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Raviol J, Plet G, Hasegawa R, Yu K, Kosukegawa H, Ohta M, Magoariec H, Pailler-Mattei C. Towards the mechanical characterisation of unruptured intracranial aneurysms: Numerical modelling of interactions between a deformation device and the aneurysm wall. J Mech Behav Biomed Mater 2024; 153:106469. [PMID: 38402693 DOI: 10.1016/j.jmbbm.2024.106469] [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: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/27/2024]
Abstract
Intracranial aneurysm is a critical pathology related to the arterial wall deterioration. This work is an essential aspect of a large scale project aimed at providing clinicians with a non-invasive patient-specific decision support tool regarding the rupture risk assessment. A machine learning algorithm links the aneurysm shape observed and a database of UIA clinical images associated with in vivo wall mechanical properties and rupture characterisation. The database constitution is derived from a device prototype coupled with medical imaging. It provides the mechanical characterisation of the aneurysm from the wall deformation obtained by inverse analysis based on the variation of luminal volume. Before performing in vivo tests of the device on small animals, a numerical model was built to quantify the device's impact on the aneurysm wall under natural blood flow conditions. As the clinician will never be able to precisely situate the device, several locations were considered. In preparation for the inverse analysis procedure, artery material laws of increasing complexity were studied (linear elastic, hyper elastic Fung-like). Considering all the device locations and material laws, the device induced relative displacements to the Systole peak (worst case scenario with the highest mechanical stimulus linked to the blood flow) ranging from 375 μm to 1.28 mm. The variation of luminal volume associated with the displacements was between 0.95 % and 4.3 % compared to the initial Systole volume of the aneurysm. Significant increase of the relative displacements and volume variations were found with the study of different cardiac cycle moments between the blood flow alone and the device application. For forthcoming animal model studies, Spectral Photon CT Counting, with a minimum spatial resolution of 250 μm, was selected as the clinical imaging technique. Based on this preliminary study, the displacements and associated volume variations (baseline for inverse analyse), should be observable and exploitable.
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Affiliation(s)
- J Raviol
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France
| | - G Plet
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France
| | - R Hasegawa
- Graduate School of Engineering, Tohuku University, 980-8579, Sendai Miyagi, Japan; Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan
| | - K Yu
- Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan
| | - H Kosukegawa
- Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan
| | - M Ohta
- Institute of Fluid Science, Tohuku University, 980-8577, Sendai Miyagi, Japan; ElyT MaX, CNRS UMI 3537, Université de Lyon, Tohoku University, France, Japan
| | - H Magoariec
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France
| | - C Pailler-Mattei
- Laboratoire de Tribologie et Dynamique des Systèmes, CNRS UMR 5513, Université de Lyon, École Centrale de Lyon, France; ISPB-Faculté de Pharmacie, Université Claude Bernard Lyon 1, Université de Lyon, France.
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Raviol J, Plet G, Langlois JB, Si-Mohamed S, Magoariec H, Pailler-Mattei C. In vivo mechanical characterization of arterial wall using an inverse analysis procedure: application on an animal model of intracranial aneurysm. ROYAL SOCIETY OPEN SCIENCE 2024; 11:231936. [PMID: 38633347 PMCID: PMC11022001 DOI: 10.1098/rsos.231936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/19/2024] [Accepted: 02/24/2024] [Indexed: 04/19/2024]
Abstract
Intracranial aneurysm is a pathology related to the deterioration of the arterial wall. This work is an essential part of a large-scale project aimed at providing clinicians with a non-invasive patient-specific decision support tool to facilitate the rupture risk assessment. It will lean on the link between the aneurysm shape clinically observed and a database derived from the in vivo mechanical characterization of aneurysms. To supply this database, a deformation device prototype of the arterial wall was developed. Its use coupled with medical imaging (spectral photon-counting computed tomography providing a spatial resolution down to 250 μm) is used to determine the in vivo mechanical properties of the wall based on the inverse analysis of the quantification of the wall deformation observed experimentally. This study presents the in vivo application of this original procedure to an animal model of aneurysm. The mechanical properties of the aneurysm wall identified were consistent with the literature, and the errors between the numerical and experimental results were less than 10%. Based on these parameters, this study allows the assessment of the aneurysm stress state for a known solicitation and points towards the definition of a rupture criterion.
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Affiliation(s)
- J. Raviol
- Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR 5513, Écully69130, France
| | - G. Plet
- Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR 5513, Écully69130, France
| | | | - S. Si-Mohamed
- Université de Lyon, INSA Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F69621, Villeurbanne69100, France
- Département de Radiologie, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron69677, France
| | - H. Magoariec
- Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR 5513, Écully69130, France
| | - C. Pailler-Mattei
- Ecole Centrale de Lyon, CNRS, ENTPE, LTDS, UMR 5513, Écully69130, France
- Université de Lyon, Université Claude Bernard Lyon 1, ISPB-Faculté de Pharmacie, Lyon69008, France
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Bae IS, Yi HJ, Ko Y, Kim YS, Chun HJ, Choi KS. Practical Incidence of Complications and Degree of Patient Satisfaction After Endovascular Coil Embolization for Unruptured Intracranial Saccular Aneurysm Based on Patients' Surveys. World Neurosurg 2019; 127:e76-e85. [PMID: 30831292 DOI: 10.1016/j.wneu.2019.02.093] [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] [Received: 12/26/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Endovascular treatment for unruptured intracranial aneurysms (UIAs) has been regarded as second to none management nowadays as the result of its proven efficacy and need for less-invasive treatment. Most researchers have focused on the anatomical outcome after endovascular treatment, so in this study we estimated the real incidence of untoward effect and degree of patients' satisfaction based on s survey. METHODS This retrospective study was approved by the institutional review board, and 112 patients treated for saccular UIAs were evaluated among a total of 135 patients. After informed consent was obtained, these patients were sent a questionnaire regarding treatment effectiveness, complications, and patient satisfaction. These data were collected and compared with angiographic and clinical outcome. RESULTS The response rate was 87.5% (98/112). Intracranial complications occurred in 10 aneurysms (10.2%): 7 ischemic and 3 hemorrhagic strokes. Other complications occurred in 30 patients (30.6%): 17 alopecia, 15 bleeding tendency, and 3 puncture-site complications. Overall, 89 (90.8%) patients reported being satisfied with their treatment. Patient satisfaction was closely correlated with clinically successful outcome of treatment. CONCLUSIONS Ninety percent of patients were satisfied with the results after endovascular treatment of UIAs. Endovascular coil embolization was effective and safe procedure, with high clinical success rate and degree of satisfaction.
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Affiliation(s)
- In-Suk Bae
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea.
| | - Yong Ko
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Young Soo Kim
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Hyoung-Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
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Kosty JA, Andaluz NO, Gozal YM, Krueger BM, Scoville J, Zuccarello M. Microsurgical treatment for unruptured intracranial aneurysms: a modern single surgeon series. Br J Neurosurg 2018; 33:322-327. [DOI: 10.1080/02688697.2018.1527286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J. A. Kosty
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - N. O. Andaluz
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Y. M. Gozal
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - B. M. Krueger
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - J. Scoville
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - M. Zuccarello
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Zheng Y, Song Y, Liu D, Liu Y, Xu Q, Tian Y, Leng B. Stent-assisted coiling embolization of tiny, wide-necked intracranial aneurysms. Acta Neurochir (Wien) 2017; 159:93-100. [PMID: 27844157 DOI: 10.1007/s00701-016-3022-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/03/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tiny, wide-necked intracranial aneurysms pose a significant therapeutic challenge for interventional neuroradiologists because of the small volume for microcatheterization and coil stabilization inside the aneurysm sac. We report our preliminary experience of stent-assisted coiling embolization of these aneurysms. METHODS A total of 50 patients with 52 tiny, wide-necked aneurysms who were treated with stent-assisted coiling from January 2007 to December 2014 were reviewed retrospectively. Baseline characteristics, procedure-related complications, angiographic follow-up results and clinical outcomes were statistically analyzed. RESULT All aneurysms were successfully treated with the stent-assisted coiling technique, and at the end of the procedure, aneurysm occlusion was complete for 45 (86.5 %), near complete for 3 (5.8 %) and incomplete for 4 (7.7 %). Procedural complications (1 intraprocedural rupture, 2 coil migrations and 1 aneurysm re-rupture) occurred in 4 (8 %) of 50 patients, resulting in permanent morbidity in 1 (2 %) patient and death in 1 (2 %) patient. Follow-up imaging was available in 43 (84.3 %) aneurysms for 6-31 months (mean, 13 months). Complete occlusion was achieved in 40 (93 %) of 43 aneurysms on long-term follow-up. One aneurysm with complete occlusion and one with incomplete occlusion after the initial embolization developed a significant recurrence (4.7 %). Clinical follow-up was available for 43 (86 %) of 50 patients at a mean of 36.7 months (range 15-66 months). Of these 43 patients, 42 (97 %) made an excellent recovery achieving a GOS of 5. None of the patients died or experienced re-bleeding or ischemic cerebral vascular events during follow-up. CONCLUSION Stent-assisted coiling embolization is feasible and relatively safe for tiny, wide-necked intracranial aneurysms of carotid arteries. Furthermore, long-term follow-up angiography indicated stent-assisted coiling seems to be effective in preventing early recanalization.
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Affiliation(s)
- Yongtao Zheng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Yanbing Song
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Dajun Liu
- Department of Neurosurgery, Second People Hospital, Taizhou, China
| | - Yingjun Liu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Qiang Xu
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yanlong Tian
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Bing Leng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Middle Road, Shanghai, 200040, China.
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Lee S, Gong TS, Lee YW, Kim HJ, Kweon CY. Results of Endovascular Coil Embolization Treatment for Small (≤ 5 mm) Unruptured Intracranial Aneurysms. J Cerebrovasc Endovasc Neurosurg 2016; 18:229-233. [PMID: 27847766 PMCID: PMC5104847 DOI: 10.7461/jcen.2016.18.3.229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 09/05/2016] [Accepted: 09/15/2016] [Indexed: 12/02/2022] Open
Abstract
Objective Researchers and clinicians have been unable to fully elucidate the natural course of and proper treatment for unruptured intracranial aneurysms (UIAs) smaller than or equal to 5 mm, particularly with regard to whether close observation or surgery is more appropriate. In this retrospective study, we evaluated the safety and efficacy of endovascular coil embolization of small (≤ 5 mm) asymptomatic UIAs by analyzing outcomes and complications associated with the procedure. Materials and Methods We analyzed data from 150 patients with small asymptomatic UIAs (≤ 5 mm) treated with coil embolization between January 2011 and December 2015. Three-dimensional angiography was used to measure aneurysm size. We evaluated procedure-related morbidity and mortality, immediate post-operative angiographic results, brain computed thomography follow-up results on post-operative day one, and clinical progress. Results UIAs occurred primarily in the anterior circulation area (142 cases, 94.67%), though eight patients exhibited UIAs of the posterior circulation. Following coil embolization, aneurysms with complete occlusion were observed in 137 cases (91.3%). Partial occlusion occurred in five cases (3.33%), while the procedure had failed in eight cases (5.33%). Procedure-related morbidity and mortality were five cases (3.33%) and zero cases, respectively. Conclusion The endovascular treatment of small asymptomatic UIAs is associated with good short-term outcomes without permanent neurologic complications as well as low overall complication and morbidity rates. Thus, the procedure should be considered for patients with smaller asymptomatic UIAs.
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Affiliation(s)
- Siwoo Lee
- Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Korea
| | - Tae-Sik Gong
- Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Korea
| | - Yong-Woo Lee
- Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Korea
| | - Hyo-Joon Kim
- Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Korea
| | - Chang-Young Kweon
- Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Korea
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Bründl E, Böhm C, Lürding R, Schödel P, Bele S, Hochreiter A, Scheitzach J, Zeman F, Brawanski A, Schebesch KM. Treatment of Unruptured Intracranial Aneurysms and Cognitive Performance: Preliminary Results of a Prospective Clinical Trial. World Neurosurg 2016; 94:145-156. [PMID: 27392894 DOI: 10.1016/j.wneu.2016.06.112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/26/2016] [Accepted: 06/27/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Few studies have addressed the effect of treatment of unruptured intracranial aneurysm (UIA) on cognitive function. OBJECTIVE Neuropsychological assessment after UIA treatment is underreported, and prospective trials have repeatedly been demanded. In 2014, we conducted a prospective controlled study to evaluate the differences in cognitive processing caused by the treatment of anterior circulation UIAs. PATIENTS AND METHODS Thirty patients were enrolled until September 2015. Ten patients received endovascular aneurysm occlusion (EV), 10 patients were treated microsurgically (MS), and 10 patients with surgically treated degenerative lumbar spine disease (LD) served as control. All patients underwent extended standardized neuropsychological assessment before (t1) and 6 weeks after treatment (t2). Tests included verbal, visual, and visuospatial memory, psychomotor functioning, executive functioning, and its subdomains verbal fluency and cognitive flexibility. We statistically evaluated intragroup and intergroup changes. RESULTS Intragroup comparisons and group-rate analysis showed no significant impairment in overall neuropsychological performance, either postinterventionally or postoperatively. However, the postoperative performance in cognitive processing speed, cognitive flexibility, and executive functioning was significantly worse in the MS group than in the EV (P = 0.038) and LD group (P = 0.02). Compared with the EV group, patients with MS showed significant postoperative impairment in a subtest for auditory-verbal memory (Wechsler Memory Scale, Fourth Edition, Logical Memory II; MS vs. EV P = 0.011). The MS group trended toward posttreatment impairment in subtests for verbal fluency and semantic memory (Regensburg Word Fluency Test; MS vs. EV P = 0.083) and in auditory-verbal memory (Wechsler Memory Scale, Fourth Edition, Logical Memory II; MS vs. LD P = 0.06). CONCLUSIONS Our preliminary data showed no effect of anterior circulation UIA treatment on overall neuropsychological function but impaired short-term executive processing in surgically treated patients.
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Affiliation(s)
- Elisabeth Bründl
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany.
| | - Christina Böhm
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Ralf Lürding
- Department of Neurology, University Medical Center Regensburg, Regensburg, Germany
| | - Petra Schödel
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Sylvia Bele
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Hochreiter
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Judith Scheitzach
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - Alexander Brawanski
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
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Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. Lancet Neurol 2014; 13:393-404. [DOI: 10.1016/s1474-4422(14)70015-8] [Citation(s) in RCA: 341] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Im SH, Han MH, Kwon OK, Kwon BJ, Kim SH, Kim JE, Oh CW. Endovascular coil embolization of 435 small asymptomatic unruptured intracranial aneurysms: procedural morbidity and patient outcome. AJNR Am J Neuroradiol 2008; 30:79-84. [PMID: 18768715 DOI: 10.3174/ajnr.a1290] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Whether treatment of small asymptomatic aneurysms is appropriate or not remains controversial. We performed a retrospective study on the procedural morbidity and mortality of coil embolization of small asymptomatic unruptured intracranial aneurysms (UIAs) to obtain a more generalized estimate of procedural risk. MATERIALS AND METHODS A total of 435 small (maximum diameter < or = 7 mm) asymptomatic UIAs in 370 patients were treated by coil embolization. Aneurysm sizes were determined by using 3D angiograms. We assessed procedure-related morbidity and mortality, immediate postprocedural angiographic results, short-term imaging follow-up results, and clinical outcomes. RESULTS Initial aneurysm occlusion was complete in 334 aneurysms, near complete in 78, and incomplete in 22. One internal carotid artery (ICA) aneurysm that ruptured during the procedure was treated with parent artery occlusion. Two hundred wide-neck aneurysms were coiled with the aid of various neck-remodeling techniques. The 44 procedure-related complications were the following: 24 thromboembolisms, 11 coil protrusions or prolapses into the parent vessel, 4 intraprocedural ruptures, 3 device-related complications, and 2 femoral-access complications. We had a total of 44 (10.1%) procedure-related complications with only 1 leading to persistent neurologic deficit. Procedure-related permanent morbidity and mortality were 0.27% (1/370) and 0%, respectively. CONCLUSIONS In this series of small unruptured asymptomatic aneurysms, endovascular treatment was achieved with good short-term angiographic outcome and low permanent neurologic impairment. The goal of this study was not to provide a conclusion about treatment guidelines for small UIA but rather to help guide future recommendations by presenting a more generalized estimate of endovascular treatment risk than is currently available.
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Affiliation(s)
- S-H Im
- Department of Neurosurgery, Dongguk University Hospital, Gyeonggido, Korea
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