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Early Career First and Senior Authorship and Its Relation to Future Neurosurgical Leadership. BACKGROUND AND OBJECTIVE: Assessing the future academic potential of neurosurgery residency applicants is challenging. Metrics such as total publications and H-index fail to capture differences in authorship roles. First and senior authors typically contribute the most, reflecting initiative and ownership. We hypothesized that individuals with more first-author or senior-author publications in their first 10 academic years are more likely to later hold departmental leadership roles. METHODS: We randomly selected a sample of 50 US academic neurosurgery programs and identified department chairs and program directors. Each leader was matched with a control subject based on academic rank and degree. Using PubMed, we quantified the numbers of total, first-author, senior-author, and combined first-/senior-author publications published in the 10 years after each individual's first publication and the H-index based on that 10-year span and compared these metrics between leaders and controls. RESULTS: Among 200 neurosurgeons (100 leaders, 100 controls), there were no significant differences in academic rank (P = .902) or degree (P = .700). Leaders and nonleaders had a similar overall publication output in their first 10 years (P = .077); however, leaders had significantly more first-author-only publications (9.23 vs 6.55, P = .033) and combined first-author and senior-author publications (15.73 vs 9.85, P = .005) and a higher H-index based on early work (13.04 vs 10.20, P = .028). On multivariable analysis controlling for degree, the number of first/senior-author publications was independently associated with higher odds of holding a leadership position (odds ratio 1.054; 95% CI, 1.008-1.108; P = .022). Total publication count and H-index were not significant predictors. CONCLUSION: The number of first-author or senior-author publications within the first 10 years of publishing is a stronger predictor of future neurosurgical leadership than overall publication count or early-career H-index. Tracking first/senior authorships-which demand greater initiative, ownership, and dedication-may provide a simple and fast way to identify future academic leaders among neurosurgery applicants.