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D’Amico RS, Barrington NM, Langer DJ. Opinion: Navigating the integration and impact of extended reality in neurosurgery. Surg Neurol Int 2024; 15:212. [PMID: 38974560 PMCID: PMC11225516 DOI: 10.25259/sni_332_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/31/2024] [Indexed: 07/09/2024] Open
Affiliation(s)
- Randy S. D’Amico
- Department of Neurological Surgery, Lenox Hill Hospital/Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, United States
| | - Nikki M. Barrington
- Department of Neuroscience, Rosalind Franklin University, North Chicago, United States
| | - David J. Langer
- Department of Neurological Surgery, Lenox Hill Hospital/Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, United States
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Li Y, Gunasekeran DV, RaviChandran N, Tan TF, Ong JCL, Thirunavukarasu AJ, Polascik BW, Habash R, Khaderi K, Ting DSW. The next generation of healthcare ecosystem in the metaverse. Biomed J 2024; 47:100679. [PMID: 38048990 PMCID: PMC11245972 DOI: 10.1016/j.bj.2023.100679] [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: 08/08/2023] [Revised: 11/04/2023] [Accepted: 11/19/2023] [Indexed: 12/06/2023] Open
Abstract
The Metaverse has gained wide attention for being the application interface for the next generation of Internet. The potential of the Metaverse is growing, as Web 3·0 development and adoption continues to advance medicine and healthcare. We define the next generation of interoperable healthcare ecosystem in the Metaverse. We examine the existing literature regarding the Metaverse, explain the technology framework to deliver an immersive experience, along with a technical comparison of legacy and novel Metaverse platforms that are publicly released and in active use. The potential applications of different features of the Metaverse, including avatar-based meetings, immersive simulations, and social interactions are examined with different roles from patients to healthcare providers and healthcare organizations. Present challenges in the development of the Metaverse healthcare ecosystem are discussed, along with potential solutions including capabilities requiring technological innovation, use cases requiring regulatory supervision, and sound governance. This proposed concept and framework of the Metaverse could potentially redefine the traditional healthcare system and enhance digital transformation in healthcare. Similar to AI technology at the beginning of this decade, real-world development and implementation of these capabilities are relatively nascent. Further pragmatic research is needed for the development of an interoperable healthcare ecosystem in the Metaverse.
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Affiliation(s)
- Yong Li
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore; The Ophthalmology & Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Dinesh Visva Gunasekeran
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore; The Ophthalmology & Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Ting Fang Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | | | | | - Bryce W Polascik
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Ranya Habash
- Bascom Palmer Eye Institute, University of Miami, Florida, USA
| | - Khizer Khaderi
- Department of Ophthalmology, Stanford University, California, USA
| | - Daniel S W Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore; The Ophthalmology & Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore; Department of Ophthalmology, Stanford University, California, USA.
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González-López P, Kuptsov A, Gómez-Revuelta C, Fernández-Villa J, Abarca-Olivas J, Daniel RT, Meling TR, Nieto-Navarro J. The Integration of 3D Virtual Reality and 3D Printing Technology as Innovative Approaches to Preoperative Planning in Neuro-Oncology. J Pers Med 2024; 14:187. [PMID: 38392620 PMCID: PMC10890029 DOI: 10.3390/jpm14020187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Our study explores the integration of three-dimensional (3D) virtual reality (VR) and 3D printing in neurosurgical preoperative planning. Traditionally, surgeons relied on two-dimensional (2D) imaging for complex neuroanatomy analyses, requiring significant mental visualization. Fortunately, nowadays advanced technology enables the creation of detailed 3D models from patient scans, utilizing different software. Afterwards, these models can be experienced through VR systems, offering comprehensive preoperative rehearsal opportunities. Additionally, 3D models can be 3D printed for hands-on training, therefore enhancing surgical preparedness. This technological integration transforms the paradigm of neurosurgical planning, ensuring safer procedures.
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Affiliation(s)
- Pablo González-López
- Department of Neurosurgery, Hospital General Universitario, 03010 Alicante, Spain
| | - Artem Kuptsov
- Department of Neurosurgery, Hospital General Universitario, 03010 Alicante, Spain
| | | | | | - Javier Abarca-Olivas
- Department of Neurosurgery, Hospital General Universitario, 03010 Alicante, Spain
| | - Roy T Daniel
- Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland
| | - Torstein R Meling
- Department of Neurosurgery, Rigshospitalet, 92100 Copenhagen, Denmark
| | - Juan Nieto-Navarro
- Department of Neurosurgery, Hospital General Universitario, 03010 Alicante, Spain
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Woodall WJ, Chang EH, Toy S, Lee DR, Sherman JH. Does Extended Reality Simulation Improve Surgical/Procedural Learning and Patient Outcomes When Compared With Standard Training Methods?: A Systematic Review. Simul Healthc 2024; 19:S98-S111. [PMID: 38240622 DOI: 10.1097/sih.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The use of extended reality (XR) technologies, including virtual, augmented, and mixed reality, has increased within surgical and procedural training programs. Few studies have assessed experiential learning- and patient-based outcomes using XR compared with standard training methods. METHODS As a working group for the Society for Simulation in Healthcare, we used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a PICO strategy to perform a systematic review of 4238 articles to assess the effectiveness of XR technologies compared with standard training methods. Outcomes were grouped into knowledge, time-to-completion, technical proficiency, reactions, and patient outcomes. Because of study heterogeneity, a meta-analysis was not feasible. RESULTS Thirty-two studies met eligibility criteria: 18 randomized controlled trials, 7 comparative studies, and 7 systematic reviews. Outcomes of most studies included Kirkpatrick levels of evidence I-III (reactions, knowledge, and behavior), while few reported level IV outcomes (patient). The overall risk of bias was low. With few exceptions, included studies showed XR technology to be more effective than standard training methods in improving objective skills and performance, shortening procedure time, and receiving more positive learner ratings. However, XR use did not show significant differences in gained knowledge. CONCLUSIONS Surgical or procedural XR training may improve technical skill development among trainees and is generally favored over standard training methods. However, there should be an additional focus on how skill development translates to clinically relevant outcomes. We recommend longitudinal studies to examine retention and transfer of training to clinical settings, methods to improve timely, adaptive feedback for deliberate practice, and cost analyses.
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Affiliation(s)
- William J Woodall
- From the Medical College of Georgia (W.J.W.), Augusta, GA; Department of Otolaryngology (E.H.C.), University of Arizona, Tucson, AZ; Departments of Basic Science Education and Health Systems & Implementation Science (S.T.), Virginia Tech Carilion School of Medicine, Roanoke, VA; University of Michigan School of Nursing (D.R.L.), Ann Arbor, MI; and WVU Rockefeller Neuroscience Institute (J.H.S.), Morgantown, WV
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Silvero Isidre A, Friederichs H, Müther M, Gallus M, Stummer W, Holling M. Mixed Reality as a Teaching Tool for Medical Students in Neurosurgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1720. [PMID: 37893438 PMCID: PMC10608296 DOI: 10.3390/medicina59101720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/03/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Simulation-based learning within neurosurgery provides valuable and realistic educational experiences in a safe environment, enhancing the current teaching model. Mixed reality (MR) simulation can deliver a highly immersive experience through head-mounted displays and has become one of the most promising teaching tools in medical education. We aimed to identify whether an MR neurosurgical simulation module within the setting of an undergraduate neurosurgical hands-on course could improve the satisfaction of medical students. Materials and Methods: The quasi-experimental study with 223 medical students [120 in the conventional group (CG) and 103 in the MR-group (MRG)] was conducted at the University Hospital Münster, Münster, Germany. An MR simulation module was presented to the intervention group during an undergraduate neurosurgical hands-on course. Images of a skull fracture were reconstructed into 3D formats compatible with the MR-Viewer (Brainlab, Munich, Germany). Participants could interact virtually with the model and plan a surgical strategy using Magic Leap goggles. The experience was assessed by rating the course on a visual analog scale ranging from 1 (very poor) to 100 (very good) and an additional Likert-scale questionnaire. Results: The satisfaction score for CG and MRG were 89.3 ± 13.3 and 94.2 ± 7.5, respectively. The Wilcoxon rank-sum test showed that MR users (Mdn = 97.0, IQR = 4, n = 103) were significantly more satisfied than CG users (Mdn = 93.0, IQR = 10, n = 120; ln(W) = 8.99, p < 0.001) with moderate effect size (r^biserial = 0.30, CI95 [0.15, 0.43]), thus indicating that the utilization of MR-simulation is associated with greater satisfaction. Conclusions: This study reports a positive response from medical students towards MR as an educational tool. Feedback from the medical students encourages the adoption of disruptive technologies into medical school curricula.
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Affiliation(s)
| | | | - Michael Müther
- Department for Neurosurgery, University Hospital Münster, 48149 Münster, Germany
| | - Marco Gallus
- Department for Neurosurgery, University Hospital Münster, 48149 Münster, Germany
| | - Walter Stummer
- Department for Neurosurgery, University Hospital Münster, 48149 Münster, Germany
| | - Markus Holling
- Department for Neurosurgery, University Hospital Münster, 48149 Münster, Germany
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McLean E, Cornwell MA, Bender HA, Sacks-Zimmerman A, Mandelbaum S, Koay JM, Raja N, Kohn A, Meli G, Spat-Lemus J. Innovations in Neuropsychology: Future Applications in Neurosurgical Patient Care. World Neurosurg 2023; 170:286-295. [PMID: 36782427 DOI: 10.1016/j.wneu.2022.09.103] [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: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 02/11/2023]
Abstract
Over the last century, collaboration between clinical neuropsychologists and neurosurgeons has advanced the state of the science in both disciplines. These advances have provided the field of neuropsychology with many opportunities for innovation in the care of patients prior to, during, and following neurosurgical intervention. Beyond giving a general overview of how present-day advances in technology are being applied in the practice of neuropsychology within a neurological surgery department, this article outlines new developments that are currently unfolding. Improvements in remote platform, computer interface, "real-time" analytics, mobile devices, and immersive virtual reality have the capacity to increase the customization, precision, and accessibility of neuropsychological services. In doing so, such innovations have the potential to improve outcomes and ameliorate health care disparities.
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Affiliation(s)
- Erin McLean
- Department of Psychology, Hofstra University, Hempstead, New York, USA; Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Melinda A Cornwell
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - H Allison Bender
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
| | | | - Sarah Mandelbaum
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Department of Clinical Psychology with Health Emphasis, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Jun Min Koay
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida, USA
| | - Noreen Raja
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Aviva Kohn
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Department of Clinical Psychology with Health Emphasis, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Gabrielle Meli
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA; Department of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Jessica Spat-Lemus
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
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Mofatteh M, Mashayekhi MS, Arfaie S, Chen Y, Mirza AB, Fares J, Bandyopadhyay S, Henich E, Liao X, Bernstein M. Augmented and virtual reality usage in awake craniotomy: a systematic review. Neurosurg Rev 2022; 46:19. [PMID: 36529827 PMCID: PMC9760592 DOI: 10.1007/s10143-022-01929-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/21/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Augmented and virtual reality (AR, VR) are becoming promising tools in neurosurgery. AR and VR can reduce challenges associated with conventional approaches via the simulation and mimicry of specific environments of choice for surgeons. Awake craniotomy (AC) enables the resection of lesions from eloquent brain areas while monitoring higher cortical and subcortical functions. Evidence suggests that both surgeons and patients benefit from the various applications of AR and VR in AC. This paper investigates the application of AR and VR in AC and assesses its prospective utility in neurosurgery. A systematic review of the literature was performed using PubMed, Scopus, and Web of Science databases in accordance with the PRISMA guidelines. Our search results yielded 220 articles. A total of six articles consisting of 118 patients have been included in this review. VR was used in four papers, and the other two used AR. Tumour was the most common pathology in 108 patients, followed by vascular lesions in eight patients. VR was used for intraoperative mapping of language, vision, and social cognition, while AR was incorporated in preoperative training of white matter dissection and intraoperative visualisation and navigation. Overall, patients and surgeons were satisfied with the applications of AR and VR in their cases. AR and VR can be safely incorporated during AC to supplement, augment, or even replace conventional approaches in neurosurgery. Future investigations are required to assess the feasibility of AR and VR in various phases of AC.
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Affiliation(s)
- Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
| | | | - Saman Arfaie
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA, USA
| | - Yimin Chen
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
| | | | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Northwestern Medicine Malnati Brain Tumor Institute, Feinberg School of Medicine, Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, UK
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Edy Henich
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Xuxing Liao
- Department of Neurosurgery, Foshan Sanshui District People's Hospital, Foshan, China
| | - Mark Bernstein
- Division of Neurosurgery, Department of Surgery, University of Toronto, University Health Network, Toronto, Ontario, Canada
- Temmy Latner Center for Palliative Care, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Paro MR, Hersh DS, Bulsara KR. History of Virtual Reality and Augmented Reality in Neurosurgical Training. World Neurosurg 2022; 167:37-43. [PMID: 35977681 DOI: 10.1016/j.wneu.2022.08.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Abstract
Virtual reality (VR) and augmented reality (AR) are rapidly growing technologies. Both have been applied within neurosurgery for presurgical planning and intraoperative navigation, but VR and AR technology is particularly promising for the education of neurosurgical trainees. With the increasing demand for high impact yet efficient educational strategies, VR- and AR-based simulators allow neurosurgical residents to practice technical skills in a low-risk setting. Initial studies have confirmed that such simulators increase trainees' confidence, improve their understanding of operative anatomy, and enhance surgical techniques. Knowledge of the history and conceptual underpinnings of these technologies is useful to understand their current and future applications towards neurosurgical training. The technological precursors for VR and AR were introduced as early as the 1800s, and draw from the fields of entertainment, flight simulation, and education. However, computer software and processing speeds are needed to develop widespread VR- and AR-based surgical simulators, which have only been developed within the last 15 years. During that time, several devices had become rapidly adopted by neurosurgeons, and some programs had begun to incorporate them into the residency curriculum. With ever-improving technology, VR and AR are promising additions to a multi-modal training program, enabling neurosurgical residents to maximize their efforts in preparation for the operating room. In this review, we outline the historical development of the VR and AR systems that are used in neurosurgical training and discuss representative examples of the current technology.
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Affiliation(s)
- Mitch R Paro
- UConn School of Medicine, Farmington, Connecticut, USA
| | - David S Hersh
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA; Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA
| | - Ketan R Bulsara
- Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA; Division of Neurosurgery, UConn School of Medicine, Farmington, Connecticut, USA.
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Iop A, El-Hajj VG, Gharios M, de Giorgio A, Monetti FM, Edström E, Elmi-Terander A, Romero M. Extended Reality in Neurosurgical Education: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:6067. [PMID: 36015828 PMCID: PMC9414210 DOI: 10.3390/s22166067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/06/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
Surgical simulation practices have witnessed a rapid expansion as an invaluable approach to resident training in recent years. One emerging way of implementing simulation is the adoption of extended reality (XR) technologies, which enable trainees to hone their skills by allowing interaction with virtual 3D objects placed in either real-world imagery or virtual environments. The goal of the present systematic review is to survey and broach the topic of XR in neurosurgery, with a focus on education. Five databases were investigated, leading to the inclusion of 31 studies after a thorough reviewing process. Focusing on user performance (UP) and user experience (UX), the body of evidence provided by these 31 studies showed that this technology has, in fact, the potential of enhancing neurosurgical education through the use of a wide array of both objective and subjective metrics. Recent research on the topic has so far produced solid results, particularly showing improvements in young residents, compared to other groups and over time. In conclusion, this review not only aids to a better understanding of the use of XR in neurosurgical education, but also highlights the areas where further research is entailed while also providing valuable insight into future applications.
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Affiliation(s)
- Alessandro Iop
- Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
- KTH Royal Institute of Technology, 114 28 Stockholm, Sweden
| | - Victor Gabriel El-Hajj
- Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Maria Gharios
- Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Andrea de Giorgio
- SnT—Interdisciplinary Center for Security, Reliability and Trust, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | | | - Erik Edström
- Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Neurosurgery, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Mario Romero
- KTH Royal Institute of Technology, 114 28 Stockholm, Sweden
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