In Reply: Operationalizing Global Neurosurgery Research in Neurosurgical Journals.

Abstract

To the Editor: We read with great interest the letter by Boyke et al1 headed “Letter: Operationalizing Global Neurosurgery Research in Neurosurgical Journals.” According to the authors, operationalizing global neurosurgery research in neurosurgical journals can create a forum for leaders across the globe to share information to reduce the worldwide burden of neurological disorders.1 We thank the author for highlighting significant remarks in neurosurgical publications about the importance of global neurosurgery research. The importance of research in reducing inequalities in neurosurgery in low- and middle-income countries (LMICs) is critical. As the worldwide neurosurgical community seeks to enhance timely access to neurosurgical treatment, the health system has continued to acquire importance in the scientific literature.2,3 The World Federation of Neurosurgical Societies is dedicated to worldwide neurosurgical treatment enhancement.4 Young neurosurgeons prioritize nontechnical and technical skill development, such as research opportunities, accessibility to peer-reviewed journals, and skill-based workshops. However, numerous obstacles, such as journal restrictions, hinder personal growth, especially in LMICs. According to a recent survey, young neurosurgeons' most prevalent global problem is a lack of research opportunities, access to neurosurgery publications, and neurosurgical textbooks.4 Major impacting neurosurgical articles are published in journals such as Journal of Neurosurgery, Acta Neurochirurgica, and World Neurosurgery; however, individual memberships can charge hundreds of dollars each year because of paywalls and requisites. The neurosurgical community should work on improving research publications more accessible to neurosurgeons. The low proportion of scientific articles published by writers from LMICs is striking.5 According to Langer et al,5 low involvement is poor research productivity, manuscript preparation, scientific literature access, poor participation in publication-related decision-making processes, and journal bias. Because many LMIC researchers may be unable to pay the manuscript-processing charge, extra funds for open-access publishing for these researchers should be sought.6 If journal publishing is a valid measure of research quality and quantity, LMICs are badly underrepresented internationally.6 In a recent assessment of research output in LMICs as demonstrated by journal publishing, Servadei et al7 discovered that just 4.52% of 6708 published reports were affiliated with an LMIC. According to subsequent bibliometric research, Africa and Southeast Asia account for less than 3% of publishing production.8 A recent assessment of randomized trials of neurosurgical procedures used in cranial and spinal neurosurgical practice discovered that just 8.8% of studies were from low-income countries.9 We argue on the limited facilities, infrastructure, and staff availability in LMICs, instead of focusing on a requirement for designated endeavors as a possible remedy. The neurosurgical community can flourish by working together in research activities, and we hope that global neurosurgery can play a role in this field. Future studies on the results of global neurosurgical initiatives implemented in low-resource nations will aid in formulating plans.