumatization does not affect endoscopic endonasal pediatric skull base surgery outcomes. Laryngoscope. 2019;129(4):832‑836. doi:10.1002/lary.27600.\u003c/li\u003e\n \u003cli\u003eHannan CJ, Kelleher E, Javadpour M. Methods of skull base repair following endoscopic endonasal tumor resection: a review. Front Oncol. 2020;10:1614. doi:10.3389/fonc.2020.01614. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWang EW, Gardner PA, Zanation AM, et al. International consensus statement on endoscopic skull‑base surgery: Executive summary. Int Forum Allergy Rhinol. 2019;9(S3):S127‑S144. doi:10.1002/alr.22327\u003c/li\u003e\n \u003cli\u003eZheng JP, Li CZ, Chen GQ, Song GD, Zhang YZ. Three‑dimensional printed skull base simulation for transnasal endoscopic surgical training. World Neurosurg. 2018;111:e773‑e782. doi:10.1016/j.wneu.2017.12.169 \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eZwagerman NT, Zenonos G, Lieber S, et al. Endoscopic transnasal skull base surgery: pushing the boundaries. J Neurooncol. 2016;130(2):319‑330. doi:10.1007/s11060-016-2274-y \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRioja E, Bernal‑Sprekelsen M, Enriquez K, et al. Long‑term outcomes of endoscopic endonasal approach for skull base surgery: a prospective study. Eur Arch Otorhinolaryngol. 2016;273(7):1809‑1817. doi:10.1007/s00405-015-3853-9 \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBattaglia P, Turri-Zanoni M, De Bernardi F, et al. Septal flip flap for anterior skull base reconstruction after endoscopic resection of sinonasal cancers: preliminary outcomes. Septal flip flap per la ricostruzione del basicranio anteriore dopo resezione di tumori nasosinusali: risultati preliminari. Acta Otorhinolaryngol Ital. 2016;36(3):194-198. doi:10.14639/0392-100X-748\u003c/li\u003e\n \u003cli\u003eLiu, S., Xu, X. \u0026amp; Zhou, J. Bone Morphogenetic Proteins in Orthopedics: A Bibliometric Analysis. JOIO 59, 1487\u0026ndash;1504 (2025). https://doi.org/10.1007/s43465-025-01414-5\u003c/li\u003e\n \u003cli\u003eLiu S, Liang R. Oncolytic Virotherapy for Glioma: A Bibliometric Roadmap for Multidisciplinary Clinical and Research Strategies. J Multidiscip Healthc. 2025;18:6167-6185. Published 2025 Sep 26. doi:10.2147/JMDH.S557248\u003c/li\u003e\n \u003cli\u003eLiu, S., \u0026amp; Zhou, J. (2025). Trends and development of enhanced recovery after surgery programs in cranial and spinal neurosurgery.\u0026nbsp;Neuro-Chirurgie, 71 5, 101704 .\u003c/li\u003e\n \u003cli\u003eHadad G, Bassagasteguy L, Carrau RL, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. 2006;116(10):1882-1886. doi:10.1097/01.mlg.0000234933.37779.e4\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSnyderman CH, Carrau RL, Kassam AB, Zanation A, Prevedello D, Gardner P, Mintz A. Endoscopic skull base surgery: Principles of endonasal oncological surgery. J Surg Oncol. 2008;97(8):658-664. doi:10.1002/jso.21020\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTosi U, Guadix SW, Souweidane MM. Neuroendoscopy: The state of the art. World Neurosurg. 2023;178:305-310. doi:10.1016/j.wneu.2023.07.125\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTariq F, Jumah F, Ravipati K, Ortiz-Torres M, Carr SB, Chicoine MR. Advances in Cranial Surgery. Mo Med. 2024;121(2):136-141.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRohde V, Behm T, Ludwig H, et al. The role of neuronavigation in intracranial endoscopic procedures. Neurosurg Rev. 2012;35(3):351-358. doi:10.1007/s10143-011-0369-7\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCandy NG, Jukes AK, Patel S, et al. Neuronavigation in endoscopic skull base surgery and the accuracy of different MRI sequences. J Clin Neurosci. 2024;123:203-208. doi:10.1016/j.jocn.2024.04.006\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWang D, Zhang H. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024;38(6):463-466. doi:10.13201/j.issn.2096-7993.2024.06.002\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eShin DW, Yee GT. Skull base reconstruction using hydroxyapatite and nasoseptal flap versus nasoseptal flap alone: meta-analysis and systematic review. Sci Rep. 2024;14:28433. doi:10.1038/s41598-024-79956-1\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eEl-Sayed IH, Roediger FC, Goldberg AN, Parsa AT, McDermott MW. Endoscopic reconstruction of skull base defects with the nasal septal flap. Skull Base. 2008;18(6):385-394. doi:10.1055/s-0028-1096202\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAsmaro K, Yoo F, Yassin-Kassab A, et al. Sinonasal Packing is Not a Requisite for Successful Cerebrospinal Fluid Leak Repair. J Neurol Surg B Skull Base. 2021;83(5):476-484. Published 2021 Dec 17. doi:10.1055/s-0041-1740622\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGoshtasbi K, Abiri A, Talati V, et al. Postoperative management following endoscopic skull base reconstruction: A multidisciplinary cross-sectional survey. Head Neck. 2025;47(7):1939-1948. doi:10.1002/hed.28116\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Khaleghi M, Shahid AH, Suggala S, et al. Modified graded skull base reconstruction for intraoperative CSF leak repair in endoscopic endonasal surgeries: a single-surgeon experience in initial years of practice and nuances in the early learning curve. Neurosurgical Focus. 2025;58(2):E6-. doi:10.3171/2024.11.FOCUS24733\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Top Ten Productive Countries.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"696\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003eRANK\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003eCountry\u003cbr\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003ePublications\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003ePercentage %\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003eCitations\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003eCitation per publication\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003eTotal link strength\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003eUNITED STATES\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e336\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e38.7%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e4503\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e13.4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e1286\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003eCHINA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e85\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e9.81%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e982\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e11.6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e278\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003eITALY\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e71\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e8.1%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e1352\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e19.0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e501\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003eJAPAN\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e53\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e6.1%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e390\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e7.4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e144\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003eUNITED KINGDOM\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e28\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e3.2%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e571\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e20.4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e215\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003eINDIA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e26\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e3%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e117\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e4.5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e48\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003eSOUTH KOREA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e23\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e2.6%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e312\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e13.6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e154\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003eCANADA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e23\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e2.6%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e565\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e24.6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e232\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e9\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003eAUSTRALIA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e22\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e2.5%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e417\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e19.0\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e187\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e10\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 121px;\"\u003eSAUDI ARABIA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e19\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e2.1%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e138\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e7.3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e82\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 224px;\"\u003etotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e686\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e8447\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e12.3 (average)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePercentages are calculated relative to the total number of publications (n = 866).\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Top Ten Productive Institutions\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"696\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003eRANK\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003eInstitutions\u003cbr\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003ePublications\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003ePercentage %\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003eCitations\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003eCitation per publication\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003eTotal link strength\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003eUniversity of Pittsburgh\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e55\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e24.8%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e985\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e17.9\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e367\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003eThe Ohio State University\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e33\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e14.9%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e543\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e16.4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e149\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003eUniversity of Brescia\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e21\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e9.5%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e271\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e12.9\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e62\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003eMayo Clinic\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e20\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e9%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e265\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e13.2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e140\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003e\u0026nbsp;\u003cbr\u003eUniversity of California, Irvine\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e17\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e7.6%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e131\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e7.7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e48\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003eCapital Medical University\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e17\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e7.6%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e162\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e9.5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e232\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003eUniversity of Insubria\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e15\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e6.7%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e332\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e22.1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e80\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003eStanford University\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e15\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e6.7%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e163\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e10.8\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e46\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e9\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003eUniversity of Pennsylvania\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e14\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e6.3%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e204\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e14.5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e118\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e10\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 114px;\"\u003eFudan University\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e14\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e6.3%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e265\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e18.9\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 79px;\"\u003e70\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 217px;\"\u003etotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e221\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e3321\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Top Ten Productive and Co-cited Journals\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"768\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003eRANK\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003eJournal\u003cbr\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003ePublications\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003ePercentage %\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003eTotal link strength\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 51px;\"\u003eRank\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003eJournal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003eCitations\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003eCitation per publication\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003eTotal link strength\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003eJournal of Neurological Surgery Part Skull Base\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e84\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e24.07%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e247\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003eJournal of Neurosurgery\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e2080\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e61.18\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e187257\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003eWorld neurosurgery\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e79\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e22.64%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e231\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003elaryngoscope\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e1905\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e61.45\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e173022\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003eJournal of Neurosurgery\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e34\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e9.74%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e214\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003eNeurosurgery\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e1492\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e248.67\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e147861\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003eInternational forum of allergy \u0026amp; rhinology\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e32\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e9.17%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e229\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003eWorld Neurosurgery\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e1309\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e16.57\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e123794\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003eLaryngoscope\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e31\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e8.88%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e116\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003eInternational Forum of Allergy \u0026amp; Rhinology\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e797\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e24.91\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e90841\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003eActa neurochirurgica\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e20\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e5.73%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e82\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51px;\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003eJournal of Neurological Surgery Part Skull Base\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e737\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e8.77\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e68323\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003eJournal of Craniofacial Surgery\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e18\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e5.16%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e25\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51px;\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003eNeurosurgical Focus\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e705\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e176.25\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e71484\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003eOperative neurosurgery\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e18\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e5.16%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e52\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003eJournal Otolaryngology Head neck\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e608\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e121.60\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e77528\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e9\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003eOtolaryngologic clinics of north america\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e17\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e4.87%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e70\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51px;\"\u003e9\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003eJournal Acta Neurochirurgica\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e518\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e25.90\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e65838\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e10\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003eNeurosurgical review\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e16\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e4.58%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e52\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 51px;\"\u003e10\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003eAmerican journal of rhinology allergy\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e373\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e26.64\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e40650\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 158px;\"\u003etotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e349\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e100%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e1318\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 144px;\"\u003eTotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e10524\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e1046598\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e Top Ten Co-cited authors\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"783\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003eRank\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003eAuthor\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003ePublications\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003epercentage %\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003eTotal link strength\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003eRank\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003eAuthor\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003eCitations\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003eTotal link strength\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003eSnyderman, Carl H.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e33\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e13.8%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e941\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003eSnyderman, Carl H.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e812\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e941\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003eGardner, Paul A.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e32\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e13.4%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e889\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003eGardner, Paul A.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e810\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e889\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003eWang, Eric W.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e31\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e13%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e1255\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003eWang, Eric W.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e780\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e1255\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003eCarrau, Ricardo L.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e26\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e10.9%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e516\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003eFernandez-miranda, juan c.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e611\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e659\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003ePrevedello, Daniel M.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e24\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e10%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e342\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003eCarrau, Ricardo L.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e521\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e516\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003eSchwartz, Theodore H.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e22\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e9.2%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e418\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003eSchwartz, Theodore H.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e408\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e418\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003eFernandez-miranda, juan c.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e19\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e7.9%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e659\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003eAnand, Vijay K.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e372\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e402\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003eKuan, Edward C.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e19\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e7.9%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e942\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003eCastelnuovo, paolo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e316\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e229\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e9\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003eAnand, Vijay K.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e16\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e6.7%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e402\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e9\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003ePrevedello, Daniel M.\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e295\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e342\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e10\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003eCastelnuovo, paolo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e16\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e6.7%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e229\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e10\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003eNicolai, piero\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e256\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e276\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 183px;\"\u003eTotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e238\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 164px;\"\u003eTotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u003c/strong\u003e 35 Most Cited References\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003eRANK\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003eArticule\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003eCitations\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003eTotal Link Strength\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eWang (2019a) [7]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e226\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e30\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eZwagerman (2019) [8]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e165\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e11\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eConger (2019) [9]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e163\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eFraser (2018) [10]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e126\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eXu (2018) [11]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e114\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eJeswani (2016) [12]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e95\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eMarchioni (2015) [13]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e84\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eCavallo (2019) [14]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e77\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e9\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eSchwartz (2019) [15]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e77\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e10\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e10\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eMuskens (2018) [16]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e72\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e11\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eBorg (2016) [17]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e70\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e12\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eVural (2021) [18]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e67\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e13\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eMaza (2019) [19]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e63\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e14\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eLocateli (2016) [20]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e63\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e15\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eYounus (2021) [21]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e62\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e16\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eDe Almeida (2015) [22]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e59\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e17\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eStapleton (2017) [23]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e56\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e18\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eBhenswala (2019) [24]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e53\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e19\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eFu (2019) [25]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e53\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e20\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eLi (2017) [26]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e51\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e21\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eAlqahtani (2016) [27]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e51\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e22\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eHsieh (2018) [28]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e49\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e23\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eSigler (2017) [29]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e48\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e24\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eDavid (2020) [30]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e45\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e25\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eYano (2017a) [31]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e45\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e26\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eLi (2016) [32]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e45\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e27\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eTurri-zanoni (2018) [33]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e44\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e28\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eHannan (2020a) [34]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e42\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e29\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eKuan (2019) [35]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e42\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e30\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eHannan (2020b) [36]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e41\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e31\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eWang (2019b) [37]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e41\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e32\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eZheng (2018) [38]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e41\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e33\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eZwagerman (2016) [39]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e41\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e34\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eRioja (2016) [40]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e41\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e35\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 159px;\"\u003eBattaglia (2016) [41]\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 152px;\"\u003e41\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 156px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6.\u003c/strong\u003e Top Ten Related Keywords\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003eRank\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003eKeywords\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003eOccourance\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003ePercentage %\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003eTotal strength\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003eSkull base\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e189\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e24.5%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e402\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003eSkull base surgery\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e84\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e10.9%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e153\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003eEndoscopic skull base surgery\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e74\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e9.6%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e124\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003eEndoscopic\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e70\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e9.1%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e195\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003eEndoscopic endonasal approach\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e68\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e8.8%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e147\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003eSkull base reconstruction\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e63\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e8.2%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e125\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003eEndoscopic surgery\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e61\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e7.9%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e121\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e8\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003eCerebrospinal fluid leak\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e57\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e7.4%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e138\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e9\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003eEndoscopy\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e53\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e6.9%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e84\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e10\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003eNasoseptal flap\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e49\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e6.3%\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e137\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 250px;\"\u003eTotal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e768\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endoscopic cranial surgery, Skull base surgery, Bibliometric analysis, Neuroendoscopy, Research trends","lastPublishedDoi":"10.21203/rs.3.rs-8760930/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8760930/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEndoscopic cranial surgery (ECS) has undergone rapid expansion over the past decade, driven by advances in visualization, navigation, and minimally invasive surgical strategies. However, the global structure, thematic evolution, and collaborative patterns of ECS research have not been systematically quantified.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA bibliometric and visualized analysis was conducted using publications retrieved from the Web of Science Core Collection (2015\u0026ndash;2025). VOSviewer and CiteSpace were applied to analyze publication trends, authorship networks, institutional and national contributions, co-cited references, and keyword clusters.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 729 eligible publications were included. The United States dominated research output and citation impact, with the University of Pittsburgh emerging as the most influential institution. Major research hotspots centered on skull base reconstruction, cerebrospinal fluid (CSF) leak prevention, and technological innovation, including neuronavigation and high-definition endoscopy. Recent trends indicate increasing focus on postoperative management and complication mitigation.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eECS research is increasingly shaped by technological refinement and complication prevention strategies. These findings provide a structured overview of the evolution of endoscopic cranial surgery and may assist neurosurgeons, trainees, and researchers in identifying established research domains, emerging priorities, and areas requiring higher-level clinical evidence.\u003c/p\u003e","manuscriptTitle":"Global Research Trends in Endoscopic Cranial Surgery: A Bibliometric and Visualized Analysis (2015–2025)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-24 16:29:04","doi":"10.21203/rs.3.rs-8760930/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dcde5a15-02b1-4c62-94c0-fba8438bf5fd","owner":[],"postedDate":"February 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T12:42:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-24 16:29:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8760930","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8760930","identity":"rs-8760930","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}