• Andreas Seas, Liming Qiu, Emma Paradie, Jasmine Hughes, Pranav I Warman, Romaric Waguia-Kouam, Nathan A Shlobin, Kennedy Carpenter, Megan von Isenburg, Michael M Haglund, Anthony T Fuller, and Alvan-Emeka K Ukachukwu.
• Duke Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA; Pratt School of Engineering, Duke University, Durham, North Carolina, USA.
• World Neurosurg. 2024 Sep 11.

BackgroundThere are critical disparities in the neurosurgical care provided around the globe due to challenges in resource allocation, training, and infrastructure. Global neurosurgical collaborations have replaced classical mission trips to address these disparities. However, the development of these collaborations and the impact of research funding on their growth have not yet been systematically studied. In this article, we use a graph theoretical approach to investigate trends in funding and co-authorship between and among authors from high-income countries (HICs) and authors from low- and middle-income countries (LMICs).MethodsA bibliometric search of the global neurosurgical literature returned 307 articles between 1985 and 2020. A connectivity analysis was conducted to compute the number of co-authorships between HIC-HIC, LMIC-HIC, and LMIC-LMIC authors. The number of connections, summarized as either a global sum of connections or an average number of connections per manuscript, were analyzed in the context of time and funding through parametric statistical tests.ResultsAn exponential increase in co-authorship collaboration was observed over time, especially after 2015. Notably, LMIC-LMIC collaborations appear to be rising at over twice the rate of other collaboration types. The presence of funding, in general, was associated with increased co-authorship of manuscripts by LMIC and HIC authors together (P = 0.033). A significant majority of the funding associated with LMIC-HIC co-authorships was supplied through charitable organizations and government grants (P = 0.034, P = 0.009, respectively). Most LMIC-LMIC co-authorships had no funding.ConclusionsThis work shows significant and rapid growth in international neurosurgical partnerships, especially in HIC-LMIC and LMIC-LMIC collaborations. Also, a significant positive relationship exists between research funding and LMIC-HIC co-authorship trends. This work encourages us as a community to continue to expand our translational collaborations with LMIC neurosurgeons and establish funding mechanisms independent of HIC authors.Copyright © 2024 Elsevier Inc. All rights reserved.

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