Changing Landscape of Hydrocephalus Treatment in Pakistan: A Brief History and Bibliometric Analysis

Hydrocephalus is estimated to affect 85 per 100,000 people around the world and despite recent advancements in surgical techniques and treatment options, it remains a major public health issue in low- and middle-income countries such as Pakistan. We did a bibliometric analysis on the trends of hydrocephalus research in Pakistan from Dr. Jooma bringing ventriculoperitoneal (VP) shunts in his personal baggage for his patients and Dr. Bhatti developing his own shunts till the development of new centers and introduction of endoscopic techniques.

We conducted a retrospective bibliometric study analyzing the trends of hydrocephalus treatment in Pakistan. All published articles in national or international journals from 1995 to 2024 were included. Descriptive statistics were computed for all variables. Trends in the type of intervention and etiology were analyzed using the chi-square test. Statistical significance was determined using a p -value threshold of < 0.05. Data were distributed in tables and were visualized using bar charts. All analyses were performed using SPSS version 27.

A total of 102 hydrocephalus-related studies were published in Pakistan during the study period. Descriptive analysis showed multiple etiologies (23.5%) as the most common cause, followed by congenital (21.6%), infectious (20.6%), and acquired (15.7%) factors. VP shunt remained the predominant intervention (40%), with a rising trend in endoscopic procedures. Most studies were observational (52.9%) and published in local journals, primarily the Pakistan Journal of Neurological Surgery (40.2%). Research output was concentrated in Karachi (39%), especially at the Aga Khan University Hospital (22.5%). Male authors outnumbered female authors across all years, highlighting a persistent gender gap in neurosurgical research.

Hydrocephalus in Pakistan presents unique challenges and opportunities for research. This study provides essential insights into hydrocephalus research and management trends over the past 3 decades. The predominance of congenital and infectious etiologies, the continued importance of shunt procedures, the evolving adoption of endoscopic procedures, and the concentration of clinical research in major urban centers illustrate the important trends in hydrocephalus. Future studies should focus on comparing the effectiveness and cost-effectiveness of different interventional approaches in the Pakistani health care setup, identifying potential risk factors for developing hydrocephalus, and devising targeted prevention strategies. Collaborative efforts, inclusive research practices, and a commitment to addressing gender disparities will be pivotal in shaping the future landscape of hydrocephalus management and research in the region. Further, addressing the challenges of neurosurgical workforce shortages, resource constraints, and infection rates is critical to improving outcomes for hydrocephalus patients in Pakistan.