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Sekhar Sethy S, Mittal S, Goyal N, Sudhakar PV, Verma V, Jain A, Verma A, Vathulya M, Sarkar B, Kandwal P. Healing Assessment of Spinal Tuberculosis: A Systematic Review. World Neurosurg 2024; 185:141-148. [PMID: 38367856 DOI: 10.1016/j.wneu.2024.02.057] [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: 12/21/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Deciding the healing end point in spinal tuberculosis (STB) remains a controversial topic. The current systematic review aims to address the controversy existing in the literature to find a comprehensive method to assess healing in STB. METHODS A thorough literature search was carried out for studies with the assessment of healing parameters in STB. Data extraction was carried out manually, which included study characteristics and healing criteria evaluated in each study. RESULTS Qualitative analysis of 8 included studies showed that healing parameters were described in 3 domains: clinical, hematologic, and radiologic response of the patient to antitubercular chemotherapy. Each domain included various individual parameters, with clinical and radiologic assessment criteria being used in most of the studies. Improvement in terms of pain, constitutional symptoms, weight gain, neurology; variation in erythrocyte sedimentation rate and C-reactive protein; and changes in radiography, magnetic resonance imaging, and positron emission tomography/computed tomography were found to be promising predictors in the assessment of healing. CONCLUSIONS Radiologic response parameters emerged as the maximally used criteria to assess healing in STB. However, in the absence of any statistical analysis and an observed lag in radiologic response, the cumulative effect of all the parameters in 3 domains (clinical, hematologic, and radiologic) can be used to declare a spinal tubercular lesion nonhealing, healing, or healed.
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Affiliation(s)
| | - Samarth Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Nikhil Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - P Venkata Sudhakar
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Vishal Verma
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Aakash Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Aman Verma
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Madhubari Vathulya
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Bhaskar Sarkar
- Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Pankaj Kandwal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
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Mehnath S, Sathish Kumar M, Chitra K, Jeyaraj M. Bone-Adhesive Hydrogel for Effective Inhibition of M. tuberculosis and Osteoblast Regeneration. ACS Infect Dis 2023; 9:2269-2281. [PMID: 37904258 DOI: 10.1021/acsinfecdis.3c00328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Currently, bone tuberculosis (TB) treatment largely involves lifelong drug prescriptions and surgical intervention, resulting in poor quality of life for patients. Therefore, the fabrication of injectable scaffolds to form a solid framework around the defective bone region is gaining importance over the extensive use of antimicrobial inhibitors. Herein, we synthesized a novel bone-adhesive and thermoresponsive hydrogel via conjugation of poly(N-isopropylacrylamide-co-glycidyl methacrylate) (PNIPAM-co-GMA) and cysteine (CYS). Thiolation of the polymer enables chemical cross-linking with the bone glycoprotein, enhancing bone adhesion and permitting control of scaffold retention time. The PNIPAM-co-GMA-CYS hydrogel shows higher cross-linking behavior at 37 °C, forms a strong gel in 260 s, and has 151 kPa adhesion strength on cortical bone. The lead compounds 5-methyl-5H-[1,2,4]triazino[5,6-b]indole-3-thiol (MTIT) and N-tert-butyl-4-methyl-6-(5-methyl-5H-[1,2,4]triazino[5,6-b]indol-3-ylthio)pyrimidin-2-amine (TMTIPA) were identified by a high-throughput screening method. Effective MTIT and TMTIPA are encapsulated in bone-adhesive hydrogel separately, and both have a high release rate above >70% in 180 h. The MTIT- and TMTIPA-loaded PNIPAM-co-GMA-CYS showed an excellent bactericidal effect, reducing the relative intracellular bacterial survival in macrophages. Furthermore, the as-synthesized hydrogel has outstanding mechanical and biocompatibility properties to become a bone-replacing material and provide support to promote bone repair. This work presents a novel bone-adhesive PNIPAM-co-GMA-CYS for the sustained release of lead compounds toward promising alternative bone TB treatment.
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Affiliation(s)
- Sivaraj Mehnath
- National Centre for Nanoscience and Nanotechnology, University of Madras, Guindy Campus, Chennai , Tamil Nadu 600 025, India
| | - Marimuthu Sathish Kumar
- Department of Bioinformatics, School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu 613 401, India
| | - Karuppannan Chitra
- Translational Research Platform for Veterinary Biologicals, Madhavaram Milk Colony, Chennai, Tamil Nadu 600 051, India
| | - Murugaraj Jeyaraj
- National Centre for Nanoscience and Nanotechnology, University of Madras, Guindy Campus, Chennai , Tamil Nadu 600 025, India
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Tang L, Fu CG, Zhou ZY, Jia SY, Liu ZQ, Xiao YX, Chen HD, Cai HL. Clinical Features and Outcomes of Spinal Tuberculosis in Central China. Infect Drug Resist 2022; 15:6641-6650. [PMID: 36386413 PMCID: PMC9664916 DOI: 10.2147/idr.s384442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose The appropriate management of spinal tuberculosis (TB) is challenging for clinicians and the key to treat spinal TB. Surgery and long course anti-TB chemotherapy may not be necessary to all situations. This study aimed to characterize the clinical features and factors affecting treatment outcomes. Patients and Methods A retrospective study of patients with spinal TB over a 5-year period at a teaching hospital in central China was conducted. Features of patients with spinal TB who received different treatment modalities and factors associated with patient outcomes at the end of chemotherapy were analyzed. Results Forty-five patients (21 men and 24 women) with spinal TB were available for analysis. The mean age was 55.39 ± 14.94 years. The most common vertebral area involved was the lumbar (42.2%). The mean number of vertebrae involved was 2.20 ± 0.59. 27 patients (60.0%) received surgical treatment, of which 21 (77.8%) received radical surgical treatment. Thirty-five patients (77.8%) had achieved a favorable status. Statistically, there was no significant correlation between favorable status and surgery, but among 27 surgical patients with spinal tuberculosis, patients receiving radical surgery tended to achieve good prognosis (P = 0.010; odds ratio = 0.053; 95% confidence interval 0.006–0.493). Moreover, there was no significant difference between long course and short course of anti-TB chemotherapy in prognosis in different treatment modalities. Conclusion Although the patients with spinal TB who needed surgical treatment often got a better prognosis when they had radical surgery, surgery was not actually a factor for the favorable outcomes of patients with spinal TB. In different treatment modalities, there was no additional benefit in longer anti-TB chemotherapy periods.
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Affiliation(s)
- Lei Tang
- Department of Spinal Surgery, Yichang Central People’s Hospital, China Three Gorges University, Yichang, People’s Republic of China
- Graduate School, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Ce-Gang Fu
- Department of Spinal Surgery, Yichang Central People’s Hospital, China Three Gorges University, Yichang, People’s Republic of China
- Department of Orthopedics, Haikou Orthopedic and Diabetes Hospital, Haikou Orthopedic and Diabetes Hospital of Shanghai Sixth People’s Hospital, Haikou, People’s Republic of China
| | - Zhen-Yu Zhou
- Department of Spinal Surgery, Yichang Central People’s Hospital, China Three Gorges University, Yichang, People’s Republic of China
- Graduate School, Ningxia Medical University, Yinchuan, People’s Republic of China
| | - Si-Yu Jia
- Department of Spinal Surgery, Yichang Central People’s Hospital, China Three Gorges University, Yichang, People’s Republic of China
| | - Zheng-Qiang Liu
- Department of Spinal Surgery, Yichang Central People’s Hospital, China Three Gorges University, Yichang, People’s Republic of China
| | - Yun-Xiang Xiao
- Department of Spinal Surgery, Yichang Central People’s Hospital, China Three Gorges University, Yichang, People’s Republic of China
| | - Hai-Dan Chen
- Department of Spinal Surgery, Yichang Central People’s Hospital, China Three Gorges University, Yichang, People’s Republic of China
- Graduate School, Ningxia Medical University, Yinchuan, People’s Republic of China
- Correspondence: Hai-Dan Chen, Department of Spinal Surgery, Yichang Central People’s Hospital, China Three Gorges University, 183 Yiling Road, Yichang, 443003, Hubei Province, People’s Republic of China, Tel +86 18086220025, Email
| | - Hui-Li Cai
- Department of Hematology, Yichang Central People’s Hospital, China Three Gorges University, Yichang, People’s Republic of China
- Hui-Li Cai, Department of Hematology, Yichang Central People’s Hospital, China Three Gorges University, 183 Yiling Road, Yichang, 443003, Hubei Province, People’s Republic of China, Email
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Vu S, Belaube N, Canestri A, Develoux M, Moreno A, Fourniols E, Lê MP, Lassel L, Pialoux G, Calin R. A case of tuberculosis and black-grain eumycetoma co-infection in a non-endemic country: clinical presentation and therapeutic management. Int J Infect Dis 2021; 112:186-188. [PMID: 34547485 DOI: 10.1016/j.ijid.2021.09.040] [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: 07/19/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022] Open
Abstract
We report a case of black-grain eumycetoma co-localized with Mycobacterium tuberculosis infection, presenting as a painless leg abscess and associated with vertebral tuberculosis. The rare association of these two pathogens raises several challenges regarding foreseeable drug interactions, side effects, the most appropriate management, and the potential link between these two diseases.
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Affiliation(s)
- Sonia Vu
- AP-HP, Infectious Diseases Department, Tenon Hospital, Sorbonne Université, Paris, France
| | - Nicolas Belaube
- AP-HP, Infectious Diseases Department, Tenon Hospital, Sorbonne Université, Paris, France
| | - Ana Canestri
- AP-HP, Infectious Diseases Department, Tenon Hospital, Sorbonne Université, Paris, France
| | - Michel Develoux
- AP-HP, Infectious Diseases Department, Tenon Hospital, Sorbonne Université, Paris, France
| | - Alicia Moreno
- AP-HP, Mycology Department, Saint-Antoine Hospital, Sorbonne Université, Paris, France
| | - Eric Fourniols
- AP-HP, Orthopaedic Surgery Department, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Minh Patrick Lê
- AP-HP, Pharmacology and Toxicology Laboratory, Paris, France; INSERM UMR-S 1144, Université de Paris, Paris, France
| | - Ludovic Lassel
- AP-HP, Infectious Diseases Department, Tenon Hospital, Sorbonne Université, Paris, France
| | - Gilles Pialoux
- AP-HP, Infectious Diseases Department, Tenon Hospital, Sorbonne Université, Paris, France
| | - Ruxandra Calin
- AP-HP, Infectious Diseases Department, Tenon Hospital, Sorbonne Université, Paris, France.
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Sun G, Wang Q, Liang Q, Song X, Chen J, Shi J, Ma W, Yuan H, Jin W, Wang Z. Clinical efficacy and safety of ultra-short-course chemotherapy in treatment of spinal tuberculosis after complete debridement: an observational study. J Int Med Res 2021; 49:300060520967611. [PMID: 33567940 PMCID: PMC7883171 DOI: 10.1177/0300060520967611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the clinical efficacy and safety of ultra-short-course chemotherapy (<4 months) in treating spinal tuberculosis following complete debridement. Methods Clinical data of patients diagnosed with spinal tuberculosis, who underwent surgery with postoperative chemotherapy for < 4 months at the General Hospital of Ningxia Medical University between January 2005 and March 2015, were retrospectively analysed. Clinical manifestations, American Spinal Injury Association grades, states of bone fusion and lesion healing, deformity correction, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels and adverse drug reactions, observed before and after surgery and at the final follow-up, were assessed. Results Sixty patients were included, comprising 26 male and 34 female patients aged 16–78 years (mean, 40.85 years). Patients received postoperative chemotherapy for 3–4 months (mean, 3.61 months) and were followed for 25–129 months (mean, 70.61 months). Spinal tuberculosis recurred after surgery in one patient, who was cured by subsequent surgery. At the final follow-up, no symptoms of tuberculosis, local pain, abscess or sinus were observed. Daily life and working abilities were almost recovered in all patients. ESR and CRP levels were restored to normal, bone grafts fused, lesions healed and neurological functions were recovered. Postoperative chemotherapy-induced complications occurred in 10 patients (16.67%). Conclusions Complete debridement plus ultra-short-course chemotherapy for 3–4 months may be safe and efficacious in treating spinal tuberculosis, and requires further investigation.
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Affiliation(s)
- Guangwei Sun
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, China.,Department of Orthopaedics, Linfen People's Hospital, Linfen, China
| | - Qian Wang
- Hillsborough Community College, Tampa, FL, USA
| | - Qiang Liang
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiangwei Song
- Department of Orthopaedics, The First Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | - Jian Chen
- Department of Spinal Surgery, Shanghai Guolong Hospital, Shanghai, China
| | - Jiandang Shi
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Wenxin Ma
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Hucheng Yuan
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Weidong Jin
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zili Wang
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
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Garg D, Goyal V. Spinal Tuberculosis Treatment: An Enduring Bone of Contention. Ann Indian Acad Neurol 2020; 23:441-448. [PMID: 33223659 PMCID: PMC7657285 DOI: 10.4103/aian.aian_141_20] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/16/2020] [Accepted: 05/01/2020] [Indexed: 11/04/2022] Open
Abstract
Spinal tuberculosis is the most common form of extrapulmonary tuberculosis. It is of great importance to neurologists because of the potentially devastating complication of paraplegia, which may set in during active disease or the healed phase. Due to the deep-seated nature of the disease, definitive diagnosis is often challenging. There is no clear consensus on the appropriate duration of therapy for spinal tuberculosis, with various guidelines recommending treatment from as short as 6 months to up to 18 months. In this article, we present a critical appraisal of the evidence on the same. In our opinion, the duration of antitubercular therapy needs to be individualized and the decision to terminate therapy should be multifactorial (clinical, radiological, pathological/microbiological where possible) rather than being enmeshed within any particular guideline.
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Affiliation(s)
- Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Vinay Goyal
- Department of Neurology, Institute of Neurosciences, Medanta, Gurugram, Haryana, India
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Du X, Ou YS, Zhu Y, Luo W, Jiang GY, Jiang DM. Oblique lateral interbody fusion combined percutaneous pedicle screw fixation in the surgical treatment of single-segment lumbar tuberculosis: A single-center retrospective comparative study. Int J Surg 2020; 83:39-46. [PMID: 32927138 DOI: 10.1016/j.ijsu.2020.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the clinical efficacy of oblique lateral interbody fusion combined posterior percutaneous pedicle screw fixation in the treatment of single segment lumbar tuberculosis. METHODS Patients who underwent surgical treatment for single segment lumbar tuberculosis from 2015 to 2018 in our department were retrospectively included in this study. The included patients were divided into two groups, namely oblique lateral interbody fusion combined percutaneous pedicle screw fixation (OLIF) group and traditional posterior transforaminal or transpedicular approach debridement and pedicle screws fixation (PTA) group, according to the surgical methods. Outcomes including operative time, operative blood loss, hospital stay, visual analogue scale (VAS) score, Oswestry disability index (ODI), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), Cobb angle correction and loss, bone fusion time, ASIA grade and complications were all recorded and compared. RESULTS A total of 60 patients were included in this study, involving 23 patients in the OLIF group and 37 patients in the PTA group. The OLIF group had less operative time, blood loss and shorter hospital stay compared with the PTA group (P < 0.05). Both the two groups achieved significant improvements in ESR, CRP and ASIA grade at the last follow-up (P < 0.05), but no significant differences were found between them (P>0.05). There were no significant differences in Cobb angle correction and loss between the two groups (P > 0.05), but the bone graft fusion time of the OLIF group was significantly shorter than the PTA group (P < 0.05). The two groups achieved similar improvement in VAS score and ODI at 12 months postoperative and the last follow-up, however, OLIF group had a lower VAS score and ODI at 1 month, 3 months and 6 months postoperative (P < 0.05). No significant difference was found in complications between the two groups (P > 0.05) and all patients were cured after active treatment. CONCLUSIONS Both OLIF and PTA can achieve satisfactory clinical efficacy in the surgical treatment of single segment lumbar TB, but OLIF has the advantages of less surgical trauma, faster postoperative recovery and shorter bone fusion time.
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Affiliation(s)
- Xing Du
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China.
| | - Yun-Sheng Ou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China.
| | - Yong Zhu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China.
| | - Wei Luo
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China.
| | - Guan-Yin Jiang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China.
| | - Dian-Ming Jiang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China.
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Gregori F, Grasso G, Iaiani G, Marotta N, Torregrossa F, Landi A. Treatment algorithm for spontaneous spinal infections: A review of the literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2019; 10:3-9. [PMID: 31000972 PMCID: PMC6469318 DOI: 10.4103/jcvjs.jcvjs_115_18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Primary spinal infections are rare pathologies with an estimated incidence of 5% of all osteomyelitis. The diagnosis can be challenging and this might result in a late identification. The etiological diagnosis is the primary concern to determine the most appropriate treatment. The aim of this review article was to identify the importance of a methodological attitude toward accurate and prompt diagnosis using an algorithm to aid on spinal infection management. Methods: A search was done on spinal infection in some databases including PubMed, ISI Web of Knowledge, Google Scholar, Ebsco, Embasco, and Scopus. Results: Literature reveals that on the basis of a clinical suspicion, the diagnosis can be formulated with a rational use of physical, radiological, and microbiological examinations. Microbiological culture samples can be obtained by a percutaneous computed tomography-guided procedure or by an open surgical biopsy. When possible, the samples should be harvested before antibiotic treatment is started. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and failure of conservative treatment. Conclusion: A multidisciplinary approach involving both a spinal surgeon and an infectious disease specialist is necessary to better define the treatment strategy. Based on literature findings, a treatment algorithm for the diagnosis and management of primary spinal infections is proposed.
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Affiliation(s)
- Fabrizio Gregori
- Department of Human Neurosciences, Division of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Giovanni Grasso
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo, Italy
| | - Giancarlo Iaiani
- Department of Tropical and Infectious Diseases, Aou Policlinico Umberto I, Rome, Italy
| | - Nicola Marotta
- Department of Human Neurosciences, Division of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | - Fabio Torregrossa
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo, Italy
| | - Alessandro Landi
- Department of Human Neurosciences, Division of Neurosurgery, Sapienza University of Rome, Rome, Italy
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