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MPharm SM, Chowdhury YA, Soon WC, Rodrigues D, Lo WB. A rare case of inferior vena cava occlusion secondary to abdominal pseudocyst associated with ventriculoperitoneal shunt-case report and review of literature. Childs Nerv Syst 2022; 38:1233-1236. [PMID: 35364705 DOI: 10.1007/s00381-021-05391-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND IMPORTANCE Abdominal pseudocyst (APC) is an uncommon but well-recognised complication of ventriculo-peritoneal (VP) shunt. Diagnosis is based on clinical features of shunt malfunction, including headaches, vomiting and drowsiness, and abdominal swelling. APCs can grow to large sizes resulting in compression of abdominal viscera; however, inferior vena cava (IVC) compression is extremely rare, and only one other case associated with VP shunt had been reported. CLINICAL PRESENTATION We report a case of a 12-year-old girl with a background of open myelomeningocoele repair, kyphoscoliosis and right-sided VP shunt in situ who presented with bilateral lower limb swelling and abdominal distension. She exhibited no features of raised intracranial pressure but had bilateral pitting oedema up to the groin. Abdominal ultrasound and CT scan showed a massive septated pseudocyst (20 × 18 × 8 cm) compressing the IVC. The APC was drained, and the shunt was externalised, with conversion to a ventriculo-atrial (VA) shunt 1 week later after cultures of the cystic fluid, cerebrospinal fluid and shunt tube came back sterile. The patient remained well with no recurrence of the abdominal fluid and no VA shunt complication at 36-month follow-up. CONCLUSION This patient had specific risk factors for development of a massive APC and the subsequent IVC compression, including prior surgeries, spinal deformity, abnormal abdominal anatomy and poor abdominal muscle tone and sensation. Early recognition of this complication and prompt alleviation of the mass effect of IVC compression can prevent long-term neurological and vascular sequalae.
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Affiliation(s)
- Shumail Mahmood MPharm
- Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Yasir A Chowdhury
- Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
| | - Wai Cheong Soon
- Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Birmingham, B15 2GW, UK
| | - Desiderio Rodrigues
- Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
| | - William B Lo
- Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, B4 6NH, UK.
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De Jesus O, Rios-Vicil C, Pellot Cestero JE, Carro-Figueroa EF. Huge subcutaneous extraperitoneal pseudocyst after migration of the ventriculoperitoneal shunt catheter. BMJ Case Rep 2021; 14:e246681. [PMID: 34853048 PMCID: PMC8638129 DOI: 10.1136/bcr-2021-246681] [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] [Accepted: 11/18/2021] [Indexed: 11/03/2022] Open
Abstract
The formation of an intraperitoneal pseudocyst as a complication of ventriculoperitoneal shunts is well known. However, the formation of a pseudocyst at the subcutaneous extraperitoneal abdominal space is unusual and likely secondary to the migration of the peritoneal catheter. We present a 53-year-old male who had placement of a ventriculoperitoneal shunt for hydrocephalus secondary to a vestibular schwannoma. Five months later, he presented with an enormously distended abdomen. Investigations showed the peritoneal catheter in the extraperitoneal space within a large right lower quadrant abdominal wall pseudocyst. The patient was taken to the operating theatre, and the shunt was externalised at the original abdominal incision. Approximately 3 L of cerebrospinal fluid were aspirated from the distal peritoneal catheter. After negative cultures, a new peritoneal catheter was placed intraperitoneally at the contralateral lower abdominal quadrant. The contralateral quadrant was utilised to prevent fluid accumulation into the old extraperitoneal cavity.
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Affiliation(s)
- Orlando De Jesus
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Christian Rios-Vicil
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Joel E Pellot Cestero
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Eric F Carro-Figueroa
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
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3
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Basilotta Márquez YNI, Mengide JP, Liñares JM, Saenz A, Argañaraz R, Mantese B. Abdominal complications in patients with a ventriculoperitoneal shunt: proposal for management recommendations from a single pediatric tertiary center. Childs Nerv Syst 2021; 37:2223-2232. [PMID: 33751170 DOI: 10.1007/s00381-021-05121-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to describe our experience in the management of patients with ventriculoperitoneal shunt-related complications (abdominal pseudocyst, bowel-related complications, and ascites) and to propose treatment recommendations. MATERIAL AND METHODS A retrospective descriptive study was conducted in patients with ventriculoperitoneal shunt-related abdominal complications seen between 2009 and 2019 at a tertiary-care pediatric center. Patients were classified according to their diagnosis into the following: group A (abdominal pseudocyst), group B (bowel-related complications), and group C (ascites). The following variables were studied in all three groups: age, sex, etiology of hydrocephalus, history of pyogenic ventriculitis, history of abdominal surgery, clinical presentation, presence of ventricular enlargement on computed tomography scan, abdominal ultrasonography, shunt series X-ray, cerebrospinal fluid cultures, urgent as well as elective surgical interventions, antibiotic treatment, length of hospital stay, follow-up, and outcome. RESULTS Overall, 48 patients were analyzed: group A, n=29; group B, n=15; and group C, n=4. In all cases, surgical decision-making was based on symptom severity at the time of diagnosis, presence of ventricular enlargement on computed tomography scan, and cerebrospinal fluid culture results. In patients with positive cultures, the shunt system was removed, and an external ventricular drain was placed. In oligosymptomatic patients, cerebrospinal fluid culture results were awaited to define long-term treatment and in patients with ventricular enlargement or clinically difficult-to-treat symptoms, the distal catheter was exteriorized at the thoracic level. CONCLUSION In patients with shunt-related abdominal complications, surgical management depends on symptom severity and/or whether infection is present at the time of diagnosis.
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Affiliation(s)
| | | | | | - Amparo Saenz
- Neurosurgery Department, Garrahan Hospital, Buenos Aires, Argentina
| | - Romina Argañaraz
- Neurosurgery Department, Garrahan Hospital, Buenos Aires, Argentina
| | - Beatriz Mantese
- Neurosurgery Department, Garrahan Hospital, Buenos Aires, Argentina
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Ferreira Furtado LM, Da Costa Val Filho JA, Moreira Faleiro R, Lima Vieira JA, Dantas Dos Santos AK. Abdominal Complications Related to Ventriculoperitoneal Shunt Placement: A Comprehensive Review of Literature. Cureus 2021; 13:e13230. [PMID: 33585146 PMCID: PMC7877257 DOI: 10.7759/cureus.13230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Ever since the shunt device became the gold standard treatment for hydrocephalus, complications due to infections and mechanical problems have increased while lives have been saved. In addition, abdominal complications have become an important issue as the peritoneum is now the main place to insert the distal catheter. The most common complications were abdominal pseudocyst, distal catheter migration, inguinal hernia, catheter disconnection, and intestinal obstruction. The pediatric population is more prone to develop most of these complications due to their rapidly growing body, weaker abdominal musculature, and increased intraabdominal pressure. The goal of this review was to study the main aspects associated with abdominal complications after ventriculoperitoneal shunt (VPS) insertion, including the pathophysiology, epidemiological aspects, as well as the rationale for management and prevention according to the current “state-of-the-art.” It is paramount to recognize the risk factors associated with various types of complications to manage them properly.
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Affiliation(s)
| | | | - Rodrigo Moreira Faleiro
- Department of Neurosurgery, João XXIII Hospital/Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, BRA
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Achufusi TGO, Chebaya P, Rawlins S. Abdominal Cerebrospinal Fluid Pseudocyst as a Complication of Ventriculoperitoneal Shunt Placement. Cureus 2020; 12:e9363. [PMID: 32742887 PMCID: PMC7384702 DOI: 10.7759/cureus.9363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The abdominal cavity has long been used for absorption of cerebrospinal fluid (CSF) in patients with hydrocephalus. Although the procedure is quite common, there are complications that can potentially arise following ventriculoperitoneal (VP) shunt insertion. Here, we report a case of a 39-year-old female patient in which a large abdominal pseudocyst was developed as a complication of VP shunt placement. Ultrasonographical evaluation of the abdomen showed a well-defined cystic mass lesion later confirmed on CT abdomen. She subsequently underwent surgical excision of the pseudocyst with resolution of previous symptoms. Clinicians should be aware of this complication since early diagnosis improves outcome and reduce patient's suffering and distress.
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Affiliation(s)
- Ted George O Achufusi
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Philip Chebaya
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Sekou Rawlins
- Gastroenterology, State University of New York Upstate Medical University, Syracuse, USA
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García-Martín A, Otero-Rodríguez A, Miranda-Zambrano D, Arandia-Guzmán DA, Torres-Carretero L, Sousa-Casasnovas P, Pascual-Argente D. Abdominal pseudocysts, an unusual complication of ventriculoperitoneal shunt systems: Literature systematic review. Neurocirugia (Astur) 2020; 32:69-77. [PMID: 32430242 DOI: 10.1016/j.neucir.2020.03.005] [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: 06/18/2019] [Revised: 11/07/2019] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
Since the first report in 1954, abdominal pseudocysts have been recognized as a particularly uncommon complication of ventriculoperitoneal shunts of CSF, so their etiology, diagnosis, and therapeutic management remain very controversial. Our objective is to offer a critical and updated systematic review of those controversial points, using a thorough search and review of the most relevant literature available. The clinical presentation of pseudocysts is normally through non-specific abdominal symptoms. The most validated etiology consists on the existence of a concomitant infection of the CSF shunt system, and so, treatment needs of antibiotherapy and total or partial substitution of the system. However, the pseudocyst itself doesn't need an active treatment, except for some specific cases. This management, algorithmically presented in the present work, achieves a lower recurrence rate than other options, but this one is still important, and is also associated with other complications of those shunts related with several other factors which need to be taken in account.
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Affiliation(s)
- Andoni García-Martín
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
| | - Alvaro Otero-Rodríguez
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - David Miranda-Zambrano
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Luis Torres-Carretero
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Pablo Sousa-Casasnovas
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Daniel Pascual-Argente
- Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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Long-Term Outcomes in Ventriculoatrial Shunt Surgery in Patients with Pediatric Hydrocephalus: Retrospective Single-Center Study. World Neurosurg 2020; 138:e112-e118. [PMID: 32061956 DOI: 10.1016/j.wneu.2020.02.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Long-term outcomes are rarely reported for patients with pediatric hydrocephalus. Ventriculoperitoneal shunting is the surgical standard; nevertheless, in selected patients, a ventriculoatrial shunt (VAS) remains an important alternative. This study aimed to analyze the causes of VAS revisions and complications. METHODS Pediatric patients who underwent their first shunt operation between 1982 and 1992 were included. The timing, cause, and modality of VAS revisions were retrospectively determined. RESULTS Overall, 138 patients were treated for hydrocephalus and 61 patients received a VAS during the follow-up period. A primary VAS was the first shunt type in 42 (68.85%) patients. In 19 (31.15%) patients, conversions to second-line VAS were carried out. The rates of VAS revisions performed for dysfunction or elective lengthening of a short atrial catheter were 52.2% and 22.9%, respectively. There was no difference in the number of VAS revisions between patients with primary VASs and second-line VASs. Age at VAS and etiology of hydrocephalus had no effect on the number of revisions. Specific VAS complications were observed in 2 patients. Deep positioning of the distal catheter led to asymptomatic tricuspid regurgitation that was reversible after shortening of the atrial catheter. Another patient presented with shunt nephritis and completely recovered after the atrial catheter was replaced with a peritoneal catheter. CONCLUSIONS VAS remains an appropriate second-line alternative in selected patients. Specific VAS complications were rarely observed and completely reversible after treatment. However, regular and specific follow-up examinations are strongly recommended to avoid cardiopulmonary or renal complications.
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Gmeiner M, Thomae W, Tolino M, Senker W, Gruber A. Bowel perforation after ventriculoperitoneal-shunt placement: case report and review of the literature. Open Med (Wars) 2020. [DOI: 10.1515/med-2020-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Abstract
Bowel perforation by a peritoneal catheter (BPPC) is a serious complication after ventriculoperitoneal shunting, with high mortality and morbidity rates. This patient presented with scalp ulceration over the shunt valve at the retromastoid region 26 years after shunt placement. During revision, the catheter distal to the valve was divided in the clavicular region. As there was no cerebrospinal fluid drainage, we decided to remove the ventricular catheter and valve. The ulceration was debrided and primarily closed. Distal to the clavicle, the disconnected peritoneal catheter was encased in a fibrous, calcified tunnel. To avoid piecemeal resection with multiple incisions, the catheter was not retrieved. Two years later, the patient presented with an abscess and pus draining from the clavicular wound. Cultures were positive for enteric bacteria. BPPC with retrograde spread of infection was suspected, and abdominal computed tomography confirmed perforation. We removed the disconnected catheter, but the perforation site could not be detected during laparotomy. The patient was treated with intravenous antibiotics and recovered without complications. To minimize complications, abandoned catheters should be avoided. Otherwise, patients unnecessarily have a life-long risk of developing abdominal complications. In patients with abandoned catheters and severe abdominal symptoms, BPPC is an important differential diagnosis.
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Affiliation(s)
- Matthias Gmeiner
- Department of Neurosurgery, Kepler University Hospital , Wagner-Jauregg-Weg 15A, 4020 Linz , Austria
- Johannes Kepler University (JKU) Linz , Altenbergerstraße 69, 4040 , Linz , Austria
| | - Wolfgang Thomae
- Kepler University Hospital, Neuromed Campus, Department of Neurosurgery , Wagner-Jauregg-Weg 15A, 4020 Linz , Austria
| | - Marco Tolino
- Kepler University Hospital, Neuromed Campus, Institute of Neuroradiology , Wagner-Jauregg-Weg 15A, 4020 Linz , Austria
| | - Wolfgang Senker
- Kepler University Hospital, Neuromed Campus, Department of Neurosurgery , Wagner-Jauregg-Weg 15A, 4020 Linz , Austria
| | - Andreas Gruber
- Johannes Kepler University (JKU) Linz , Altenbergerstraße 69, 4040 , Linz , Austria
- Kepler University Hospital, Neuromed Campus, Department of Neurosurgery , Wagner-Jauregg-Weg 15A, 4020 Linz , Austria
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Gmeiner M, Wagner H, Schlögl C, van Ouwerkerk WJ, Senker W, Sardi G, Rauch P, Holl K, Gruber A. Adult Outcome in Shunted Pediatric Hydrocephalus: Long-Term Functional, Social, and Neurocognitive Results. World Neurosurg 2019; 132:e314-e323. [DOI: 10.1016/j.wneu.2019.08.167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022]
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10
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Sellier A, Monchal T, Joubert C, Bourgouin S, Desse N, Bernard C, Balandraud P, Dagain A. Update about ventriculoperitoneal shunts: When to combine visceral and neurosurgical management? J Visc Surg 2019; 156:423-431. [DOI: 10.1016/j.jviscsurg.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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TB Meningitis and TB Peritonitis: Abdominal Pseudocyst and VP-Shunt Link. Case Rep Radiol 2019; 2019:4893547. [PMID: 31183240 PMCID: PMC6512015 DOI: 10.1155/2019/4893547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 01/28/2019] [Accepted: 04/16/2019] [Indexed: 11/29/2022] Open
Abstract
TB meningitis (TBM) carries high morbidity and mortality and is a relatively common extrapulmonary TB in the third world countries. TBM as thick exudative disease manifests on MRI and CT as nodular basal leptomeningitis, hydrocephalus, basal infarcts, and tuberculomas. Hydrocephalus is treated with ventriculoperitoneal shunting (VPS). Shunt malfunction and revision are common. We report a case of multidrug-resistant TBM with spinal involvement and dissemination of the disease via VPS causing TB peritonitis (TBP). TBP presented as a large abdominal pseudocyst around the catheter tip with shunt malfunction. There was no evidence for any other site of extra-CNS disease. TBP per se is relatively less common. This is the first case reporting VPS as a means of TB spread.
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Zhang K, Gao M, Wang G, Shi Y, Li X, Lv Y, Zhang G, Gai Z, Liu Y. Hydrocephalus in cblC type methylmalonic acidemia. Metab Brain Dis 2019; 34:451-458. [PMID: 30564975 DOI: 10.1007/s11011-018-0351-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/22/2018] [Indexed: 12/29/2022]
Abstract
Methylmalonic acidemia (MMA) is a typical type of organic acidemia caused by defects in methylmalonyl-CoA mutase or adenosyl-cobalamin synthesis. Hydrocephalus (HC), results from an imbalance between production and absorption of cerebrospinal fluid (CSF), causeing enlarged cerebral ventricles and increased intracranial pressure, is a condition that requires urgent clinical decision-making. MMA without treatment could result in brain damage. However, HC in MMA was rarely reported. In this study, 147 MMA were identified from 9117 high risk children by gas chromatography mass spectrometry (GC/MS) for organic acidurias screening in urine samples and liquid chromatography-tandem mass spectrometry (LC-MS/MS) for amino acids detection in blood samples. Totally 10 cases with MMA and HC were determined by brain MRI/CT, as well as gene mutation testing either by high throughput sequencing or Sanger sequencing. Besides, homocysteine was also analyzed for the 10 MMA with HC. Out of them, 9 cases carry out compound heterozygous mutations or homozygous mutation in MMACHC gene, and 1 case has MUTmutation. The mutation c.609G > A in MMACHC was the most common in the cbl type patients. Although MMA has a high incidence in Shandong province of China, especially cblC type. All of the 10 patients were not correctly diagnosed before developing HC. As a result, when a child develops progressive and refractory HC, the screening for inherited metabolic diseases should be immediately conducted.
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Affiliation(s)
- Kaihui Zhang
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, 23976 Jingshi Road, Jinan, 250022, Shandong, China
| | - Min Gao
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, 23976 Jingshi Road, Jinan, 250022, Shandong, China
| | - Guangyu Wang
- Department of Neurosurgery, Qilu Children's Hospital of Shandong University, Jinan, 250022, Shandong, China
| | - Yingying Shi
- Department of Imaging, Qilu Children's Hospital of Shandong University, Jinan, 250022, Shandong, China
| | - Xiaoying Li
- Department of Neonatology, Qilu Children's Hospital of Shandong University, Jinan, 250022, Shandong, China
| | - Yvqiang Lv
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, 23976 Jingshi Road, Jinan, 250022, Shandong, China
| | - Guangye Zhang
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, 23976 Jingshi Road, Jinan, 250022, Shandong, China
| | - Zhongtao Gai
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, 23976 Jingshi Road, Jinan, 250022, Shandong, China.
| | - Yi Liu
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, 23976 Jingshi Road, Jinan, 250022, Shandong, China.
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