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Iatrogenic dorsal spinal cord herniation and repair with clip-based expansile duraplasty: a case report. Spinal Cord Ser Cases 2022; 8:36. [PMID: 35347110 PMCID: PMC8960805 DOI: 10.1038/s41394-022-00505-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Myelopathy arising due to dorsal herniation of the spinal cord is a rare phenomenon, particularly so in the thoracic region. Where cases of thoracic dorsal cord herniation have been reported, the aetiology has typically been non-iatrogenic. CASE PRESENTATION We report the case of a paediatric oncology patient who presented with neurological deterioration secondary to thoracic dorsal spinal cord herniation, manifesting three months after laminectomy for biopsy of a spinal medulloblastoma lesion. We repaired the dural defect using non-penetrating titanium clips to create a secure expansile duraplasty, resulting in radiologically evident reduction of the cord herniation as well as corresponding clinical improvement. DISCUSSION Thoracic dorsal spinal cord herniation is an extremely rare occurrence after spinal surgery. Non-penetrating titanium clips can be used to form a secure expansile duraplasty following reduction of the cord herniation. Successful repair of the dural defect re-anteriorises the cord and can confer neurological benefit.
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Ogbu I, Eltoukhy M, Tzerakis N. Duroplasty in iatrogenic dorsal spinal cord herniation: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 2:CASE21347. [PMID: 35855089 PMCID: PMC9265190 DOI: 10.3171/case21347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The case report detailed an unusual presentation of an iatrogenic dorsal cord herniation at the level of the thoracic cord after insertion of an epidural catheter 8 months before presentation to the neurosurgical clinic. OBSERVATIONS Only 13 cases of iatrogenic dorsal cord herniation, most of which occurred after spinal surgery, have been described in the literature. This was the first case of a spinal cord hernia described after the insertion of an epidural catheter. In this case study, the authors described a 38-year-old man who presented with progressive lower limb weakness, sensory deficits, perianal numbness, and urinary/fecal incontinence. He was diagnosed with a spinal cord hernia that reherniated after an initial sandwich duroplasty repair. Definitive repair was made after his re-presentation using an expansile duroplasty. LESSONS In patients with previous spinal instrumentation who present with neurological symptoms, spinal cord herniation should be considered a likely differential despite its rarity. In this case, a simple duroplasty was insufficient to provide full resolution of symptoms and was associated with recurrence. Perhaps a combination of graft and expansile duroplasty may be used for repair, especially when associated with a tethered cord and in the presence of significant adhesions.
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Affiliation(s)
- Ikenna Ogbu
- Department of Neurosurgery, Royal Stoke University Hospital, University Hospitals of North Midlands (UHNM), Staffordshire, West Midlands, United Kingdom
| | - Mohamed Eltoukhy
- Department of Neurosurgery, Royal Stoke University Hospital, University Hospitals of North Midlands (UHNM), Staffordshire, West Midlands, United Kingdom
| | - Nikolaos Tzerakis
- Department of Neurosurgery, Royal Stoke University Hospital, University Hospitals of North Midlands (UHNM), Staffordshire, West Midlands, United Kingdom
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Wang L, Yang X, Wang H, Chen Z, Sun C, Li W. Pseudomeningocele-a rare complication following thoracic spinal decompression surgery: clinical features, treatment guidelines, technical notes, and evaluation of results. INTERNATIONAL ORTHOPAEDICS 2021; 45:2609-2618. [PMID: 34398291 DOI: 10.1007/s00264-021-05156-5] [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: 04/25/2021] [Accepted: 07/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Pseudomeningocele (PMC) is a rare complication following thoracic spinal decompression surgery. The aim of this study is to assess the clinical features and treatment of PMC and provide the technical notes with revision surgery. METHODS Between January 2010 and December 2019, patients who developed PMC after posterior thoracic surgery were enrolled. An additional 25 patients who suffered cerebrospinal fluid leakage (CSFL) but did not develop PMC in the same period were randomly selected. General data, intra-operative factors, CSFL position, cost, modified Japanese Orthopaedic Association (mJOA) scores, patient satisfaction, and clinical features were recorded and compared between the two groups. RESULTS Eighteen patients were diagnosed with PMC after thoracic spinal surgery. The average length, width, and depth were 16.25 ± 5.73 cm, 6.96 ± 3.61 cm and 4.39 ± 2.2 cm, respectively. The most common symptom was neurological deficits following incision problems and headache. Compared with the control group, the PMC group showed a longer duration of initial surgery, greater estimated blood loss, an increased rate of CSFL on the ventral side, reduced mJOA scores, and lower patient satisfaction at the final follow-up. CONCLUSION PMC is a rare complication of thoracic surgery with an incidence of 1.12%. PMC typically occurs at the upper and lower thoracic spine, resulting in increased health care costs, poorer neurological recovery, and a lower rate of patient satisfaction. The management of PMC should be individualized depending on diagnosis time and symptoms.
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Affiliation(s)
- Longjie Wang
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Xiaoxi Yang
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Hui Wang
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zhongqiang Chen
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Chuiguo Sun
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Haidian District, 49 North Garden Road, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
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Nakashima H, Ishikawa Y, Kato F, Kanemura T, Shinjo R, Ando K, Kobayashi K, Ishiguro N, Imagama S. Postoperative iatrogenic spinal cord herniation: three case reports with a literature review. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:383-389. [PMID: 32581417 PMCID: PMC7276416 DOI: 10.18999/nagjms.82.2.383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although a majority of spinal cord herniation reportedly occurs idiopathically, postoperative iatrogenic spinal cord herniation is rare. Therefore, the incidence rate, pathogenic mechanism, and clinical outcomes are not clear. We present three cases of postoperative iatrogenic spinal cord herniation and present a literature review. Our data base included 32253 patients who underwent spinal surgery, and among these patients, 3 showed postoperative spinal cord herniation. Postoperative spinal cord herniation was observed in a 55-year-old man and a 60-year-old man. Both these patients underwent cervical laminoplasty for degenerative cervical myelopathy; however, intraoperative dural tear was reported. They presented with severe quadriplegia and sensory disorders at 8 years and 2 months after initial surgery. The third case of postoperative spinal cord herniation was of a 47-year-old woman who underwent Th11/12 schwannoma resection. Her neurological symptoms did not improve after tumor resection, and MRI at 2 months after surgery revealed spinal cord herniation. All the 3 patients underwent spinal cord reduction surgery; one patient showed sufficient neurological improvement while 2 patients with cervical spinal cord herniation showed limited neurological improvement due to preoperative severe quadriplegia. Although postoperative iatrogenic spinal cord herniation is a relatively rare pathology, careful observation with postoperative MRI is required in cases of patients with new neurological symptoms after dural injury and durotomy.
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Affiliation(s)
- Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Spine & Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Yoshimoto Ishikawa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Spine & Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan
| | - Tokumi Kanemura
- Department of Spine & Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Ryuichi Shinjo
- Department of Spine & Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Late Cervical Spinal Cord Herniation Resulting from Post-Traumatic Brachial Plexus Avulsion Injury. World Neurosurg 2020; 137:1-7. [PMID: 32004737 DOI: 10.1016/j.wneu.2020.01.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Spinal cord herniation (SCH) is often described as occurring spontaneously in the thoracic spine, with few cases of cervical SCH reported as a late complication of traumatic brachial plexus avulsion. We present 2 cases of nerve root avulsion and pseudomeningocele formation, resulting in delayed cervical SCH and neurologic deterioration. CASE DESCRIPTION Case 1: A 37-year old man presented with progressive leg weakness 2 years after experiencing traumatic C8 and T1 root avulsions. Magnetic resonance imaging (MRI) showed previously documented C8-T1 nerve avulsions with new SCH in a T1 pseudomeningocele. A C7-T1 costotransversectomy and C4-T4 instrumented fusion were completed, allowing SCH reduction and patch graft repair of the dural defects without the need for adhesiolysis. At last follow-up, the patient's leg weakness had resolved. Case 2: A 32-year old man presented with progressive right arm numbness, weakness, and signs of myelopathy 9 years after experiencing C8 and T1 root avulsions. MRI showed previously documented root avulsions and new SCH with extensive and compressive pseudomeningocele formation. A C7 transpedicular approach with C5-T1 instrumented fusion was completed for dural repair. A large pseudomeningocele was found and drained on drilling the C7 pedicle, and adhesiolysis was required at the spinal cord avulsion site to reduce the SCH and allow patch graft repair. At last follow-up, the patient's right arm weakness was improving, although numbness persisted. CONCLUSIONS SCH is a rare cause of delayed neurologic deterioration after brachial plexus avulsion, with few case reports describing its occurrence. We present 2 cases of this complication and describe its successful surgical treatment through dural repair after instrumented fusion.
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Finneran MM, Schaible K. Ventral Herniation of the Cervical Cord After Single-Level Corpectomy. World Neurosurg 2020; 136:12-16. [PMID: 31917311 DOI: 10.1016/j.wneu.2019.12.165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Spinal cord herniation in the cervical spine is an exceptionally rare occurrence. It is most often cited in association with surgery and almost exclusively with a posterior approach. Herniation with an anterior approach has been reported in 3 cases after multilevel corpectomy, all of which involved herniation through a dural defect sustained during surgery. CASE DESCRIPTION A 49-year-old man presented to the emergency room with generalized fatigue. He had a previous anterior C5 corpectomy and posterior cervical fusion from C2-T4 performed 17 years prior for a cervical kyphotic deformity that developed after a laminectomy. Magnetic resonance imaging of the cervical spine demonstrated a significant ventral cord herniation into the C5 ventral corpectomy site. The patient underwent a C4-6 vertebral corpectomy with C3-7 anterior reconstruction, fusion, and instrumentation with successful reduction and anatomic realignment of the spinal cord herniation. CONCLUSIONS We present a case of cervical cord herniation that occurred into the ventral corpectomy site without obvious dural defect. We hypothesize that cerebral spinal pulsations over time degraded the corpectomy site and ultimately promoted herniation of the spinal cord. Here, we discuss the successful surgical management of this unique pathology and discuss a relevant review of the literature.
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Affiliation(s)
- Megan M Finneran
- Department of Neurosurgery, Advocate BroMenn Medical Center, Normal, Illinois, USA.
| | - Keith Schaible
- Department of Neurosurgery, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
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Guppy KH, Silverthorn JW. Spinal Cord Herniation After Cervical Corpectomy with Cerebrospinal Fluid Leak: Case Report and Review of the Literature. World Neurosurg 2017; 100:711.e7-711.e12. [DOI: 10.1016/j.wneu.2017.01.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 11/26/2022]
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Ailon T, Smith JS, Nassr A, Smith ZA, Hsu WK, Fehlings MG, Fish DE, Wang JC, Hilibrand AS, Mummaneni PV, Chou D, Sasso RC, Traynelis VC, Arnold PM, Mroz TE, Buser Z, Lord EL, Massicotte EM, Sebastian AS, Than KD, Steinmetz MP, Smith GA, Pace J, Corriveau M, Lee S, Riew KD, Shaffrey C. Rare Complications of Cervical Spine Surgery: Pseudomeningocoele. Global Spine J 2017; 7:109S-114S. [PMID: 28451481 PMCID: PMC5400191 DOI: 10.1177/2192568216687769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN This study was a retrospective, multicenter cohort study. OBJECTIVES Rare complications of cervical spine surgery are inherently difficult to investigate. Pseudomeningocoele (PMC), an abnormal collection of cerebrospinal fluid that communicates with the subarachnoid space, is one such complication. In order to evaluate and better understand the incidence, presentation, treatment, and outcome of PMC following cervical spine surgery, we conducted a multicenter study to pool our collective experience. METHODS This study was a retrospective, multicenter cohort study of patients who underwent cervical spine surgery at any level(s) from C2 to C7, inclusive; were over 18 years of age; and experienced a postoperative PMC. RESULTS Thirteen patients (0.08%) developed a postoperative PMC, 6 (46.2%) of whom were female. They had an average age of 48.2 years and stayed in hospital a mean of 11.2 days. Three patients were current smokers, 3 previous smokers, 5 had never smoked, and 2 had unknown smoking status. The majority, 10 (76.9%), were associated with posterior surgery, whereas 3 (23.1%) occurred after an anterior procedure. Myelopathy was the most common indication for operations that were complicated by PMC (46%). Seven patients (53%) required a surgical procedure to address the PMC, whereas the remaining 6 were treated conservatively. All PMCs ultimately resolved or were successfully treated with no residual effects. CONCLUSIONS PMC is a rare complication of cervical surgery with an incidence of less than 0.1%. They prolong hospital stay. PMCs occurred more frequently in association with posterior approaches. Approximately half of PMCs required surgery and all ultimately resolved without residual neurologic or other long-term effects.
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Affiliation(s)
- Tamir Ailon
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Justin S. Smith
- University of Virginia, Charlottesville, VA, USA,Justin S. Smith, University of Virginia, PO Box 800212, Charlottesville, VA 22908, USA.
| | | | - Zachary A. Smith
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Wellington K. Hsu
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Alan S. Hilibrand
- Jefferson Medical College, The Rothman Institute, Philadelphia, PA, USA
| | | | - Dean Chou
- University of California San Francisco, CA, USA
| | | | | | | | | | - Zorica Buser
- University of Southern California, Los Angeles, CA, USA
| | | | - Eric M. Massicotte
- Toronto Western Hospital, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | | | - Khoi D. Than
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - Jonathan Pace
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Mark Corriveau
- University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Sungho Lee
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - K. Daniel Riew
- Columbia University, New York, NY, USA,New York-Presbyterian/The Allen Hospital, New York, NY, USA
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Heller RS, Hwang SW, Riesenburger RI. Dorsal Cervical Spinal Cord Herniation Precipitated by Kyphosis Deformity Correction for Spinal Cord Tethering. World Neurosurg 2017; 100:709.e1-709.e4. [DOI: 10.1016/j.wneu.2017.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/31/2017] [Accepted: 02/02/2017] [Indexed: 11/25/2022]
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Rahimizadeh A, Soufiani H, Rahimizadeh S. Remote Cervical Pseudomeningocele Following Anterior Cervical Corpectomy and Fusion: Report of a Case and Review of the Literature. Int J Spine Surg 2016; 10:36. [PMID: 27909657 DOI: 10.14444/3036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Iatrogenic cervical pseudomeningocele is a rare event and majority are located posteriorly as a delayed complication of inadvertent dural tear after decompressive laminectomy. However, iatrogenic anterior cervical pseudomeningocele subsequent to discectomy or corpectomy is a rare pathology. The time necessary for formation of pseudomeningocele varies and depend on the width of the dural tear and the flow of cerebrospinal fluid leakage. Large tears with high CSF flow usually result in early collection of the cerebrospinal fluid in anterior compartment of the neck designated acute pseudomeningoceles. Micro-tears of dura mater, with low flow of cerebrospinal fluid may lead to late formation of a pseudomeningocele known as chronic ones. Herein a 49- year-old woman in whom cervical pseudomeningocele appeared clinically as a mass on the anterior aspect of the neck, six months after anterior cervical corpectomy for cervical spondylotic myelopathy is presented. Otherwise, she was neurologically stable. Cystoperitoneal shunt was proposed which she refused. Surprisingly, at 2-year follow-up, the cyst had remained of the same size. To the best of our knowledge, this is the first example of post-operative chronic cervical pseudomeningocele in the literature, the event that might propose the self-limited natural course of this rare pathology in chronic cases.
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Aiyer SN, Shetty AP, Kanna R, Maheswaran A, Rajasekaran S. Spinal cord herniation following cervical meningioma excision: a rare clinical entity and review of literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25 Suppl 1:216-9. [PMID: 26846229 DOI: 10.1007/s00586-016-4412-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Spinal cord herniation following surgery is an extremely uncommon clinical condition with very few reports in published literature. This condition usually occurs as a spontaneous idiopathic phenomenon often in the thoracic spine or following a scenario of post traumatic spinal cord/nerve root injury. Rarely has it been reported following spinal cord tumor surgery. PURPOSE To document a case of cervical spinal cord herniation as a late onset complication following spinal cord tumor surgery with an atypical presentation of monoparesis. DESIGN Case report. METHODS We describe the clinical presentation, operative procedure, post operative outcome and review of literature of this rare clinical condition. RESULTS A 57-year-old man presented with right upper limb monoparesis due to a spinal cord herniation 6 years after a cervical intradural meningioma excision. The patients underwent surgery to reduce the herniation and duroplasty with subsequent complete resolution of symptoms. CONCLUSIONS Spinal cord herniation must be considered as differential diagnosis in scenarios of spinal cord tumor excision presenting with late onset neurological deficit. These cases may present as paraparesis, Brown-sequard syndrome and rarely as in our case as monoparesis.
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Affiliation(s)
- Siddharth N Aiyer
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - Rishi Kanna
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - Anupama Maheswaran
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - S Rajasekaran
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India.
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Iencean SM, Poeata I. Late postoperative cervical spinal cord herniation. Spine J 2014; 14:856-7. [PMID: 24362002 DOI: 10.1016/j.spinee.2013.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/14/2013] [Indexed: 02/03/2023]
Affiliation(s)
- Stefan M Iencean
- Department of Neurosurgery, "Gr T Popa" University of Medicine and Pharmacy Iasi, 16 Universitatii St, Iasi 700115, Romania
| | - Ion Poeata
- Department of Neurosurgery, "Gr T Popa" University of Medicine and Pharmacy Iasi, 16 Universitatii St, Iasi 700115, Romania
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