Shortfalls in published neurosurgical literature.

Expenditure related to neurosurgery has increased unevenly since the early 1990s. In this study we explored the literature by which clinical evidence is obtained to better direct neurosurgical practice. We searched different types of neurosurgery literature and four major neurosurgical procedures (excision of brain lesion, cerebral aneurysm clipping/coiling, discectomy, spine fusion) written in English on PubMed from 1996, the year of its launch, using the keyword "cost". Only a small and static portion of the neurosurgical literature was indexed as level I clinical evidence (randomized controlled trials), with a lack of cost appraisal in the outcome analysis of neurosurgical interventions. By way of rectification, a major increase in funding of grade I studies with cost analysis, and the requirement by peer-reviewed journals of a cost-benefit analysis, would promote the quality of clinical research yielding unquestionable advantage on national healthcare practice.