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Ekanem UOI, Chaiyamoon A, Cardona JJ, Berry JF, Wysiadecki G, Walocha JA, Iwanaga J, Dumont AS, Tubbs RS. Prevalence, Laterality, and Classification of Ossified Petroclival Ligaments: An Anatomical and Histological Study With Application to Skull Base Surgery. Cureus 2023; 15:e36469. [PMID: 37090401 PMCID: PMC10117410 DOI: 10.7759/cureus.36469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Background The petroclival ligament (PL) forms the roof of Dorello's canal (DC). In humans, partial and complete ossification of this ligament have been reported. When completely ossified, DC is transformed into a bony foramen for the abducens nerve and accompanying vascular structures. As this osteological finding might have an impact on skull base surgery, this anatomical study was performed. Methodology Using 100 adult human skulls, the presence of an ossified PL was noted and classified. The diameter of the resultant bony foramen and laterality were documented. Additionally, PL was evaluated histologically in 10 heads. Results Overall, 8% of the sides were found to have partial or complete ossification of the PL. Partial ossification (type I) was noted on 3% of the sides. Completely ossified PL was identified on 5% of the sides. Some ossified ligaments (2.5%) were seen as an ossified bridge (type II), and others (2.5%) were converted into small foramina (type III). Three skulls (3%) were found to have a completely ossified ligament bilaterally. The mean diameter of the underlying DC was 0.8 mm. Partially ossified ligaments were statistically more likely to be on the right sides, and the diameter of the underlying DC was statistically smaller in type III. Histologically, the PL was found to have bone within it on three skull sides. Conclusions An ossified ligament can be found on imaging of the skull base. Moreover, during surgical approaches to the petroclival region and, specifically, DC, skull base surgeons should be cognizant of this anatomical variation.
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Affiliation(s)
| | - Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, THA
| | - Juan J Cardona
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - J Franklin Berry
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Grzegorz Wysiadecki
- Department of Anatomy and Histology, Medical University of Poland, Lodz, POL
| | - Jerzy A Walocha
- Department of Anatomy, Jagiellonian University Medical College, Krakow, POL
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, St. George's, GRD
- Department of Neurosurgery and Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, USA
- Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA
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Karapinar BO, Warille AA, Baş O, Emirzeoğlu M, Bilgiç S. An atypical anatomical variation of the petrosphenoidal ligament in a newborn cadaver. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2023; 45:137-141. [PMID: 36592185 DOI: 10.1007/s00276-022-03072-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE To report an atypical anatomical variation of the petrosphenoidal ligament in a newborn cadaver and to discuss its clinical significance. METHODS During a study of ten newborn cadavers, the skull base was dissected to reveal the anatomy of the petrosphenoidal ligament and its relationship with the abducens nerve. An atypical anatomical variation was observed, and this is described. The length of the right and left ligaments to the point where it splits into two arms, the joint length of the two ligaments at the junction of the clivus, the length of the ligament proceeding to the posterior clinoid process, and the abducens nerve's diameter as it passes below the ligament were measured on ImageJ software. RESULTS The petrosphenoidal ligaments were y-shaped, and the attachment of the proximal ligaments was bifid. In the midline above the clivus, some ligament bundles joined the contralateral petrosphenoidal ligament, whilst another group of bundles originated at the posterior clinoid process. At the entry to Dorello's canal, the abducens nerve had a diameter of 0.59 mm on the left and 0.65 mm on the right. The part of the ligaments converging on the clivus in the midline after dividing into two arms was 10.68 mm. CONCLUSIONS We think that this case report will provide useful information for surgical procedures to the petroclival region, transnasal surgical approaches, and surgical interventions involving the carotid artery.
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Affiliation(s)
- Burak Oğuzhan Karapinar
- Department of Medical Services and Techniques, Ondokuz Mayıs University Health Services of Vocational School, Samsun, Turkey.
| | - Aymen A Warille
- Department of Anatomy, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Orhan Baş
- Department of Anatomy, Faculty of Medicine, Samsun University, Samsun, Turkey
| | - Mehmet Emirzeoğlu
- Department of Anatomy, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Sait Bilgiç
- Department of Anatomy, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Clarke E, Golberg M, Smędra A, Mazur M, Mazurek A, Balawender K, Barszcz K, Żytkowski A. Bilateral caroticoclinoid foramen and unilateral abducens nerve canal found on the fetal skull – Case report. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kontzialis M, Ahmed AK, Gallia GL, Texalidis P, Aygun N, Blitz AM. High resolution 3D magnetic resonance imaging of Gruber's ligament: a pilot study. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1157-1163. [PMID: 35909192 DOI: 10.1007/s00276-022-02996-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/20/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Gruber's ligament (GL), a surgical landmark, extends from the lateral upper clivus to the petrous apex (PA), forming the superior boundary of Dorello's canal (DC). It overlies the interdural segment of the abducens nerve (CN VI). High-resolution 3D skull base MRI (SB-MRI) demonstrates anatomic details visible to the surgeon, but not well seen on traditional cross-sectional imaging. The aim of this study was to demonstrate visualization of the GL and its relationship to CN VI utilizing contrast enhanced high-resolution SB-MRI. METHODS Two neuroradiologists retrospectively reviewed in consensus the SB-MRIs of 27 skull base sides, among 14 patients. GL detection rate, confidence of detection, and GL length were recorded. When GL was successfully identified, the position of the interdural segment of CN VI within DC was recorded. RESULTS GL was readily identified in 16 skull base sides (59%), identified with some difficulty in 2 skull base sides (7%), and failed to be identified in 9 skull base sides (33%). The mean GL length was 7.1 mm (4.5-9.3 mm). Among the 18 cases where GL was successfully identified, CN VI was readily identified in all cases (100%), coursing the lateral third of DC in 72% of sides, and middle third in the remaining 28% of sides. CONCLUSION GL can be identified in approximately two-thirds of cases utilizing 3D high resolution SB-MRI. CN VI passes most commonly along the lateral third of DC. This is the first report demonstrating visualization of GL and its relation to CN VI, on imaging.
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Affiliation(s)
- Marinos Kontzialis
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair Street, Chicago, IL, 60611, USA.
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gary L Gallia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pavlos Texalidis
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nafi Aygun
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Ari M Blitz
- Department of Radiology, Case Western Reserve University School of Medicine University Hospitals, Cleveland, OH, USA
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Prevalence of Petrooccipital Fissure Fusion: Osteological Study with Application to Approaches to the Skull Base and Imaging Interpretation. World Neurosurg 2022; 163:e53-e58. [PMID: 35189417 DOI: 10.1016/j.wneu.2022.02.040] [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: 01/04/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The petrooccipital fissure (POF) has relevance to skull base approaches, various tumors and craniosynostoses, and some cases of age-related hearing loss. However, the prevalence of fusion and classification of such is rarely found in the extant medical literature. METHODS One-hundred and 10 dry human skulls (220 sides) were used for this study. The skulls were evaluated for fusion of the POF. Both the endocranial and exocranial aspects of the POF were analyzed. A classification scheme was developed to better describe the location of POF fusion. RESULTS A fused POF was identified on 36 sides (16.4%) and commonly found bilaterally (11%). Of these, 30 sides (83.3%) were completely fused (type I) and 6 sides (2.7%) were partially fused (types II and III). For the partially fused fissures, the fused part was on all but 2 sides with the most anterior portion of the petrous part of the temporal bone and adjacent clivus (type II). For the 2 sides (both right sides), the fusion was more posteriorly located between the petrous part of the temporal bone and lateral clivus (type III). Fusion of the POF was more often found in specimens with a partially or fully ossified petroclival ligament. Completely fused POF was positively correlated to sides with an intrajugular bony septum. CONCLUSIONS A POF fusion was relatively common and associated with an ossified petroclival ligament and intrajugular bony septation. Such a prevalence is important for clinicians and skull base surgeons interpreting imaging of the skull base.
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Żytkowski A, Clarke E, Musiał A, Dubrowski A, Mazur M, Iwanaga J, Tubbs RS, Wysiadecki G. Atypical attachment of the petrosphenoidal (petroclival) ligament to the posterior genu of the cavernous internal carotid artery – Case report. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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The effect of morphological variability of Dorello's canal on surgical procedures - a review. Ann Anat 2022; 243:151939. [PMID: 35378252 DOI: 10.1016/j.aanat.2022.151939] [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: 11/04/2021] [Revised: 03/26/2022] [Accepted: 03/27/2022] [Indexed: 11/22/2022]
Abstract
Dorello's canal is an arched structure of bone-fibrous character located in the petroclival venous confluence atop the petrosal bone in the petroclival region. It is bordered by the petrosphenoidal ligament, the petrous part of the temporal bone and the lateral border of the upper part of clivus. Its content in the vast majority of variants comprises the abducens nerve, the inferior petrosal sinus, the venous drainage and the dorsal meningeal artery or its medial branch. With the development of microsurgical techniques, this area has gained huge clinical importance, mainly concerning the order in which the above-mentioned elements (especially the position of the abducens nerve) are arranged in relation to each other. These structures appear in different variant forms and necessitate an individual clinical approach. The main purpose of this review is to present condensed information about possible intercorrelations among them and to indicate, on the basis of the available literature and research, possible surgical approaches and the need to consider the variability when treatments in this region are planned.
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Abstract
An ossified left petroclinoid ligament was found during routine dissection of the skull base in an adult male cadaver. The petroclinoid ligament is clinically and surgically important given its anatomical relationships to cranial nerves III, V, and VI, so its ossification is a risk factor for injuries due to trauma, increased intracranial pressure, and vascular and tumor compression resulting in abducens and oculomotor palsies. The causes of petroclinoid ligament ossification are yet to be completely elucidated although several reports have associated them with age-related and physiological processes. Assessing the integrity of the petroclinoid ligament is important during skull base surgical interventions to avoid postoperative complications. Therefore, this paper reviews the petroclinoid ligament and its variation, the ossified petroclinoid ligament.
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Affiliation(s)
| | - Pervez A Khan
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine.,Department of Structural & Cellular Biology, Tulane University School of Medicine.,Department of Neurosurgery, Ochsner Health System.,Department of Anatomical Sciences, St. George's University
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Iwanaga J, Patra A, Ravi KS, Dumont AS, Tubbs RS. Anatomical relationship between the foramen ovale and the lateral plate of the pterygoid process: application to percutaneous treatments of trigeminal neuralgia. Neurosurg Rev 2022; 45:2193-2199. [PMID: 35031899 DOI: 10.1007/s10143-021-01715-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022]
Abstract
Our aim was to clarify the variations in the positional relationship between the base of the lateral plate of the pterygoid process and the foramen ovale (FO), which block inserted needles during percutaneous procedures to the FO usually used for the treatment of trigeminal neuralgia. Ninety skulls were examined. The horizontal relationship between the FO and the posterior border of the base of the lateral plate of the pterygoid process was observed in an inferior view of the skull base. Skulls that showed injury to either the FO or the lateral plate of the pterygoid process on either side were excluded. One hundred and sixty sides of eighty skulls were eligible. The relationship between the FO and the posterior border of the base of the lateral plate was classified into four types. Among the 160 sides, type III (direct type) was the most common (35%), followed by type I (lateral type, 29%) and type IV (removed type, 21%); type II (medial type) was the least common (15%). Of the 80 specimens, 53 showed the same type bilaterally. In type IV, the posterior border of the base of the lateral plate is disconnected from the FO, so percutaneous procedures for treating trigeminal neuralgia could fail in patients with this type.
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Affiliation(s)
- Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA. .,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA. .,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan. .,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Apurba Patra
- Department of Anatomy, All India Institute of Medical Sciences, Bathinda, India
| | - Kumar Satish Ravi
- Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, India
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,University of Queensland, Brisbane, Australia
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10
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McCormack IG, Xu L, Nerva J, Berry JF, Melgar M, Wysiadecki G, Walocha J, Iwanaga J, Dumont AS, Tubbs RS. Anatomy of the Dorsal Meningeal Artery Including Its Variations: Application to Skull Base Surgery and Diagnostic and Interventional Imaging. World Neurosurg 2021; 155:e41-e48. [PMID: 34365050 DOI: 10.1016/j.wneu.2021.07.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The blood supply to the skull base is important to surgeons and those performing interventional and diagnostic procedures in this region. However, 1 vessel with a vast distribution in this area, the dorsal meningeal artery (DMA), has had few anatomic studies performed to investigate not only its normal anatomy but also its variations. Therefore the current study aimed to analyze the DMA via cadaveric dissection. METHODS In 10 adults, latex-injected, cadaveric heads (20 sides), the DMA was dissected using a surgical microscope. This artery and its branches were documented and measured. RESULTS A DMA was identified on all sides. In the majority (85%), it was a branch of the meningohypophysial trunk or common stem with either the inferior hypophysial or tentorial arteries and always had branches that traversed the basilar venous plexus. Multiple branches of the DMA were identified and categorized as bony, dural, neural, and vascular. CONCLUSIONS Surgeons operating at the skull base or clinicians interpreting imaging of this area should have a good working knowledge of the DMA and its typical and variant anatomy.
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Affiliation(s)
- Isabella G McCormack
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Lu Xu
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - John Nerva
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - John F Berry
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Miguel Melgar
- Memorial Neurosciences Center, Memorial Hospital at Gulfport, Gulfport, Mississippi, USA
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA.
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada; Queensland University, Brisbane, Australia
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Microsurgical Anatomy of the Inferomedial Paraclival Triangle: Contents, Topographical Relationships and Anatomical Variations. Brain Sci 2021; 11:brainsci11050596. [PMID: 34064376 PMCID: PMC8147798 DOI: 10.3390/brainsci11050596] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/24/2021] [Accepted: 05/02/2021] [Indexed: 11/17/2022] Open
Abstract
The inferomedial triangle is one of the two surgical triangles in the paraclival subregion of the skull base. It is delineated by the posterior clinoid process, the dural entrance of the trochlear nerve and the dural entrance of the abducens nerve. The aim of the present article is to describe the anatomical variations within the inferomedial triangle. Measurements of the triangle’s borders and area were supplemented by detailed observations of the topographical anatomy and various arrangements of its contents. Nine adult cadaveric heads (18 sides) and 28 sagittal head sections were studied. The mean area of the inferomedial triangle was estimated to be 60.7 mm2. The mean lengths of its medial, lateral and superior borders were 16.1 mm, 11.9 mm and 10.4 mm, respectively. The dorsal meningeal artery was identified within the inferomedial triangle in 37 out of 46 sides (80.4%). A well-developed petrosphenoidal ligament of Grüber was identified within the triangle on 36 sides (78.3%). Although some structures were variable, the constant contents of the inferomedial triangle were the posterior petroclinoid dural fold, the upper end of the petroclival suture, the gulfar segment of the abducens nerve and the posterior genu of the intracavernous internal carotid artery.
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