Forty-five years of academic neurosurgery in Paraguay: A systematic review and bibliometric analysis of the transition to self-reliance

Abstract

Background: While the global neurosurgical burden is highest in low- and middle-income countries, scientific output remains dominated by high-income nations. Paraguay has seen a dramatic seven-fold increase in its neurosurgical workforce since 1980, yet its academic footprint remains under-studied. We aimed to systematically characterize Paraguay’s neurosurgical scientific evolution (1980–2025) to identify barriers to research productivity and establish a roadmap for academic growth. Methods: A systematic bibliometric analysis was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Google Scholar, and the Anales de la Facultad de Ciencias Médicas were searched for neurosurgical publications affiliated with Paraguayan institutions or reporting domestic patient data. We analyzed 45 years of data across variables, including publication type, indexation status, language, authorship roles, and international collaboration. Results: Thirty-eight publications were identified over the 45-year study period. While the historical output was less than one article per year, a significant upward trend emerged in the past decade. Only 31.5% of studies were published in indexed journals (all in English), while 68.4% remained in non-indexed, predominantly Spanish-language sources. Case reports (42.1%) and original clinical studies (28.9%) were the primary publication types, focusing largely on vascular and pediatric neurosurgery. International collaboration (31.5%) was the strongest predictor of indexation; however, Paraguayan investigators rarely held first or senior authorship positions in these partnerships, revealing a persistent “leadership gap” in global collaborations. Conclusion: Paraguayan neurosurgery is at a critical inflection point, transitioning from sporadic clinical reporting to structured academic inquiry. While international partnerships are vital for global visibility, they currently lack authorship equity for local surgeons. To bridge this gap, national efforts must prioritize the institutionalization of research infrastructure, digital registries, and “vertical integration” models that involve residents and students. This study provides the first strategic framework for transforming clinical milestones into a sustainable national research ecosystem.