It is concluded that surgeons in KSA should be more aware of the informed consent guidelines and they should adhere to them. In addition, there is room for the introduction of formal training on informed consent in both countries and for making written information more widely available particularly in KSA.

Objectives To examine the factors that influence country self-citation rate (SCR) in clinical neurology and to assess the impact of self-citation on the ranking of the top 50 countries. Methods SCImago Journal & Country Rank was used to collect data for the 50 most cited countries in clinical neurology during 1996–2019. Country SCR was correlated with several productivity parameters and examined statistically. Countries that dropped in their ranking after the exclusion of self-citations were identified. Results The median (range) country SCR for the 50 most cited countries was 11.3%. (5.3%- 47%). Country SCR correlated significantly with total citable documents and total cites numbers and rankings. The exclusion of self-citations led to a drop in the ranking of 8(16%) countries only. No significant difference between the total and net total cites rankings was observed. Conclusions Self-citation can be appropriate and reflect an expansion on earlier research. Highly cited productive countries tend to have high country SCR. Excluding self-citations had minimal impact on the ranking of the top 50 countries. Our findings indicate that self-citation is unlikely to influence country standing amongst the top 50 and does not support the argument for eliminating self-citations from citation-based metrics. A more globalization through international collaboration in research is encouraged.

Choroid plexus papilloma (CPP) is primarily found in children less than 2 years of age but can also be diagnosed prenatally. The presentation of a large CPP during infancy is not uncommon and surgical excision is usually recommended without delays. As a result, information about the growth rate of CPP during infancy is lacking. We report a preterm infant who presented with a choroid plexus papilloma that grew from being undetected on MRI to reaching a large size in 5 months. The case is unique in that it provides documentation of the rapid growth potential of this benign tumour in infancy. A possible explanation for this occurrence is discussed.

This review is a bibliometric analysis of the contribution of neurosurgeons from the Kingdom of Saudi Arabia (KSA) to the international neurosurgical literature over the last three decades. The study aimed at determining changes in publication trends over time and assessing the impact of these changes on citation numbers. All publications in the PubMed-indexed neurosurgical journals that were authored by at least one Saudi neurosurgeon were selected. The articles were divided into two study groups according to publication year whether during the last decade (2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020) or the previous two decades (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). Changes in publication trends were determined by comparing the bibliometric characteristics of the articles in both groups. The impact of the changes on citation numbers was assessed by correlating the annual citation rates for the articles with their bibliometric qualities.A total of 352 publications were suitable for the review (200 articles published during 2011-2020, and 152 during 1991-2010). Temporal changes in the publishing journals and first authors' centres and regions were observed. The articles that were published in the last decade were associated with a significantly higher annual publication rate, a greater number of authors, centres, and countries, and a larger sample size compared to those published in the previous two decades. They also had a lower percentage of Saudi total and first authorship as well as a smaller proportion of case reports. The annual citation rate was significantly impacted by the duration from publication, sample size, and study type during both study periods. However, only during the last decade, the annual citation rate was positively influenced by the journal's impact factor, number of authors, centres, countries, and percentage of Saudi authorship.We conclude that KSA neurosurgeons' contribution to international neurosurgical journals had increased considerably over the last decade. The publications were authored by neurosurgeons from a wider range of centres and regions than in the past. A bigger portion of publications had become more multi-authored, multi-centred, and multi-national as well as reported larger sample sizes and lesser rates of case reports. The changes in publication trends correlated positively with the articles' annual citation rates. The findings could be considered encouraging.

Background: We compared cutting and coagulation of a novel ferromagnetic tool (FMwand) with modalities currently used in the clinical setting. Methods: 24 F344 rats with 9L gliosarcoma flank tumours were randomized into 2 groups (n = 12): 1) Five parallel incisions were made into the tumor of each rat using monopolar electrosurgery (MES) cut mode, MES coagulation (coag) mode, FMwand, carbon dioxide (CO2) laser and cold scalpel. 2) Two parallel incisions were made comparing the MES and the FMwand, both with resecting loop tips. The study was then repeated by a second surgeon. The surgeons applied a grading scale (1 = worst, 5 = best) based on their observations. Results: Average scores for FMwand were superior in ease of tissue dissection (3.58), distortion upon tissues (3.67), and smoke production (2.87). CO2 laser led in effectiveness of hemostasis (4.32). MES cut mode had the highest scores for ease of cleaning of tip (3.17) and speed of dissection (3.92). The FMwand loop device led in all attributes except for ease of cleaning. Conclusions: The FMwand outperformed CO2 laser significantly in ease and speed. It was superior compared to MES cut mode for hemostasis and superior compared to coag mode in ease and speed, distortion upon tissues and smoke production. The FMwand loop was significantly better compared to MES loop for hemostasis, distortion, ease and speed. The FMwand was shown to be safe and effective for hemostatic soft tissue cutting and coagulation.