Significance, applications, and contributions of Gamma Knife radiosurgery in advancing neurosurgical care in lower-middle-income countries: a systematic review.

Objective: Gamma Knife radiosurgery (GKRS) is an important neurosurgical intervention most commonly used for pathologies such as meningiomas, acoustic neuromas, paragangliomas, arteriovenous malformations, and trigeminal neuralgia. While the widespread availability of GKRS in developed countries makes it ubiquitous in neurosurgical research, there is a huge disparity in research in lower-middle-income countries (LMICs). This study aimed to quantify research undertaken by authors in LMICs on GKRS.

Methods: The authors systematically reviewed PubMed for research articles that reported on GKRS from LMICs. Studies reporting on neurosurgically treated pathologies in which either the first or corresponding author was affiliated with an institution in an LMIC were included.

Results: A total of 190 papers from LMICs met the criteria; 142 articles were from Asia and 48 were from Africa. India had the highest number of papers, whereas no papers from LMICs in South America or Oceania met the criteria for inclusion. The most frequently published type of study was retrospective, tumors were the most common pathologies studied, and arteriovenous malformations were the single most studied individual pathology. There was no significant difference in the mean number of each article type or for neoplastic, vascular, or functional pathologies per country between Asia and Africa. Articles were most often published in Neurology India, and 24 studies had a female first author, whereas 22 had a female corresponding author.

Conclusions: This study reveals the relatively low number of studies providing high-quality evidence from LMICs such as randomized controlled trials and meta-analyses, as well as gender inequities and very high disparities among LMICs in GKRS research.