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Li A, Bai X, Chen M, Li Z, Sun T. Epidemiological Characteristics and Prognosis Model of Pineal Region Tumors: A Retrospective Analysis Based on the SEER Database. World Neurosurg 2024; 184:e219-e227. [PMID: 38266997 DOI: 10.1016/j.wneu.2024.01.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND A pineal region tumor is a rare intracranial tumor, and its specific location leads to its own characteristics. This study aimed to provide some insight for medical practice in the care of pineal region tumors. We investigated the key epidemiological characteristics and survival prognosis of pineal tumors based on the epidemiological data from the Surveillance, Epidemiology, and End Results database. METHODS Data of pineal region tumor patients from 1975 to 2019 were extracted from the Surveillance, Epidemiology, and End Results database. The data were divided into 3 pathologic groups: germ cell tumors, pineal parenchymal tumors, and other. The patients' overall survival (OS) was analyzed using the Kaplan-Meier method. The prognostic effects of the patient characteristics on OS were explored using the Cox proportional hazard model. The analysis results are presented as tabular data, Kaplan-Meier plots, forest plots, and nomograms. A calibration curve was used to verify the nomograms. All analyses were performed for all patients overall and stratified by pathological group using SPSS and R language. RESULTS Based on the predefined inclusion and exclusion criteria, 628 patients were included in this study, of whom 440 (70.1%) were male and 188 (29.9%) were female. Most patients were aged 0-19 years. The pathological type was germinoma for 225 patients (35.8%). Age, surgery, behavioral code, and pathology were significant factors for OS. A calibration curve was used to verify that the nomograms had a good prediction effect. CONCLUSIONS An intuitive nomogram was developed and verified and can predict the prognosis of patients with pineal tumors.
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Affiliation(s)
- Ao Li
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, China; Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, China; School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Xue Bai
- Department of Emergency, The Third Clinical Medical College of Ningxia Medical University (People's Hospital of Ningxia Hui Autonomous Region), Yinchuan, China
| | - Mengfei Chen
- Department of Emergency, The Third Clinical Medical College of Ningxia Medical University (People's Hospital of Ningxia Hui Autonomous Region), Yinchuan, China
| | - Zhuoqi Li
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, China; Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, China
| | - Tao Sun
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, China; Ningxia Key Laboratory of Cerebrocranial Disease, Incubation Base of National Key Laboratory, Ningxia Medical University, Yinchuan, China.
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Dai W, Liu H, Chen Y, Chen Z. Imaging Findings and Clinical Analysis of Primary Intracranial Pure Yolk Sac Tumors in Children and Adolescents: A Retrospective Study from China. AJNR Am J Neuroradiol 2022; 43:1054-1059. [PMID: 35798388 DOI: 10.3174/ajnr.a7556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Primary intracranial pure yolk sac tumor is very rare. Our aim was to summarize the characteristics of primary intracranial pure yolk sac tumors from the clinical and imaging aspects in a retrospective study. MATERIALS AND METHODS We studied 5 patients with primary intracranial pure yolk sac tumors in Guangzhou Women and Children's Medical Center from January 2015 to June 2021. A comprehensive literature search was performed on the electronic database of the China National Knowledge Infrastructure (1990 to June 2021). Clinical data based on age, sex, treatment, CT, and MR imaging findings were collected and analyzed. RESULTS A total of 25 patients were included in the study, 21 boys and 4 girls. Twenty-one patients underwent plain MR imaging and an enhanced examination, 9 patients underwent DWI, and 12 patients underwent plain CT and/or an enhanced examination. The tumors were posterior fossa in 9 cases and supratentorial in 16 cases. All tumors showed marked enhancement after enhanced scanning by MR imaging or CT. The signal on DWI was similar to that of the cerebral cortex, and the ADC map was similar to or slightly higher than that of the cerebral cortex. Among the cases, 13 were followed up from 2 months to 5 years. There was no recurrence or metastasis in 9 patients with postoperative chemotherapy or chemoradiotherapy followed up for 1.5-5 years. Four patients died 2 months to 1.5 years after only an operation, or chemoradiotherapy but no operation. CONCLUSIONS There are some relatively specific imaging findings of primary intracranial yolk sac tumors that could assist in their diagnosis. Surgery combined with radiation therapy and/or chemotherapy can achieve a better prognosis.
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Affiliation(s)
- W Dai
- From the Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - H Liu
- From the Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Y Chen
- From the Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Z Chen
- From the Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Paun L, Lavé A, Patet G, Bartoli A. Supratentorial Pediatric Midline Tumors and Tumor-like Lesions: Clinical Spectrum, Natural History and Treatment Options. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040534. [PMID: 35455578 PMCID: PMC9032564 DOI: 10.3390/children9040534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 04/10/2023]
Abstract
Childhood Central Nervous System tumors account for 25% of all pediatric tumors. Large availability and broadening of indications to imaging has made incidental findings more common. Among these, midline lesions have different clinical relevance depending on their intrinsic pattern of behaviour and on their specific location. In this narrative review we describe the natural history and treatment options of midline lesions in children.
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Xu ZN, Yue XY, Cao XC, Liu YD, Fang BS, Zhao WH, Li C, Xu S, Zhang M. Multidisciplinary treatment of primary intracranial yolk sac tumor: A case report and literature review. Medicine (Baltimore) 2021; 100:e25778. [PMID: 34106610 PMCID: PMC8133229 DOI: 10.1097/md.0000000000025778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Intracranial yolk sac tumors (YSTs) are rare malignancies with limited treatment options and a dismal prognosis. They are usually managed with surgical resection and chemoradiotherapy. PATIENT CONCERNS Here, we report a patient with primary YST in the pineal region who achieved long term survival. Despite undergoing treatment, he experienced several recurrences over a 15-year period. DIAGNOSIS Brain magnetic resonance imaging (MRI) demonstrated the presence of space-occupying lesions in the pineal region and the medial tail of the left lateral ventricle. The tumors were excised, and the histological diagnosis suggested an intracranial YST. INTERVENTIONS The patient achieved long term survival after combined modality therapy including surgery, stereotactic radiosurgery (SRS)/intensity modulated radiation therapy (IMRT), chemotherapy, and targeted therapy. OUTCOMES The disease remained stable. However, the patient gave up treatment and passed away in October 2020, with a total survival of about 15 years. LESSONS To the best of our knowledge, this patient with intracranial YST had received a longer survival compared with other published reports. We summarize previously published reports of intracranial YST and discuss the importance of multidisciplinary treatment. SRS may have a role, as a focal boost to residual tumor after resection or in case of recurrence after conventional radiotherapy, in the multimodality management of intracranial YSTs.
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Affiliation(s)
- Zhen-Ning Xu
- Department of Radiation Oncology, Hebei General Hospital, Shijiazhuang
- Graduate School of North China University of Science and Technology, Tangshan, China
| | - Xiang-Yong Yue
- Department of Radiation Oncology, Hebei General Hospital, Shijiazhuang
| | - Xiao-Ci Cao
- Department of Radiation Oncology, Hebei General Hospital, Shijiazhuang
| | - Ya-Dong Liu
- Department of Radiation Oncology, Hebei General Hospital, Shijiazhuang
| | - Bao-Shuan Fang
- Department of Radiation Oncology, Hebei General Hospital, Shijiazhuang
| | - Wen-Hao Zhao
- Department of Radiation Oncology, Hebei General Hospital, Shijiazhuang
| | - Chen Li
- Department of Radiation Oncology, Hebei General Hospital, Shijiazhuang
| | - Shuai Xu
- Department of Radiation Oncology, Hebei General Hospital, Shijiazhuang
| | - Ming Zhang
- Department of Radiation Oncology, Hebei General Hospital, Shijiazhuang
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Pineal Gland Tumors: A Review. Cancers (Basel) 2021; 13:cancers13071547. [PMID: 33801639 PMCID: PMC8036741 DOI: 10.3390/cancers13071547] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Pineal neoplasms are tumors with different and variable morphological, histological, and radiological characteristics and, consequently different diagnosis and management. Due to their rarity, pineal tumors may be misdiagnosed. Pineal tumors, are divided into germ cell tumors, pineal parenchymal tumors and tumors that derive from adjacent structures. In this review, we report the clinical relevance of the main pineal gland tumors, underlining the importance of studying the triggering causes of pineal region carcinogenesis, to realize appropriate diagnosis and, consequently, better clinical management. Abstract The pineal gland is a small, pinecone-shaped endocrine gland that participates in the biological rhythm regulation of vertebrates. The recognized major product of the pineal gland is melatonin—a multifunctional endogenous indoleamine. Accumulating evidence suggests that the pineal gland is important for preserving ideal health conditions in vertebrate. Tumors of the pineal region account for approximately 3–11% of pediatric brain neoplasms but fewer than 1% of brain neoplasms in adults. It is fundamental to expand advanced imaging techniques together with both clinical and laboratory knowledge, to help to differentiate among pineal neoplasms and thus facilitate accurate primary diagnoses and proper therapeutic interventions. In this review, we report the gross anatomy of the pineal gland and its functional significance and discuss the clinical relevance of pineal gland tumors, underlining the importance of identifying the leading causes of pineal region masses.
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Okamoto M, Yamaguchi S, Ishi Y, Motegi H, Mori T, Hashimoto T, Terashita Y, Hirabayashi S, Sugiyama M, Iguchi A, Cho Y, Manabe A, Houkin K. Diagnostic Capability of Cerebrospinal Fluid-Placental Alkaline Phosphatase Value in Intracranial Germ Cell Tumor. Oncology 2020; 99:23-31. [PMID: 32906115 DOI: 10.1159/000509395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/11/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Most types of intracranial germ cell tumors (IGCTs) are sensitive to chemoradiation. However, biopsy specimens are usually small and thus cannot be used for obtaining an accurate pathological diagnosis. Recently, the cerebrospinal fluid (CSF) placental alkaline phosphatase (PLAP) value has been considered a new biomarker of IGCTs. The present study aimed to evaluate the discriminatory characteristics of the CSF-PLAP value upon diagnosis and at the time of recurrence in patients with IGCTs. METHODS Between 2015 and 2019, this study included 37 patients with tumors located in the intraventricular and/or periventricular region. The CSF-PLAP level was assessed before the patients received any treatment. The PLAP level was evaluated during and after first-line chemoradiotherapy in 7 patients with IGCTs. The CSF-PLAP values were compared according to histological diagnosis, and the correlation between these values and radiographical features was assessed. The CSF-PLAP values of 6 patients with IGCTs with suspected recurrence were evaluated based on neuroimaging findings. RESULTS The CSF-PLAP values were significantly higher in patients with IGCTs than in those with other types of brain tumor (n = 19 vs. 18; median: 359.0 vs. <8.0 pg/mL). The specificity and sensitivity were 88 and 95%, respectively, with a cutoff value of 8.0 pg/mL. In patients with IGCT, the CSF-PLAP value was higher in patients with germinoma than in those with nongerminomatous germ cell tumors (n = 12 vs. 7; median: 415.0 vs. 359.0 pg/mL). Regarding the time course, the CSF-PLAP value decreased to below the detection limit after the reception of first-line chemoradiotherapy in all 7 patients. A significant correlation was observed between the initial CSF-PLAP value and the tumor reduction volume after receiving first-line chemoradiotherapy (p < 0.0003, R2 = 0.6165, logY = 1.202logX - 1.727). Among the patients with suspected IGCT recurrence (n = 6), the CSF-PLAP value was high in patients with recurrence (n = 3; median: 259.0 pg/mL), and that in patients (n = 3) without recurrence was below the lower detection limit. CONCLUSIONS The CSF-PLAP level is a useful biomarker during the initial diagnosis of IGCTs and at the time of recurrence. It may be associated with the volume of germinomatous components of tumors.
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Affiliation(s)
- Michinari Okamoto
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shigeru Yamaguchi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan,
| | - Yukitomo Ishi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroaki Motegi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takashi Mori
- Department of Oral Radiology, Hokkaido University Hospital, Sapporo, Japan.,Department of Radiation Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takayuki Hashimoto
- Department of Radiation Medical Science and Engineering, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of Radiation Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yukayo Terashita
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shinsuke Hirabayashi
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Minako Sugiyama
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akihiro Iguchi
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuko Cho
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Celik O, Ozyurt S, Saglican Y. Suprasellar germinoma with hypopituitarism in an 18-year old man: A case report and review of literature. Clin Neurol Neurosurg 2020; 196:106026. [PMID: 32580069 DOI: 10.1016/j.clineuro.2020.106026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/20/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022]
Abstract
An 18 year old patient was presented to the ophtalmology outpatient clinic with blurrred vision, headache and fatigue for 6 months. Ophtalmological examination showed loss of visual acuity in the left eye and decreased in the right eye and bilateral optic atrophy. Further physical examination pointed out delayed sexual development. Hypopituitarism was observed in endocrinological examination. Brain magnetic resonance imaging (MRI) demonstrated contrast enhancing mass lesion at suprasellar region with involvement of posterior perimesencephalic cisternal region. The mass resected by craniotomy and pathology showed germinoma. Afterwards he received systemic chemotherapy with bleomisin, etoposide, cisplatin for 4 cycles followed by cranial radiotherapy with 30.6 Gy with a boost to the primary tumor at a dose of 19.8 Gy. On his follow-up MRI, there are no signs of residual tumor nor tumor recurrence. His final examination reveals slightly increased visual acuity in the right eye and he continued to take hydrocortisone and L-thyroxin. After one year follow-up, human chorionic gonadotropin (hCG) alpha treatment was started for sexual development. Here in, we present a case with suprasellar germinoma in the context of the review of the literature.
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Affiliation(s)
- Ozlem Celik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Acibadem Medical School, University of Acibadem, Istanbul, Turkey.
| | - Semih Ozyurt
- Department of Internal Medicine, Acibadem Medical School, University of Acibadem, Istanbul, Turkey
| | - Yesim Saglican
- Department of Pathology, Acibadem Medical School, University of Acibadem, Istanbul, Turkey
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Gheban BA, Rosca IA, Crisan M. The morphological and functional characteristics of the pineal gland. Med Pharm Rep 2019; 92:226-234. [PMID: 31460502 PMCID: PMC6709953 DOI: 10.15386/mpr-1235] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/20/2019] [Accepted: 02/03/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction The pineal gland is a photo-neuro-endocrine organ situated inside the brain, that secretes serotonin, melatonin and N,N-dymethyltriptamine. This narrative review will address the latest information gathered on this function of the gland as well as the unknown roles it may have. The different histological and pathological findings of the pineal gland have demonstrated a role in clinical manifestations of numerous endocrine, neurological and psychiatric pathologies. Materials For this narrative review we used the NCBI website database PubMed. The search terms were “Pineal Gland” AND/OR “histology, melatonin, DMT, pathology”. Total number of articles included were 86. Results We have reviewed physiological information of melatonin and DMT, anatomical, histological and histopathological information on the pineal gland and its role in endocrine, neurological and psychiatric pathology. Conclusion The role of melatonin in immunity and its potential therapeutic effects show promising potential for further research. DMT seems to have a role in psychiatric pathology and potential therapeutic effects. Proper tumoral screening and diagnostic protocol are required.
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Affiliation(s)
- Bogdan Alexandru Gheban
- Morphological Sciences Department, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Ioana Andreea Rosca
- Radiotherapy Department, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Maria Crisan
- Histology and Dermatology Department, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
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Abstract
Background: The pineal gland, a small, pinecone-shaped organ deep within the brain, is responsible for producing melatonin. The gland consists of pineal parenchymal cells and glial cells that can form neoplasms. Pineal region neoplasms can also arise from germ cells and adjacent structures. This review focuses on detection of serum and cerebrospinal fluid (CSF) biomarkers of germ cell tumors and pineal parenchymal cell tumors, as these types comprise most neoplasms specific to the pineal region. Methods: For this review, we searched PubMed using the following keywords: biomarkers, germ cell tumor, germinoma, melatonin, pineal, pineal gland, pineal neoplasm, pinealoma, pineal parenchymal cell tumor, pineal region, and pineal tumor. We limited our search to full-text English articles and identified other relevant sources from the reference lists of identified articles. Results: Serum and CSF biomarker assays have a role in cases of suspected pineal germ cell or parenchymal neoplasms. Biomarkers including alpha-fetoprotein, beta-human chorionic gonadotropin, and placental alkaline phosphatase inform diagnosis and treatment and are important for monitoring germ cell tumor response to treatment. No biomarkers are currently available that inform diagnosis or treatment of pineal parenchymal tumors, although melatonin assays may have a role in monitoring response to treatment. Conclusion: Serum and CSF biomarkers in conjunction with clinical and radiographic evidence of a pineal region mass can inform the decision whether to undertake stereotactic biopsy or surgical excision or whether to proceed straight to medical treatment.
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Kong Z, Wang Y, Dai C, Yao Y, Ma W, Wang Y. Central Nervous System Germ Cell Tumors: A Review of the Literature. J Child Neurol 2018; 33:610-620. [PMID: 29848146 DOI: 10.1177/0883073818772470] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Central nervous system germ cell tumors are rare intracranial tumors that mainly occur in pediatrics with substantial variation in the incidence among different regions and genders. Histologically, central nervous system germ cell tumors can be divided into germinomas and nongerminomatous germ cell tumors. The molecular pathology of central nervous system germ cell tumors, particularly germinomas, is mainly based on the presence of isochromosome 12p, gain-of-function of the KIT gene, and a globally low DNA methylation profile. Diagnoses and differential diagnoses are conducted through imaging, tumor marker detection, surgical biopsy, and cerebrospinal fluid cytology. Germinomas are often treated via whole-ventricular radiotherapy or neoadjuvant chemotherapy combined with reduced-dose whole-ventricular radiotherapy, whereas nongerminomatous germ cell tumors are mainly treated with chemotherapy, surgical resection, and radiotherapy (individually or in combination), depending on tumor composition. Because the main population of patients is pediatric, extending overall survival and reducing treatment side effects should be the main goals of future studies.
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Affiliation(s)
- Ziren Kong
- 1 Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaning Wang
- 1 Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Congxin Dai
- 1 Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Yao
- 1 Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenbin Ma
- 1 Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Wang
- 1 Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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