Enhanced Recovery After Surgery (ERAS) has garnered considerable attention and demonstrated substantial clinical benefits across multiple surgical specialties. However, its integration into cranial and spinal neurosurgery remains nascent and fraught with challenges. This study aims to systematically assess the current research landscape, identify emerging hotspots, and forecast future directions for ERAS in neurosurgery through comprehensive bibliometric analysis. These findings seek to inform clinical practice and guide future investigations.

Relevant publications indexed in the Web of Science Core Collection from January 1, 1999, to December 1, 2024, were analyzed. Bibliometric tools, primarily CiteSpace, were utilized to evaluate annual publication trends, author and institutional contributions, journal dissemination, keyword co-occurrence, and citation network structures.

A total of 273 articles were included. The analysis reveals that ERAS implementation in spinal neurosurgery has reached a relatively advanced stage, while its application in cranial procedures remains underdeveloped, yet promising. The United States and China are leading in publication output, although China’s global influence is comparatively limited. Key research themes include hospital length of stay, cost-effectiveness, postoperative complication management, and multimodal analgesia. Anticipated trends suggest a growing focus on personalized ERAS protocols tailored to specific neurosurgical conditions and enhanced patient engagement in recovery processes.

Through bibliometric and visualization techniques, this study offers a comprehensive overview of ERAS-related neurosurgical research, delineating its evolution and thematic shifts. The insights derived herein may facilitate strategic planning, foster interdisciplinary collaboration, and promote evidence-based advancements in perioperative neurosurgical care.