1
|
Ji Z, He C, Li J, Geng J, Hu P, Li G, Zhang H. Safety and Efficacy of Low-Profile Braided Stents versus Flow Diverters in the Reconstructive Technique in the Treatment of Patients with Vertebrobasilar Dolichoectasia Aneurysms: A Cohort of 47 Patients with Long-Term Follow-Up. AJNR Am J Neuroradiol 2024; 45:176-182. [PMID: 38238095 DOI: 10.3174/ajnr.a8091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/02/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND PURPOSE Vertebrobasilar dolichoectasia aneurysm is a rare type of cerebrovascular disorder with a poor natural history, and endovascular treatment is widely accepted. Whether a high-profile braided stent (flow diverter) could promote occlusion of vertebrobasilar dolichoectasia aneurysm without increasing the complications rather than a low-profile braided stent remains uncertain. The aim of the study was to present a single-center experience of the safety and efficacy of a low-profile braided stent versus a flow diverter in treating patients with vertebrobasilar dolichoectasia aneurysms. MATERIALS AND METHODS The retrospective review was conducted on a total of 432 consecutive patients diagnosed with posterior circulation aneurysms who underwent endovascular treatment in our center from August 2013 to December 2021. Among these patients, 47 individuals with vertebrobasilar dolichoectasia aneurysms who were treated with low-profile braided stents or flow diverters were included. Vertebrobasilar dolichoectasia aneurysms involving only the vertebral artery were excluded. Patients were divided into 2 groups: the low-profile braided stent group and the flow diverter group based on the device used. Safety and efficacy outcomes were subsequently analyzed. RESULTS There were 25 total patients enrolled in low-profile braided stent group and 22 patients in flow diverter group. The safety of low-profile braided stents and flow diverters in the treatment of vertebrobasilar dolichoectasia aneurysms was evaluated by clinical outcome, a new neurologic deficit due to procedural complications, and neurologic death. The rates of good clinical outcome were similar between the 2 groups (low-profile braided stent, 56%, versus flow diverter, 59.1%; P = .831), and the rates of neurologic death were also similar (low-profile braided stent, 12%, versus flow diverter, 9.1%; P = .747). Higher rates of new neurologic deficits due to procedural complications were observed in the flow diverter group, but the difference was not significant (low-profile braided stent, 24%, versus flow diverter, 40.9%; P = .215). The efficacy was evaluated by angiographic occlusion of vertebrobasilar dolichoectasia aneurysms and progression of mass effect resulting from these aneurysms. Significantly higher rates of complete occlusion of vertebrobasilar dolichoectasia aneurysms were shown in the flow diverter group (41.2%; P = .028) than in the low-profile braided stent group (10%). CONCLUSIONS Both low-profile braided stents and flow diverters have similar high risks in reconstructive techniques in the treatment of vertebrobasilar dolichoectasia aneurysms, while a flow diverter is more effective in promoting complete occlusion of vertebrobasilar dolichoectasia aneurysm than a low-profile braided stent. A flow diverter may be a better alternative for carefully selected patients with vertebrobasilar dolichoectasia aneurysms.
Collapse
Affiliation(s)
- Zhe Ji
- From the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Chuan He
- From the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Jingwei Li
- From the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Jiewen Geng
- From the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Peng Hu
- From the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Guilin Li
- From the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Hongqi Zhang
- From the Department of Neurosurgery, China International Neuroscience Institute, Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China
| |
Collapse
|
2
|
Zhong W, Zhang T, Su C, Zhou D, Zhuang J, Li M, Xu Y, Liu M, Zhang M, Wang Y, Wang D, Su W. Reconstructive endovascular treatment for basilar artery trunk aneurysms: complications and clinical and angiography outcomes. J Neurointerv Surg 2023; 15:1194-1200. [PMID: 36639233 PMCID: PMC10715499 DOI: 10.1136/jnis-2022-019864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Basilar artery trunk aneurysms (BTAs) are rare intracranial aneurysms. We aim to investigate the procedural complications and clinical and angiographic outcomes of BTAs treated with reconstructive endovascular treatment (EVT). METHODS We retrospectively reviewed the data of 111 patients with BTAs who underwent reconstructive EVT during 2013-2022. The factors associated with procedural complications and clinical and angiographic outcomes were analyzed. RESULTS The study included 81 men and 30 women (median age 60 years). Overall, 26 (23.4%) cases presented with subarachnoid hemorrhage and 85 (76.6%) presented with unruptured aneurysms. Periprocedural ischemic and hemorrhagic complications occurred in 29 (26.1%) and 4 (3.6%) cases, respectively. The rate of favorable clinical outcomes was 83.8% (92/111) and the mortality rate was 14.4% (16/111). Angiographic follow-up data were available for 77/95 (81.1%) survivors; 57 (74.0%) and 20 (26%) aneurysms exhibited complete and incomplete obliteration, respectively. Old age, high Hunt and Hess grades (IV-V), hemorrhagic complications, and increased aneurysm size were independent risk factors for unfavorable clinical outcomes (p<0.05). Increased aneurysm size and incomplete aneurysm occlusion on immediate angiography were independent risk factors for incomplete occlusion during follow-up (p<0.05). CONCLUSION Reconstructive EVTs are a feasible and effective treatment for BTAs but are associated with a high risk of ischemic and hemorrhagic complications and a high mortality rate. Larger aneurysms may predict unfavorable clinical outcomes and aneurysm recurrence during follow-up. Hemorrhagic complications may predict unfavorable clinical outcomes, whereas immediate complete aneurysm occlusion may predict total occlusion during follow-up.
Collapse
Affiliation(s)
- Weiying Zhong
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science,Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
- State Key Laboratory of Generic Manufacture Technology of Traditional Chinese Medicine, Lunan Pharmaceutical Group Co. Ltd, Linyi, China
| | - Tongfu Zhang
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science,Shandong University, Jinan, China
- Department of Neurosurgery, Yangxin County People's Hospital, Binzhou, China
| | - Chenran Su
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science,Shandong University, Jinan, China
| | - Donglin Zhou
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science,Shandong University, Jinan, China
| | - Jianfeng Zhuang
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science,Shandong University, Jinan, China
| | - Maogui Li
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science,Shandong University, Jinan, China
| | - Yangyang Xu
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science,Shandong University, Jinan, China
| | - Ming Liu
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science,Shandong University, Jinan, China
| | - Mingxiang Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Yunyan Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science,Shandong University, Jinan, China
| | - Donghai Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science,Shandong University, Jinan, China
| | - Wandong Su
- Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science,Shandong University, Jinan, China
| |
Collapse
|
3
|
Han J, Liang F, Zhang Y, Zhang Y, Liang S, Zhu H, Chang Y, Ma C, Liu L, Jia Z, Jiang C. Pipeline embolization devices for the treatment of nonsaccular aneurysms in pediatric patients. Front Neurol 2023; 14:1115618. [PMID: 36925937 PMCID: PMC10011091 DOI: 10.3389/fneur.2023.1115618] [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: 12/04/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
Objective Pediatric nonsaccular aneurysms are rare but challenging lesions; pipeline embolization devices (PEDs) are their potential treatment option. In this study, we aimed to evaluate the safety and efficacy of PEDs for treatment of these aneurysms. Methods We retrospectively selected pediatric patients with nonsaccular aneurysms treated using PEDs between June 2015 and July 2021 from our prospectively maintained database. For each patient, demographics, aneurysm characteristics, procedure details, and clinical and angiographic follow-up data were collected and summarized. Results This study included 16 pediatric patients with 16 nonsaccular aneurysms treated with PEDs. A median clinical follow-up time of 1,376 days was achieved in 93.75% of the patients. The complication rate of the included patients was 25%, with two patients developing mass effect, one patient undergoing major ischemic stroke, and one patient experiencing stent foreshortening after the procedure. The complete occlusion rate of aneurysms without any neurologic sequelae was 93.33%, with a median angiographic follow-up period of 246 days. The mortality rate was 6.25%. Conclusions The use of PEDs to treat pediatric nonsaccular aneurysms is feasible, with a high rate of complete occlusion of the aneurysm and favorable follow-up outcomes.
Collapse
Affiliation(s)
- Jintao Han
- Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China
| | - Fei Liang
- Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China
| | - Yuxiang Zhang
- Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China
| | - Yupeng Zhang
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shikai Liang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Haoyu Zhu
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuzhou Chang
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Ma
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Lian Liu
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zichang Jia
- Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China
| | - Chuhan Jiang
- Department of Neurosurgery, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
4
|
Zhang Y, Peng Q, Zhou Y, Wang C, Zhang L, Yang X, Mu S. Outcomes of reconstructive endovascular treatment of vertebrobasilar dissecting aneurysms with intramural hematoma. Front Neurol 2022; 13:914878. [PMID: 36034310 PMCID: PMC9403782 DOI: 10.3389/fneur.2022.914878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Vertebrobasilar dissecting aneurysms (VBDAs) with an intramural hematoma (IMH) usually cause symptoms because of mass effect and grow in size over time. Clinical outcomes are generally poor. Objective This study aimed to examine outcomes of reconstructive endovascular treatment (EVT) in patients with VBDAs with IMH. Safety and effectiveness were compared between flow diverters (FDs) and conventional stents. Methods We retrospectively analyzed the clinical and radiological data of 36 VBDAs with IMH in 36 patients who underwent EVT with either FDs or conventional stents from January 2012 to December 2020 at our institution. Results Among the 36 study patients, 20 were treated with FDs and 16 with conventional stents. Incidence of procedure-related complications did not significantly differ between the two stents. IMH growth occurred after EVT in a significantly higher proportion of conventional stent group aneurysms (zero vs. 31.3% [5/16]; p = 0.012). Among the five aneurysms with IMHs that grew, all recurred. Change in IMH size after EVT was significantly lower in the FD group (−2.7 vs. +8.1%, p = 0.036). However, after the recurrent aneurysms were removed from the conventional stent group, change in IMH size did not significantly differ between the two groups (−2.7 vs. +1.0%, p = 0.332). The proportion of patients who experienced an improvement in mRS score after EVT was significantly higher in the FD group (60 vs. 25%, p = 0.036). Conclusion IMHs in VBDAs stop growing after successful reconstructive EVT. Although both FD and conventional stent treatment are effective, FD treatment may be superior based on clinical outcomes and effect on IMH size.
Collapse
|
5
|
Wu Q, Li T, Jiang W, Hernesniemi JA, Li L, He Y. Conservative Therapy vs. Endovascular Approach for Intracranial Vertebrobasilar Artery Trunk Large Aneurysms: A Prospective Multicenter Cohort Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:9682507. [PMID: 35770042 PMCID: PMC9236797 DOI: 10.1155/2022/9682507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
Background Intracranial vertebrobasilar trunk large (≥10 mm) aneurysms (IVBTLAs) are rare and challenging to manage. In this study, we describe the natural prognosis and evaluate the safety and efficacy of endovascular treatment of IVBTLAs compared with conservative therapy. Methods This prospective multicenter cohort study included patients with IVBTLAs, who chose either endovascular treatment (endovascular group) or conservative therapy (conservative group) after discussion with their doctors. The primary endpoint was the incidence of serious adverse events (SAEs) related to the target vessel, while secondary endpoints included target vessel-related mortality, major stroke, other serious adverse events, and aneurysm occlusion rate. Results In total, 258 patients were referred to our two centers for the management of vertebrobasilar aneurysms, and 69 patients had IVBTLAs. Among them, 51 patients underwent endovascular treatment, and 18 patients received conservative therapy. The incidence of target vessel-related SAEs was 15.7% (8/51) in the endovascular group and 44.4% (8/18) in the conservative group (P = 0.031). The target vessel-related mortality was 2.0% (1/51) in the endovascular group and 38.9% (7/18) in the conservative group (P < 0.001). The cumulative survival rates in the endovascular group and conservative group within 1-year, 3-year, and 5-year were 98.0% vs. 83.3%, P = 0.020; 98.0% vs. 66.7%, P = 0.001; and 98.0% vs. 35.6%, P < 0.001, respectively. Multivariate analysis revealed conservative therapy, giant aneurysm, and ischemic onset as risks factor for SAEs. Conclusions Compared with conservative treatment, endovascular treatment of the IVBTLAs may be associated with a lower incidence of SAEs, with higher 1-year, 3-year, and 5-year survival rates. Conservative therapy, giant aneurysm, and ischemic onset were associated with a high risk of SAEs.
Collapse
Affiliation(s)
- Qiaowei Wu
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tianxiao Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Weijian Jiang
- Department of Vascular Neurosurgery, Chinese People's Liberation Army Rocket Force Characteristic Medical Center, Beijing, China
| | - Juha Antero Hernesniemi
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Li Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Yingkun He
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
| |
Collapse
|
6
|
Sim SY, Chung J, Choi JH, Kim MJ, Shin YS, Lim YC. Basilar artery trunk aneurysm: clinical and angiographic outcomes of endovascular treatment. J Neurointerv Surg 2021; 14:262-267. [PMID: 34315801 DOI: 10.1136/neurintsurg-2021-017698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Basilar artery (BA) trunk aneurysms are rare, and the clinical characteristics and outcomes of endovascular treatment (EVT) remain unclear. The purpose of this study was to report clinical and angiographic outcomes of BA trunk aneurysm treated with EVT and to analyze risk factors for unfavorable outcomes. METHODS From October 2004 to December 2020, a total of 40 patients with BA trunk aneurysms underwent EVT. Clinical characteristics and outcomes were evaluated retrospectively from a prospectively collected database. Of the 40 enrolled patients, nine were treated by coiling without stents, 17 were treated by stent-assisted coiling, six by stent only, five by flow diverters, and three by vertebral artery occlusion. RESULTS In total, 27 (67.5%) patients had subarachnoid hemorrhage as an initial presentation, and 20 (50.0%) had large/giant aneurysms. Procedure-related complications occurred in five patients (12.5%); favorable clinical outcome was achieved in 27 patients (67.5%); and six patients (15.0%) died. Favorable angiographic outcome was achieved in 26 (83.9%) of 31 patients who underwent follow-up angiography. Poor initial Hunt-and-Hess grade (OR 7.67, 95% CI 1.55 to 37.80; p=0.018) was the only independent risk factor for unfavorable clinical outcome. Large/giant aneurysm (OR 8.14, 95% CI 1.88 to 27.46; p=0.047) and long lesion (OR 14.25, 95% CI 1.48 to 69.80; p=0.013) were independent risk factors for unfavorable angiographic outcomes during follow-up. CONCLUSIONS EVT might be a feasible option for this rare disease entity. Unfavorable angiographic outcome might be expected in a large/giant aneurysm or a long lesion. It can be difficult to treat BA trunk aneurysms by EVT, needing multiple procedures or various techniques due to diverse clinical and angiographic features.
Collapse
Affiliation(s)
- Sook Young Sim
- Department of Neurosurgery, Inje University Ilsan Paik Hospital, Goyang, Korea (the Republic of)
| | - Joonho Chung
- Department of Neurosurgery, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
| | - Jai Ho Choi
- Department of Neurosurgery, Catholic University of Korea School of Medicine, Seoul, Seoul, Korea (the Republic of)
| | - Myeong Jin Kim
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Incheon, Korea (the Republic of)
| | - Yong Sam Shin
- Department of Neurosurgery, Catholic University of Korea School of Medicine, Seoul, Seoul, Korea (the Republic of)
| | - Yong Cheol Lim
- Department of Neurosurgery, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Gyeonggi-do, Korea (the Republic of)
| |
Collapse
|
7
|
Shim YW, Park JH, Kim ST, Baek JW, Lee HG, Ko JH, Paeng SH, Pyo SY, Jin SC, Jeong HW, Jeong YG. Vertebral Artery Dissecting Aneurysm Causing Central Tapia's Syndrome: A Case Report. Neurointervention 2021; 16:185-189. [PMID: 34162196 PMCID: PMC8261113 DOI: 10.5469/neuroint.2021.00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
The central type of Tapia’s syndrome is an extremely rare presentation, characterized by unilateral paralysis of the vagal and hypoglossal nerves, contralateral hemiparesis, or hemihypesthesia. This report describes a case of a middle-aged patient who developed central Tapia’s syndrome due to a right vertebral artery dissecting aneurysm (VADA). The patient complained about swallowing difficulty and odynophagia. Right vocal cord paralysis, mild tongue deviation to the right side, left hypesthesia, and decreased temperature sensation with left hemiparesis were observed in neurologic exams. A right VADA and compression of the medulla oblongata due to the VADA were diagnosed on magnetic resonance imaging. Endovascular flow diversion of the right VADA was performed. After 1 year, all neurological symptoms and vocal cord paralysis were nearly resolved, but left hypesthesia remained with decreased nociception. We present and discuss how a VADA caused those symptoms and propose endovascular flow diversion as a treatment option.
Collapse
Affiliation(s)
- Yong Woo Shim
- Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jung Hyun Park
- Department of Neurosurgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Sung-Tae Kim
- Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Wook Baek
- Department of Diagnostic Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyun Gon Lee
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jung Hae Ko
- Department of Endocrinology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Hwa Paeng
- Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Se Young Pyo
- Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung-Chul Jin
- Department of Neurosurgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hae Woong Jeong
- Department of Diagnostic Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young Gyun Jeong
- Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| |
Collapse
|