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K P P, M K, Narindar A, Chaurasia B. Endoscopic Membranectomy's Role in the Treatment of Nonhomogeneous Chronic Subdural Hematoma (EMiT-CSDH): Prospective Single-arm Interventional Pilot Study. World Neurosurg 2024; 190:e281-e289. [PMID: 39033811 DOI: 10.1016/j.wneu.2024.07.112] [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: 04/17/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition characterized by blood accumulation within the border cell layer. Despite various treatment options-medical, endovascular, and surgical-recurrence rates remain high. Our pilot study investigates the safety and efficacy of endoscopic membranectomy (EM) in reducing recurrence in nonhomogenous CSDH. METHODS This was a prospective single-arm interventional pilot study from March to June 2023. It included patients of all ages who presented with symptomatic nonhomogenous CSDH requiring surgical intervention. RESULTS A total of 19 patients were enrolled in this study. The average age was 60.4 ± 10.4 years. The male:female ratio was 5.3:1. In this group, 73.7% (n = 14) of patients had a history of trauma. All patients presented with a history of altered sensorium and contralateral limb weakness. The most common type of CSDH was trabecular (42.1%), followed by gradient (21%), separated (15.8%), and laminar (15.8%). The average duration of surgery was 43.42 ± 10 minutes. CSDH may be thin or thick based on its tractability and has significance in EM technique. All patients started recovering within 24 hours. All patients were asymptomatic, without any neurologic deficit, at 2 weeks, and remained so at the 6-month review. In 17 patients, the 6-month follow-up computed tomography did not show any bleeding/recurrence. There were no postoperative seizures, wound-healing issues, or infections. CONCLUSIONS There are multiple treatment options for CSDH at present. EM is a potentially safe and effective treatment for CSDH, with lower recurrence and faster recovery. Large-scale controlled studies on EM are required.
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Affiliation(s)
- Priyadharshan K P
- Department of Neurosurgery, Govt. Kilpauk Medical College, Chennai, India
| | - Kodeeswaran M
- Department of Neurosurgery, Govt. Kilpauk Medical College, Chennai, India
| | - Arun Narindar
- Department of Neurosurgery, Govt. Kilpauk Medical College, Chennai, India
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal.
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Gharaibeh S, Shurman A, Gharaibeh A, Torcuator R. A Case Report of Tranexamic Acid for the Treatment of Chronic Subdural Hematoma in an 86-Year-Old Patient. Cureus 2024; 16:e66846. [PMID: 39144412 PMCID: PMC11323430 DOI: 10.7759/cureus.66846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2024] [Indexed: 08/16/2024] Open
Abstract
Fibrinolytic and coagulative hyperactivity is proven to have a role in liquefaction and progression of chronic subdural hematoma (CSDH). Tranexamic acid was one of the pharmaceutical options that was explored, as it inhibits the hyper-fibrinolytic activity and reduces the vascular permeability in CSDH, leading to a gradual resolution of the hematoma. In this case study, we present a case of using tranexamic acid for CSDH treatment in an 86-year-old patient with co-morbidities. The complete resolution of the hematoma following using tranexamic acid in this case with no history of recurrence in two years follow-up supports its efficacy in CSDH treatment and may be considered as one of the strategies that help prevent surgeries.
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Affiliation(s)
- Shatha Gharaibeh
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, USA
- Clinical Research, Insight Research Institute, Flint, USA
| | - Abdallah Shurman
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, USA
- Clinical Research, Insight Research Institute, Flint, USA
| | - Abeer Gharaibeh
- Clinical Research, Insight Institute of Neurosurgery and Neuroscience, Flint, USA
- Clinical Research, Insight Research Institute, Flint, USA
| | - Roy Torcuator
- Neurosurgery, Insight Institute of Neurosurgery and Neuroscience, Flint, USA
- Neurosurgery, Insight Surgical Hospital, Warren, USA
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Moran-Guerrero JA, Martínez HR, Gonzalez-Sanchez DG, Perez-Martinez LE, Flores-Salcido RE, Ferrigno AS, Caro-Osorio E, Salazar-Alejo M, Avalos-Montes PJ, Figueroa-Sanchez JA. Backup Frontal Drainage System for Urgent Tension Pneumocephalus Management After Chronic Subdural Hematoma Surgery: A Retrospective Cohort Study. World Neurosurg 2024; 188:68-75. [PMID: 38692567 DOI: 10.1016/j.wneu.2024.04.138] [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: 04/03/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To describe a simple variation of burr hole craniostomy for the management of chronic subdural hematoma (CSDH) that uses a frontal drainage system to facilitate timely decompression in the event of tension pneumocephalus and spares the need for additional surgery. METHODS We conducted a retrospective analysis of 20 patients with CSDH who underwent burr hole craniostomy and 20 patients who underwent the same procedure alongside the placement of a 5 Fr neonatal feeding tube as a backup drainage for the anterior craniostomy. Depending on the situation, the secondary drain stayed for a maximum of 72 hours to be opened and used in emergency settings for drainage, aspiration, or as a 1-way valve with a water seal. RESULTS The outcomes of 20 patients who underwent this procedure and 20 controls are described. One patient from each group presented tension pneumocephalus. One was promptly resolved by opening the backup drain under a water seal to evacuate pneumocephalus and the other patient had to undergo a reopening of the craniostomy. CONCLUSIONS The described variation of burr hole craniostomy represents a low-cost and easy-to-implement technique that can be used for emergency decompression of tension pneumocephalus. It also has the potential to reduce reoperation rates and CSDH recurrence. Prospective controlled research is needed to validate this approach further.
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Affiliation(s)
- Jose A Moran-Guerrero
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Hector R Martínez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | | | - Luis E Perez-Martinez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Rogelio E Flores-Salcido
- Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Ana S Ferrigno
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - E Caro-Osorio
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Misael Salazar-Alejo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Pablo J Avalos-Montes
- Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico
| | - Jose A Figueroa-Sanchez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico; Instituto de Neurología y Neurocirugía Centro Médico Zambrano Hellion TecSalud, Monterrey, Mexico.
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Mirkarimi T, Salek M. An 85-Year-Old Man with Gradual Decrease in the Level of Consciousness and Vomiting; a Photo Quiz. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2023; 11:e37. [PMID: 37215233 PMCID: PMC10197904 DOI: 10.22037/aaem.v11i1.2030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Talayeh Mirkarimi
- Emergency Department, Alborz University of Medical Science, Karaj, Iran
| | - Mohammad Salek
- Haematology, Oncology and Stem cell Transplantation research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Song P, Li Z, Ke Y, Wang W, Wei H, Ji B, Liu J, Chen Q, Cai Q. A novel imaging classification system for the neuroendoscopic treatment of chronic subdural hematoma. Am J Transl Res 2021; 13:12235-12248. [PMID: 34956450 PMCID: PMC8661176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/21/2021] [Indexed: 06/14/2023]
Abstract
Chronic subdural hematoma (CSDH) is common, especially in patients over 50 years of age, and represents about 10% of all intracranial hematomas. The pathogenesis, diagnosis, and treatment of CSDH are controversial. The purpose of this study was to document the clinical application of a novel imaging classification system for the neuroendoscopic treatment of CSDH. This was a prospective study of sixty patients who underwent neuroendoscopic CSDH treatment beginning in January 2017, with a 6-month follow-up. Hematomas were classified into two types based on imaging features: simple (type I) and complex (type II). Complex type was further subclassified as septated (type II-A), stratified (type II-B), recurrent (type II-C), thin-layer (type II-D), bilateral (type II-E), or mixed (type II-F). Most hematomas were located on the left side. Type II hematomas had fibrous septa and bridging veins in the cavities. Bender classification and Glasgow Outcome Scale (GOS) scores were improved after neuroendoscopic surgery and hematoma thickness was improved significantly in all CSDHs on days 1, 7, and 14 after surgery (all P<0.05). Lung infection, pneumocephalus, and seizures occurred in 17, 12, and 8 patients, respectively. Neither a recurrence of symptoms nor CSDH occurred based on the analysis of images. All patients recovered well and none suffered additional bleeding, recurrence, or intracranial infection. This novel imaging classification for CSDH provides a useful guide for the successful neuroendoscopic treatment of CSDH.
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Affiliation(s)
- Ping Song
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei Province, China
| | - Zhiyang Li
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei Province, China
| | - Yuyong Ke
- Department of Neurosurgery, Yangxin People’s HospitalHuangshi 435200, Hubei Province, China
| | - Wenju Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei Province, China
| | - Hangyu Wei
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei Province, China
| | - Baowei Ji
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei Province, China
| | - Junhui Liu
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei Province, China
| | - Qianxue Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei Province, China
| | - Qiang Cai
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei Province, China
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Tamura R, Sato M, Yoshida K, Toda M. History and current progress of chronic subdural hematoma. J Neurol Sci 2021; 429:118066. [PMID: 34488045 DOI: 10.1016/j.jns.2021.118066] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022]
Abstract
Chronic subdural hematoma (CSDH) is characterized by an encapsulated collection of old blood. Although CSDH has become the most frequent pathologic entity in daily neurosurgical practice, there are some unresolved research questions. In particular, the causes and recurrent risk factors of CSDH remain as an object of debate. The split of the dural border layer forms a few tiers of dural border cells over the arachnoid layer. Tissue plasminogen activator plays an important role as a key factor of defective coagulation. Historically, CSDH has often been treated via burr hole craniostomy using a closed drainage system. Several different operative strategies and peri-operative strategies such as the addition of burr holes, addition of cavity irrigation, position of drain, or postural position, have been described previously. Although the direction of the drainage tube, residual air, low intensity of T1-weighted images on MRI, and niveau formation have been reported as risk factors for recurrence, antiplatelet or anticoagulant drug use has not yet been verified as a risk factor. Recently, pharmaceutical strategies, including atorvastatin, significantly improved the neurological function in CSDH patients. Many case series, without randomization, have been reported; and given its promising result, several randomized clinical trials using pharmaceutical as well as operative and perioperative strategies were initiated to obtain sufficient data. In contrast, relatively fewer basic studies have achieved clinical applications in CSDH, although it is one of the most common clinical entities. Further scientific basic research may be essential for achieving a novel treatment strategy for CSDH.
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Affiliation(s)
- Ryota Tamura
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Department of Neurosurgery, Kawasaki Municipal Hospital, Shinkawadori, Kawasaki-ku, Kanagawa 210-0013, Japan
| | - Mizuto Sato
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Lepić M, Mandić-Rajčević S, Pavlićević G, Benović R, Novaković N, Rasulić L. Fatal Acute Pneumocephalus after Bilateral Drainage for Chronic Subdural Hematomas: Case Report. J Neurol Surg A Cent Eur Neurosurg 2021; 83:206-209. [PMID: 34261139 DOI: 10.1055/s-0041-1730963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pneumocephalus is a well-known complication in the surgical treatment of chronic subdural hematomas; however, its influence remains controversial. The amount of subdural air may vary, and it may cause worsening of symptoms, increase reoccurrence rates, and worsen the outcomes. Lethal outcome following acute onset of massive pneumocephalus was not previously reported. CASE REPORT An 81-year-old man with bilateral hematomas underwent surgery under local anesthesia. Both hematomas were approached in the same surgery, and the drains were placed subdurally. After initial improvement, severe hypertension developed, followed by vital function and neurologic deterioration. Massive pneumocephalus with subarachnoid and contralateral intracerebral hemorrhage was revealed, causing a severe midsagittal shift. Emergency irrigation to evacuate subdural air was performed. However, there was no improvement. Further computed tomography confirmed subdural air collection, but it also revealed hemorrhage progression and intraventricular propagation. No further surgery was indicated. CONCLUSION Pneumocephalus is an underestimated but potentially devastating complication. Both intraoperative avoidance and postoperative prevention should be utilized to avoid subdural air ingress, and thus evade potentially fatal complications.
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Affiliation(s)
- Milan Lepić
- Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia.,Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan Mandić-Rajčević
- School of Public Health and Health Management and Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Goran Pavlićević
- Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia.,Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Radomir Benović
- Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Nenad Novaković
- Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia.,Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Lukas Rasulić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department for Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
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Awake surgery in sitting position for chronic subdural hematoma. Acta Neurochir (Wien) 2021; 163:1857-1865. [PMID: 33464424 DOI: 10.1007/s00701-021-04704-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Chronic subdural hematoma (CSDH) is a common pathology in neurosurgery, especially in the elderly patients, and its incidence is likely to double in the next decade. Considering various features of CSDH and the procedure itself, a sitting position may retain the best characteristics of classic positioning, while offering additional comfort for both the patient and the surgeon. The aim of this study was to describe the technical aspects of this procedure in the sitting position, to evaluate safety and discuss the benefits and shortcomings of this modification. METHOD This study included a series of 55 patients surgically treated for CSDH in a sitting position at our department between December 2017 and September 2019, representing all the patients operated on during the study period by a single surgeon. Bilateral hematomas were present in 19 patients. Outcomes, during the 6-month follow-up period, were defined as good (CSDH and symptoms resolved) or poor (lethal outcome or reoccurrence). All complications were noted, with emphasis on pneumocephalus, and complications related to the sitting position: tension pneumocephalus, venous air embolism, and compression nerve injury. RESULTS Complications previously associated with the sitting position were not noted. The Glasgow Coma Scale and Markwalder Grading Scale scores improved significantly after the surgery (p < 0.001 and p = 0.018). Complications were noted in 17 patients (30.9%), and included 5 cerebrospinal fluid drainages, 3 hematoma reoccurrences, 2 wound infections, and 9 more single-occurring complications. The in-hospital mortality was 5.4% (3 out of 55 patients), while the overall mortality was 16.4% within the 6-month follow-up period. CONCLUSIONS In our series, even the severely ill patients tolerated the position well. No complications associated with the sitting position were noted. Future studies should confirm the safety of this position and evaluate the potential advantages for both the patient and the surgeon.
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Ota HCU, Smith BG, Alamri A, Robertson FC, Marcus H, Hirst A, Broekman M, Hutchinson P, McCulloch P, Kolias A. The IDEAL framework in neurosurgery: a bibliometric analysis. Acta Neurochir (Wien) 2020; 162:2939-2947. [PMID: 32651707 PMCID: PMC7593304 DOI: 10.1007/s00701-020-04477-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Idea, Development, Exploration, Assessment and Long-term study (IDEAL) framework was created to provide a structured way for assessing and evaluating novel surgical techniques and devices. OBJECTIVES The aim of this paper was to investigate the utilization of the IDEAL framework within neurosurgery, and to identify factors influencing implementation. METHODS A bibliometric analysis of the 7 key IDEAL papers on Scopus, PubMed, Embase, Web of Science, and Google Scholar databases (2009-2019) was performed. A second journal-specific search then identified additional papers citing the IDEAL framework. Publications identified were screened by two independent reviewers to select neurosurgery-specific articles. RESULTS The citation search identified 1336 articles. The journal search identified another 16 articles. Following deduplication and review, 51 relevant articles remained; 14 primary papers (27%) and 37 secondary papers (73%). Of the primary papers, 5 (36%) papers applied the IDEAL framework to their research correctly; two were aligned to the pre-IDEAL stage, one to the Idea and Development stages, and two to the Exploration stage. Of the secondary papers, 21 (57%) explicitly discussed the IDEAL framework. Eighteen (86%) of these were supportive of implementing the framework, while one was not, and two were neutral. CONCLUSION The adoption of the IDEAL framework in neurosurgery has been slow, particularly for early-stage neurosurgical techniques and inventions. However, the largely positive reviews in secondary literature suggest potential for increased use that may be achieved with education and publicity.
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Affiliation(s)
| | - Brandon G Smith
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - Faith C Robertson
- Department. of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Hani Marcus
- The Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Allison Hirst
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK
| | - Marike Broekman
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK
- Department of Neurosurgery, Haaglanden Medical Center/Leiden University Medical Center, The Hague, Netherlands
| | - Peter Hutchinson
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - Peter McCulloch
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK
| | - Angelos Kolias
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK.
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK.
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Zoli M, Serracchioli A, Mazzatenta D. Commentary. J Neurosci Rural Pract 2019; 10:118-119. [PMID: 30765982 PMCID: PMC6337987 DOI: 10.4103/jnrp.jnrp_316_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Matteo Zoli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alessandra Serracchioli
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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11
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Meybodi KT. Commentary. J Neurosci Rural Pract 2019; 10:120. [PMID: 30765984 PMCID: PMC6337969 DOI: 10.4103/jnrp.jnrp_306_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Keyvan Tayebi Meybodi
- Department of Neurological Surgery, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
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