The Neuro-Fluid Paradigm in Microgravity: A Bibliometric Mapping of Spaceflight-Associated Neuro-Ocular Syndrome (SANS) and Intracranial Hypertension

Background Spaceflight-associated neuro-ocular syndrome (SANS) remains a critical physiological barrier to long-duration space exploration. While historically characterized by isolated ocular pathology, emerging evidence suggests a complex etiology rooted in central nervous system fluid dynamics. This study provides a quantitative bibliometric synthesis mapping the conceptual transition toward intracranial and glymphatic mechanics. Methods A comprehensive search of the Web of Science Core Collection was executed in April 2026. Bibliometric metadata from 194 strictly curated peer-reviewed documents were extracted, specifically capturing document types, prolific authors, active journals, and funding agencies. Programmatic network analysis then evaluated annual production, conceptual clusters, institutional collaboration, and citation impact to map the thematic evolution of the field. Results Analysis reveals a 2011 inflection point initiating an exponential publication surge that peaked in 2025. Keyword mapping connects microgravity to idiopathic intracranial hypertension via optic disc edema and intracranial pressure, alongside a recently emerging glymphatic node. Institutional matrices reveal a highly centralized research infrastructure heavily anchored by The National Aeronautics and Space Administration (NASA) and Texas Medical Center ecosystem. Lee et al. and npj Microgravity emerged as the most prolific author and journal, respectively. However, citation analysis confirms the highest impact foundational literature is consistently published in mainstream terrestrial clinical journals. Curatorial extraction shows the 194 English documents feature a high concentration of theoretical reviews necessitated by the constrained astronaut population, bridging ophthalmology and neuroscience. Finally, the dataset maintains a cumulative impact of 4,621 citations averaging 23.8 per document. Conclusion The literature has definitively transitioned from descriptive ocular observations toward complex mechanistic models of glymphatic clearance and systemic cerebrospinal fluid dynamics. This conceptual evolution establishes microgravity as an invaluable analog for terrestrial intracranial hypertension and underscores the critical necessity for automated precision surveillance during future interplanetary exploration.