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Shi X, Liu Y, Zhang Z, Tao B, Zhang D, Jiang Q, Chen G, Ma H, Feng Y, Xie J, Zheng X, Zhang J. The value of radiographic features in predicting postoperative facial nerve function in vestibular schwannoma patients: A retrospective study and nomogram analysis. CNS Neurosci Ther 2024; 30:e14526. [PMID: 37990346 PMCID: PMC11017437 DOI: 10.1111/cns.14526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE The purpose of this study was to identify significant prognostic factors associated with facial paralysis after vestibular schwannoma (VS) surgery and develop a novel nomogram for predicting facial nerve (FN) outcomes. METHODS Retrospective data were retrieved from 355 patients who underwent microsurgery via the retrosigmoid approach for VS between December 2017 and December 2022. Univariate and multivariate logistic regression analysis were used to construct a radiographic features-based nomogram to predict the risk of facial paralysis after surgery. RESULTS Following a thorough screening process, a total of 185 participants were included. The univariate and multivariate logistic regression analysis revealed that tumor size (p = 0.005), fundal fluid cap (FFC) sign (p = 0.014), cerebrospinal fluid cleft (CSFC) sign (p < 0.001), and expansion of affected side of internal auditory canal (IAC) (p = 0.033) were independent factors. A nomogram model was constructed based on these indicators. When applied to the validation cohort, the nomogram demonstrated good discrimination and favorable calibration. Then we generated a web-based calculator to facilitate clinical application. CONCLUSION Tumor size, FFC and CSFC sign, and the expansion of the IAC, serve as good predictors of postoperative FN outcomes. Based on these factors, the nomogram model demonstrates good predictive performance.
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Affiliation(s)
- Xudong Shi
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Yuyang Liu
- Department of Neurosurgery920th Hospital of Joint Logistics Support ForceKunmingChina
| | - Zehan Zhang
- Department of Neurosurgerythe Air Force Hospital of Southern Theater CommandGuangzhouChina
| | - Bingyan Tao
- Department of Neurosurgery961th Hospital of Joint Logistics Support ForceQiqiharChina
| | - Ding Zhang
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Qingyu Jiang
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Guilin Chen
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Hengchao Ma
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Yaping Feng
- Department of Neurosurgery920th Hospital of Joint Logistics Support ForceKunmingChina
| | - Jiaxin Xie
- Department of Neurosurgery920th Hospital of Joint Logistics Support ForceKunmingChina
| | - Xuan Zheng
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
| | - Jun Zhang
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
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Yang S, Wang J, Yang C, Li Z, Qiao Y, Wang C, Wang J, Hong W, Wang B. An Investigation Into Whether the Facial Nerve and Auditory Nerve can be Protected by Removal of the Posterior Wall of the Internal Auditory Canal Under 30° Neuroendoscopy During Vestibular Schwannoma Surgery. J Craniofac Surg 2023:00001665-990000000-01148. [PMID: 37921469 DOI: 10.1097/scs.0000000000009826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/12/2023] [Indexed: 11/04/2023] Open
Abstract
The aim of this study was to evaluate the surgical technique of microresection of vestibular schwannoma by removing the posterior wall of the internal auditory canal (IAC) under neuroelectrophysiological monitoring and 30° neuroendoscopy, with respect to the protection of facial and auditory nerve function. Forty-five cases of microscopic resection of auditory neuromas were performed through a posterior approach to the inferior occipital sigmoid sinus using a 30° neuroendoscope to assist in the removal of the posterior wall of the IAC during surgery. Patients underwent cranial enhancement magnetic resonance imaging examination and functional assessment of the facial and auditory nerves before and after surgery, and clinical data were collected for retrospective analysis. All tumors were removed in 41 patients, and most of the tumors were removed in 4 patients. The facial nerve was anatomically preserved in 43 patients (95.6%), and the percentage of facial nerve function preservation (House-Brackmann grade I-II) was 84.4%. Forty patients (88.9%) had anatomical preservation of the auditory nerve, with a 66.7% functional preservation rate. At 3 to 39 months of follow-up, 45 patients were reviewed with 3.0 T-enhanced magnetic resonance imaging, and no tumor recurrence was observed in any of the patients. Microscopic resection of auditory neuroma through the posterior approach of the inferior occipital sigmoid sinus with intraoperative use of 30° neuroendoscopic assistance to abrade the posterior wall of the IAC can eliminate dead space in certain anatomical areas during surgery and minimize surgical damage to the facial and auditory nerves, which is the basis for preservation of facial and auditory nerve function.
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Affiliation(s)
- Siming Yang
- Departments of Neurosurgery
- Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
- Anhui Medical University, Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
| | - Jianbiao Wang
- Departments of Neurosurgery
- Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
- Anhui Medical University, Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
| | - Chi Yang
- Departments of Neurosurgery
- Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
- Anhui Medical University, Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
| | - Zhengyuan Li
- Orthopaedics, First Affiliated Hospital of Anhui Medical University
- Anhui Medical University, Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
| | - Yang Qiao
- Departments of Neurosurgery
- Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
- Anhui Medical University, Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
| | - Cunzhi Wang
- Departments of Neurosurgery
- Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
- Anhui Medical University, Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
| | - Jingtao Wang
- Departments of Neurosurgery
- Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
- Anhui Medical University, Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
| | - Wenming Hong
- Departments of Neurosurgery
- Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
- Anhui Medical University, Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
| | - Bin Wang
- Departments of Neurosurgery
- Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
- Anhui Medical University, Department of Clinical Medicine, Hefei, Anhui, People's Republic of China
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Jia C, Xu C, Wang M, Chen J. How to Precisely Open the Internal Auditory Canal for Resection of Vestibular Schwannoma via the Retrosigmoid Approach. Front Surg 2022; 9:889402. [PMID: 35836606 PMCID: PMC9274124 DOI: 10.3389/fsurg.2022.889402] [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: 03/04/2022] [Accepted: 06/09/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The aim of this study was to investigate how to precisely expose the intrameatal portion of vestibular schwannomas (VSs) without damaging the labyrinth. Methods This was a retrospective study of patients who had undergone retrosigmoid resection of a VS in our institution from April 2018 to December 2021. The patients were divided into microsurgery (MS) and navigation endoscopic-assisted (combined surgery, CS) groups and the effects of image guidance and endoscopy evaluated. The tumors in the CS group were then divided into medial and lateral types by fusion imaging and the differences between the two types analyzed. Results Data of 84 patients were analyzed. Residual tumor was detected by postoperative MRI at the fundus of the internal auditory canal in 5 of the 31 patients in the MS group and 1 of the 53 in the CS group. The labyrinth was damaged in four patients in the MS group but was not damaged in any of the CS group patients. The CS group included 29 lateral type and 24 medial type schwannomas. Endoscopic-assisted resection of residual tumor in the IAC was performed significantly more often on medial than on lateral tumors. Conclusion Navigation and endoscopy are useful in assisting the exposure of the intrameatal portion of VSs. Preoperative MRI/CT fusion imaging is helpful in preoperative evaluation and surgical planning in patients undergoing VS surgery. Tumors of the medial type require endoscopic assistance for resection.
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Affiliation(s)
- Chenguang Jia
- Department of neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Chengshi Xu
- Department of neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Mengyang Wang
- Department of neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Jincao Chen
- Department of neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
- Brain Research Center, Zhongnan Hospital, Wuhan University, Wuhan, China
- Correspondence: Jincao Chen
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Kapitanov DN, Shimansky VN, Kolycheva MV, Shevchenko KV, Lebedeva MA, Chernikova NA, Shelesko EV. [The causes of late diagnostics of vestibular shwannomas]. Vestn Otorinolaringol 2019; 84:36-41. [PMID: 30938340 DOI: 10.17116/otorino20198401136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM The objective of the present study was to elucidate the causes of late diagnostics of vestibular shwannomas based on the results of the analysis of the medical histories of the patients admitted to the Academician N.N. Burdenko National Medical Research Centre of Neurosurgery for the management of this condition. MATERIAL AND METHODS We undertook the retrospective review of a series of 192 cases of vestibular shwannomas in the patients treated based at the N.N. Burdenko National Medical Research Centre of Neurosurgery in 2015. The study included the analysis of demographic characteristics of the patients as well as their anamnestic and clinical data. RESULTS AND DISCUSSION A total of 55 (29%) patients were found to have small tumours (Samii T1-T3) whereas 137 (71%) ones presented with giant neoplasms including T4a and T4b tumours (in accordance with the Samii classification) in 63 (33%) and 74 (38%) patients respectively. The duration of the disease from the appearance of its first clinical symptoms up to the establishment of the definitive diagnosis was 41 months on the average. 37 (19%) patients appeared to have paid no attention to the unilateral impairment of hearing. 46 (24%) patients applied for the medical assistance to the therapists and neurologists. 56 (29%) patients had remained for a long time under the supervision of the ENT specialists and surdologists based at the local outpatient facilities. CONCLUSION More than 2/3 of the examined patients presenting with vestibular shwannomas apply for the medical assistance at the late stages of the disease. Such situation can be attributed to the low level of oncological alertness among the general population and health providers, the poor awareness of the general practitioners and otorhinolaryngologists about this pathology, the unavailability or inefficient application of the modern neurovisualization technologies, in the first place magnetic resonance imaging. The problems encountered in connection with the performance of screening studies give evidence of the necessity of the introduction of up-to-date otoneurological and audiological investigations as well as the neurovisualization techniques into the everyday clinical practice for the comprehensive examination of all the patients suffering from unilateral hearing loss.
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Affiliation(s)
- D N Kapitanov
- Federal State Autonomous Institution 'N.N. Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047
| | - V N Shimansky
- Federal State Autonomous Institution 'N.N. Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047
| | - M V Kolycheva
- Federal State Autonomous Institution 'N.N. Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047
| | - K V Shevchenko
- Federal State Autonomous Institution 'N.N. Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047
| | - M A Lebedeva
- Federal State Autonomous Institution 'N.N. Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047
| | - N A Chernikova
- Federal State Autonomous Institution 'N.N. Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047
| | - E V Shelesko
- Federal State Autonomous Institution 'N.N. Burdenko National Scientific and Practical Center for Neurosurgery' of the Ministry of Healthcare of the Russian Federation, Moscow, Russia, 125047
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Long-Term Tumor Control Rates Following Gamma Knife Radiosurgery for Acoustic Neuroma. World Neurosurg 2019; 122:366-371. [DOI: 10.1016/j.wneu.2018.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/31/2018] [Accepted: 11/02/2018] [Indexed: 11/19/2022]
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Sabab A, Sandhu J, Bacchi S, Jukes A, Zacest A. Postoperative headache following treatment of vestibular schwannoma: A literature review. J Clin Neurosci 2018; 52:26-31. [PMID: 29656878 DOI: 10.1016/j.jocn.2018.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 03/01/2018] [Accepted: 04/02/2018] [Indexed: 01/04/2023]
Abstract
Vestibular schwannoma (VS) is a brain tumour arising from Schwann cells that is typically closely associated with the vestibulocochlear nerve. Post-operative headaches (POH) are a potentially common complication of surgery for VS. Greatly differing rates of POH have previously been reported, particularly with different surgical approaches. The aim of this review is to identify and summarise the available peer-reviewed evidence on rates of POH following operative (or radiosurgery) treatment for VS, in addition to information about the treatment and prognosis of POH in these patients. A systematic search was conducted of Pubmed, Medline, Scopus and EMBASE in April 2017 using the medical subject headings (acoustic neuroma OR vestibular schwannoma) AND headache. Eligibility determination and data extraction were performed in duplicate with standardised forms. POH is common following surgery for VS. Differing rates of POH have been reported with different management approaches, patient age and tumour size. There are relatively few studies that have directly compared the rates of POH with different surgical approaches. The retrosigmoid approach with craniotomy appears to have lower rates of POH than when the retrosigmoid approach is performed with craniectomy. Patients under the age of 65 and with tumours <1.5 cm in size appear to have a higher risk of POH. The most commonly documented management of POH involves simple analgesia, although the majority of patients report this treatment is of only minimal benefit. Further prospective studies comparing rates of POH following different surgical approaches and radiosurgery are required.
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Affiliation(s)
- Ahad Sabab
- Adelaide Medical School, University of Adelaide, South Australia, Australia.
| | - Jaspreet Sandhu
- Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - Alistair Jukes
- Department of Neurosurgery, Royal Adelaide Hospital, South Australia, Australia
| | - Andrew Zacest
- Department of Neurosurgery, Royal Adelaide Hospital, South Australia, Australia
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Identification of cranial nerves near large vestibular schwannomas using superselective diffusion tensor tractography: experience with 23 cases. Acta Neurochir (Wien) 2015; 157:1239-49. [PMID: 25948078 DOI: 10.1007/s00701-015-2431-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The preservation of the facial nerve (FN) and acoustic function in large vestibular schwannoma (VS) surgery is challenging because of nerve course uncertainties and morphological deviations. Preoperative diffusion tensor tractography (DTT) has been proposed to predict the FN location. This study was conducted to evaluate the effectiveness of this technique for identifying the FN, cochlear nerve (CN) and trigeminal nerve (TN) in large VSs. METHODS The study included 23 consecutive patients with VS of Hannover classification T3b to T4b from November 2013 through May 2014. Diffusion tensor images and anatomical images were acquired. The DTT images of the cranial nerves were extracted before surgery for each patient to determine the relationships of these nerves with the tumor. The results were then validated during the tumorectomy. RESULTS In 21 (91.30%) patients, the location of the FN on the DTT images agreed with the intraoperative findings, including in 2 patients in whom the FN passed through the interface between the parenchyma and the cystic changes and in 3 patients with a membranoid FN. The CN or fibers of unclear function were observed on DTT images in four patients with functional hearing. One penetrating fiber of unknown function was effectively constructed. The TN was accurately detected on the DTT images for all patients. CONCLUSIONS DTT effectively revealed the location of the FN, including cases in which the FN was membranoid or passed through the interface between an area exhibiting cystic changes and the tumor nodule. Fibers aside from the FN and the TN were revealed by DTT in patients who retained functional hearing. Penetrating fibers were also found using DTT. This technique can be useful during VS resection.
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Intraoperative neurophysiological monitoring in peripheral nerve surgery: Technical description and experience in a center. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Herrera-Pérez M, Oller-Boix A, Pérez-Lorensu PJ, de Bergua-Domingo J, Gonzalez-Casamayor S, Márquez-Marfil F, Díaz-Flores L, Pais-Brito JL. Intraoperative neurophysiological monitoring in peripheral nerve surgery: Technical description and experience in a centre. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:266-74. [PMID: 25572819 DOI: 10.1016/j.recot.2014.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/05/2014] [Accepted: 11/08/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Intraoperative neurophysiological monitoring has experienced a spectacular development in the past 20 years, particularly in the fields of neurosurgery and spine surgery. it has become a useful, almost indispensable, tool in preventing nerve damage during surgery. The aim of this article is to describe the intraoperative technique and analyze its results in the field of peripheral nerve surgery. OBJECTIVE To describe the usefulness of a technique in peripheral nerve surgery, the technique used and the experience in a centre. PATIENTS AND METHODS A retrospective study was conducted on 30 cases of peripheral nerve surgery performed in this centre from 2009 to 2013, using the intraoperative monitoring technique. RESULTS Of the total of 13 peripheral nerve tumors recorded, there were 11 excellent results and 2 good results, one temporary hypoesthesia and one with almost complete sensory, except for motor, recovery. Traumatic injury was recorded in 17 cases, of which 6 required performing a graft, and the remaining 11 cases only neurolysis was performed, with complete motor and sensory recovery. CONCLUSIONS Intraoperative neurophysiological monitoring is a useful tool in the secondary surgery of peripheral nerve injury and the intraneural tumor pathology.
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Affiliation(s)
- M Herrera-Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, La Laguna, Tenerife, España; Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, España.
| | - A Oller-Boix
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - P J Pérez-Lorensu
- Unidad de Monitorización Neurofisiológica Intraoperatoria, Servicio de Neurofisiología Clínica, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - J de Bergua-Domingo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - S Gonzalez-Casamayor
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - F Márquez-Marfil
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - L Díaz-Flores
- Servicio de Radiodiagnóstico, Hospital Universitario de Canarias, La Laguna, Tenerife, España
| | - J L Pais-Brito
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, La Laguna, Tenerife, España; Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, España
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