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INTRODUCTION Pharyngeal pouches were first described by Ludlow in 1769, and after more than a century, Zenker published a full clinical pathological description in 1877 [1,2]. The occurrence of squamous cell carcinoma (SCC) arising in Zenker's diverticulum is a very rare entity. However, the published incidence rates fall between 0.3% and 7% among occasional reports in the literature [3]. SCC in the pouch is diagnosed mainly after obtaining full histopathologic examination of the specimen following surgical resection [4]. For this reason, the procedure of choice for suspected SCC in the pouch is by complete surgical excision of the pouch. We report a rare case of recurrent Zenker's diverticulum and SCC development in the pouch. CASE PRESENTATION A 71-year-old British male patient presented to our institute with a history of dysphagia and regurgitation for the past 20 years. Endoscopy was done earlier, and he was diagnosed with Zenker's diverticulum. He underwent endoscopic stapling of the diverticulum in the years 2006, 2009, and 2011 without any symptomatic improvement. At that time, he denied any history of weight or appetite changes. He complained of new symptoms such as dysphagia and regurgitation mostly to soft food and liquids, which aggravate with coughing, and also of a decrease in weight and appetite. The patient is a smoker and an occasional alcohol consumer. On physical examination, it was found that he was healthy, and all systems exam were unremarkable. All laboratory investigations were normal. Barium swallow showed pharyngeal pouch as Zenker's diverticulum (Figures 1, 2). A written consent was obtained from the patient for surgery and publications. The patient underwent left neck incision, diverticulectomy, and cricopharyngeal myotomy under general anesthesia. Postoperative recovery was uneventful. He was discharged home after few days in a good stable condition. Histology results showed an esophageal pouch consisting of a cyst-like lesion measuring 4.03.51.0 cm 3 (Figure 3). The cyst wall was thickened. The inner mucosal surface showed fungating mass lesion measuring 1.51.00.5 cm 3 , tan white in color, and friable in consistency. The resection margins were free of the lesion and were marked with staples. Microscopic results showed moderately differentiated SCC (Figures 4a, b).

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Background: Citation analysis reflects the scientific recognition and influential performance of a published article within its field. We aim to identify the top 100 most-cited articles on astrocytoma using this bibliometric analysis method. Methods: In May 2020, we performed a thorough search in the Scopus database using the word “Astrocytoma.” The top 100 most-cited articles were arranged based on citation count in descending order. The resultant articles were then analyzed with an assessment of pertinent factors. Results: The most-cited articles on astrocytoma had been cited 23,720 times. The top-cited article received a total of 682 citations, with an average of 34.1 citations annually. The list comprised eight clinical trials, in which the highest cited article received 625 citations. Articles were published from 1975 to 2015 with the 1995–2005 era as the most prolific period. Neuropathology studies were the most studied category, followed by clinical studies. The United States of America was the most significant contributor, with 49 published articles. The University of California San Francisco was the most contributing institution by producing 11 articles. Articles were published in 32 different journals led by the Cancer Research Journal, with a total of 12 publications. Approximately 160 authors contributed to the list in which Scheithauer, B.W. contributed the most with a total of eight articles. Conclusion: This report clustered the most impactful articles on astrocytoma. It serves as an adequate tool to identify publication trends and helps in achieving evidence-based clinical practice.

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Background: Radiosurgery is an effective, alternative treatment modality in managing patients with cerebral arteriovenous malformations (AVMs). The present study aims to highlight the scholarly impact of the top-100 most cited articles on the radiosurgical management of AVMs. Methods: A title-specific search using the keyword “arteriovenous malformation” was conducted in the Scopus database. The outcome of the search was rearranged based on the citations count. Articles were categorized into four entities; clinical, gamma knife radiosurgery, linear accelerator (LINAC) radiosurgery, and proton beam radiosurgery. The exclusion criteria were applied to spinal or non-intracranial AVM, conference papers, non-English articles predominantly discussing the endovascular or microsurgical management. Results: The top-100 articles on the radiosurgical management of AVM were published between 1972 and 2016. Approximately one-third of the publications were produced between 1995 and 2000. The average citations per year for all papers were seven. The most-studied entity was pertinent to the clinical application of gamma knife radiosurgery in AVM (68%). The United States was the most active country in studying the radiosurgical application in AVM. The Journal of Neurosurgery published approximately one-third of the most-cited articles in the list. The top-3 most contributing authors, publishing 80% of articles in the list, were Lunsford et al. Conclusion: The radiosurgical management of AVMs evolved significantly throughout the years. Identifications of the publication trends facilitate the acquisition of evidence-based articles for authors investigating various radiosurgical techniques in the treatment of AVMs.