Global research trends in confocal laser endomicroscopy for brain tumor surgery, 2010–2026: A bibliometric review

Background: Confocal laser endomicroscopy (CLE) enables real-time microscopic assessment of tissue during brain tumor surgery and has been investigated as an adjunct to intraoperative diagnosis and fluorescence-guided resection. Previous reviews have largely focused on the technical characteristics and clinical applications of CLE. This study aimed to provide a quantitative overview of the development of the field, its collaborative structure, intellectual foundations, and major research themes. Methods: The Web of Science Core Collection was searched on May 30, 2026. After title and abstract screening, 114 publications from 2010 to 2026 were included. Bibliographic data were analyzed using VOSviewer version 1.6.20. Co-authorship, citation, co-citation, author-keyword co-occurrence, and bibliographic coupling analyses were performed. Publications with zero citations were additionally examined according to publication year, document type, and research topic. Results: The 114 publications received 1801 citations and had a dataset H-index of 25. Publication output increased after 2018 and reached its highest annual level in 2024. The United States, Germany, and Italy were the leading contributing countries, while Mark C. Preul, Jennifer M. Eschbacher, and Evgenii Belykh were among the leading contributors. The main thematic core included CLE, brain tumors, fluorescein sodium, glioma, and fluorescence-guided surgery, with recent work extending toward telepathology and artificial intelligence-assisted image interpretation. Thirty-two publications (28.1%) were uncited; 16 (50.0%) were meeting abstracts, and 19 (59.4%) were published between 2024 and 2026. Conclusion: CLE research in brain tumor surgery has expanded since 2010, with published studies increasingly addressing potential clinical applications, telepathology, and computer-assisted image interpretation rather than demonstrating established adoption in routine clinical practice. Uncited publications included both publication types with lower citation visibility and recent studies with limited time to accumulate citations. These bibliometric patterns should not be interpreted as evidence of the clinical effectiveness of CLE. Further multicenter studies using standardized imaging and interpretation protocols and clinically relevant outcomes are needed to clarify the role of CLE in routine neurosurgical practice.