Transforming Global Neurosurgical Education Through Mixed Reality Development: A 12-Year Bibliometric Analysis

Abstract

This study visualizes and analyzes global research collaborations, their current state, and the developmental trends of mixed reality (MR) education modules to predict future directions in neurosurgery. A structured review was conducted, focusing on MR, education, and neurosurgery, using Medline, Scopus, and Embase databases from January 1, 2013, to January 31, 2024. Search terms included ("mixed reality") AND (education) AND (neurosurgery). Data on application purposes, design, and geographic locations were extracted. The global distribution and collaboration in emerging neurosurgical MR technologies were assessed using qualitative data extraction and bibliometric analyses. The search yielded 1,063 articles; 127 duplicates were removed. The remaining 936 articles were screened for relevance by two independent authors. Twenty-five articles on MR development or use, authored by 181 individuals from 21 countries, were included. Of these articles, 17 (68%) focused on cranial MR, two (8%) on spine MR, and six (24%) on both cranial and spine or unspecified neurosurgical MR training. Authors from China and the United States contributed the most articles (six each) and made significant contributions to the field, despite having limited international collaborations (one each). Both countries also had the most single-center publications (four each). The United States had the highest citation count (150). The leading journal publishing neurosurgical MR developments was Neurosurgical Focus, with six (24%) publications. The most common keywords were "mixed reality" (14), "neurosurgery" (five), and "augmented reality" (four), with 40, 20, and 13 connections to other keywords, respectively. MR applications in neurosurgery have a significant impact on trainee education. Current prototypes and applications complement traditional apprenticeship models, and it is anticipated that MR will increasingly integrate into neurosurgical curricula as more institutions allocate resources to develop this emerging technology through international collaboration. Additionally, MR applications offer a safe training environment.

Keywords: bibliometric analysis; global; mixed reality; mixed-reality modules; neurosurgical education; neurosurgical procedures; technology.

Figure 1. Search strategy flow diagram

Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Figure 2. Network visualization map of global collaboration and journal data showing the number of publications on neurosurgical mixed reality (MR)

A: network visualization map of global collaboration in neurosurgical MR development created by the VOSviewer tool (Centre for Science and Technology Studies, Leiden University, The Netherlands) [4], revealing the global collaboration between countries that have developed MR neurosurgical technology; B: journal data showing the number of publications on neurosurgical MR applications by country, January 1, 2013, to January 31, 2024. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Figure 3. Citation numbers by year and country, January 1, 2013, to January 31, 2024

Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Figure 4. Network visualization map of keywords

Constructed using the VOSviewer tool  (Centre for Science and Technology Studies, Leiden University, The Netherlands) [4], based on neurosurgical mixed reality publications from January 1, 2013, to January 31, 2024. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.