The Focus of High Impact Studies in Cranioplasty Research: A Deeper Dive to Understand Gaps and Opportunities

Cranioplasty is a critical reconstructive procedure, with research focused on many different areas. Despite this variety, there is a lack of research analyzing the most impactful studies on cranioplasty. The authors conducted a comprehensive search of the Web of Science (WoS) Core Collection for studies on cranioplasty and selected the top 100 articles by citation count. Bibliometric data, study design, materials used, and study sample sizes were extracted. Spearman correlation tests and Kruskal-Wallis tests were conducted to analyze citation patterns. The top 100 cranioplasty studies, published between 1979 and 2020, were cited an average of 136.7 ± 65.1 times. The majority of studies (n = 68) were classified as clinical, while 21 were reviews and 11 were basic science. Most clinical studies were single-center (92.6%), while 7.4% were multicenter studies. Excluding case reports (n = 7), the median sample size in clinical studies was 70 patients (IQR: 25-147). Studies with larger sample sizes received more citations per year on average (rho = 0.44, P < 0.001), and more recent studies tended to use larger sample sizes (rho = 0.37, P = 0.002). Over half (52.3%) of clinical studies included patients who had reconstruction with autologous bone, followed by titanium (32.3%), polymethylmethacrylate (PMMA) (29.2%), hydroxyapatite (12.3%), and polyetheretherketone (9.3%). These findings demonstrate that the most impactful studies on cranioplasty are predominantly single-center investigations, most with <100 patients, yet have significantly shaped the field.