1
|
Haidegger M, Klock N, Kneihsl M, Fandler-Höfler S, Eppinger S, Eller K, Seiler S, Enzinger C, Gattringer T. Recurrent cerebrovascular events after recent small subcortical infarction. J Neurol 2024:10.1007/s00415-024-12460-8. [PMID: 38802623 DOI: 10.1007/s00415-024-12460-8] [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: 04/04/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Recent small subcortical infarcts (RSSI) are the neuroimaging hallmark feature of small vessel disease (SVD)-related acute lacunar stroke. Long-term data on recurrent cerebrovascular events including their aetiology after RSSI are scarce. PATIENTS AND METHODS This retrospective study included all consecutive ischaemic stroke patients with an MRI-confirmed RSSI (in the supply area of a small single brain artery) at University Hospital Graz between 2008 and 2013. We investigated associations between clinical and SVD features on MRI (STRIVE criteria) and recurrent cerebrovascular events, using multivariable Cox regression adjusted for age, sex, vascular risk factors and MRI parameters. RESULTS We analysed 332 consecutive patients (mean age 68 years, 36% women; median follow-up time 12 years). A recurrent ischaemic cerebrovascular event occurred in 70 patients (21.1%; 54 ischaemic strokes, 22 transient ischaemic attacks) and was mainly attributed to SVD (68%). 26 patients (7.8%) developed intracranial haemorrhage. In multivariable analysis, diabetes (HR 2.43, 95% CI 1.44-3.88), severe white matter hyperintensities (HR 1.97, 95% CI 1.14-3.41), and cerebral microbleeds (HR 1.89, 95% CI 1.32-3.14) on baseline MRI were related to recurrent ischaemic stroke/TIA, while presence of cerebral microbleeds increased the risk for intracranial haemorrhage (HR 3.25, 95% CI 1.39-7.59). A widely used SVD summary score indicated high risks of recurrent ischaemic (HR 1.22, 95% CI 1.01-1.49) and haemorrhagic cerebrovascular events (HR 1.57, 95% CI 1.11-2.22). CONCLUSION Patients with RSSI have a substantial risk for recurrent cerebrovascular events-particularly those with coexisting chronic SVD features. Recurrent events are mainly related to SVD again.
Collapse
Affiliation(s)
- Melanie Haidegger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Nina Klock
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Simon Fandler-Höfler
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Sebastian Eppinger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Kathrin Eller
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Stephan Seiler
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036, Graz, Austria.
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
| |
Collapse
|
2
|
Gruber J, Gattringer T, Mayr G, Schwarzenhofer D, Kneihsl M, Wagner J, Sonnberger M, Deutschmann H, Haidegger M, Fandler-Höfler S, Ropele S, Enzinger C, von Oertzen T. Frequency and predictors of poststroke epilepsy after mechanical thrombectomy for large vessel occlusion stroke: results from a multicenter cohort study. J Neurol 2023; 270:6064-6070. [PMID: 37658859 PMCID: PMC10632247 DOI: 10.1007/s00415-023-11966-x] [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: 08/08/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Poststroke epilepsy (PSE) represents an important complication of stroke. Data regarding the frequency and predictors of PSE in patients with large-vessel occlusion stroke receiving mechanical thrombectomy (MT) are scarce. Furthermore, information on acute and preexisting lesion characteristics on brain MRI has not yet been systematically considered in risk prediction of PSE. This study thus aims to assess PSE risk after acute ischemic stroke treated with MT, based on clinical and MRI features. METHODS In this multicenter study from two tertiary stroke centers, we included consecutive acute ischemic stroke patients who had received MT for acute intracranial large vessel occlusion (LVO) between 2011 and 2017, in whom post-interventional brain MRI and long term-follow-up data were available. Infarct size, affected cerebrovascular territory, hemorrhagic complications and chronic cerebrovascular disease features were assessed on MRI (blinded to clinical information). The primary outcome was the occurrence of PSE (> 7 days after stroke onset) assessed by systematic follow-up via phone interview or electronic records. RESULTS Our final study cohort comprised 348 thrombectomy patients (median age: 67 years, 45% women) with a median long-term follow-up of 78 months (range 0-125). 32 patients (9%) developed PSE after a median of 477 days (range 9-2577 days). In univariable analyses, larger postinterventional infarct size, infarct location in the parietal, frontal or temporal lobes and cerebral microbleeds were associated with PSE. Multivariable Cox regression analysis confirmed larger infarct size (HR 3.49; 95% CI 1.67-7.30) and presence of cerebral microbleeds (HR 2.56; 95% CI 1.18-5.56) as independent predictors of PSE. CONCLUSION In our study, patients with large vessel occlusion stroke receiving MT had a 9% prevalence of PSE over a median follow-up period of 6.5 years. Besides larger infarct size, presence of cerebral microbleeds on brain MRI predicted PSE occurrence.
Collapse
Affiliation(s)
- Joachim Gruber
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria.
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
| | - Georg Mayr
- Department of Neuroradiology, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | - Daniel Schwarzenhofer
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
| | - Markus Kneihsl
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Judith Wagner
- Department of Neurology, Evangelisches Klinikum Gelsenkirchen, Academic Hospital University Essen-Duisburg, Gelsenkirchen, Germany
| | - Michael Sonnberger
- Department of Neuroradiology, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | - Hannes Deutschmann
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Melanie Haidegger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
| | - Simon Fandler-Höfler
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8026, Graz, Austria
| | - Tim von Oertzen
- Department of Neurology 1, Neuromed Campus, Kepler University Hospital, Wagner-Jauregg-Weg 15, 4020, Linz, Austria.
| |
Collapse
|
3
|
Khan Y, Verhaeghe N, Devleesschauwer B, Cavillot L, Gadeyne S, Pauwels N, Van den Borre L, De Smedt D. The impact of the COVID-19 pandemic on delayed care of cardiovascular diseases in Europe: a systematic review. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:647-661. [PMID: 37667483 DOI: 10.1093/ehjqcco/qcad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/17/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
AIMS Cardiovascular diseases (CVD) are the leading cause of death worldwide. The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems, causing delays in essential medical services, and potentially impacting CVD treatment. This study aims to estimate the impact of the pandemic on delayed CVD care in Europe by providing a systematic overview of the available evidence. METHODS AND RESULTS PubMed, Embase, and Web of Science were searched until mid-September 2022 for studies focused on the impact of delayed CVD care due to the pandemic in Europe among adult patients. Outcomes were changes in hospital admissions, mortality rates, delays in seeking medical help after symptom onset, delays in treatment initiation, and change in the number of treatment procedures. We included 132 studies, of which all were observational retrospective. Results were presented in five disease groups: ischaemic heart diseases (IHD), cerebrovascular accidents (CVA), cardiac arrests (CA), heart failures (HF), and others, including broader CVD groups. There were significant decreases in hospital admissions for IHD, CVA, HF and urgent and elective cardiac procedures, and significant increases for CA. Mortality rates were higher for IHD and CVA. CONCLUSION The pandemic led to reduced acute CVD hospital admissions and increased mortality rates. Delays in seeking medical help were observed, while urgent and elective cardiac procedures decreased. Adequate resource allocation, clear guidelines on how to handle care during health crises, reduced delays, and healthy lifestyle promotion should be implemented. The long-term impact of pandemics on delayed CVD care, and the health-economic impact of COVID-19 should be further evaluated.
Collapse
Affiliation(s)
- Yasmine Khan
- Department of Public Health and Primary Care, Ghent University, Ghent 9000, Belgium
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels 1050, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Ghent 9000, Belgium
- Research Institute for Work and Society, KU Leuven, Leuven 3000, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent 9000, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke 9000, Belgium
| | - Lisa Cavillot
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Research Institute of Health and Society, University of Louvain, Brussels 1200, Belgium
| | - Sylvie Gadeyne
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels 1050, Belgium
| | - Nele Pauwels
- Faculty of Medicine, Ghent University, Ghent 9000, Belgium
| | - Laura Van den Borre
- Department of Epidemiology and Public Health, Sciensano, Brussels 1050, Belgium
- Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels 1050, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent 9000, Belgium
| |
Collapse
|
4
|
Zhang B, Kang W, Xiong S, Huang X, Chen P, Huang J, Hou Y, Ma L, Xiang T. Changes in the epidemiological characteristics of prehospital emergency services before and during the COVID-19 pandemic, Chengdu, 2016-2021. Sci Rep 2023; 13:7796. [PMID: 37179377 PMCID: PMC10182747 DOI: 10.1038/s41598-023-34852-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/09/2023] [Indexed: 05/15/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) brought a healthy crisis all around the world. It's not only affected healthcare utilization, but also some disease's incidence. We collected pre-hospital emergency data in Chengdu from January 2016 to December 2021, and studied the demand for emergency medical services (EMSs), emergency response times (ERTs), and the disease spectrum in the city proper of Chengdu as a whole. A total of 1,122,294 prehospital emergency medical service (EMS) instances met the inclusion criteria. Under the influence of COVID-19, notably in 2020, the epidemiological characteristics of prehospital emergency services in Chengdu were considerably altered. However, as the pandemic was brought under control, they returned to normal or even earlier in 2021.The COVID-19 pandemic had an effect on people's medical care-seeking behavior and the performance of prehospital emergency services. Although the indicators associated with prehospital emergency services eventually recovered as the epidemic was brought under control, they remained marginally different from before the outbreak.
Collapse
Affiliation(s)
- Bihua Zhang
- Institute of Biomedical Engineering, College of Medicine, Southwest Jiaotong University, Chengdu, China
- Department of Emergency, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, No. 82 Qinglong Street, Chengdu, Sichuan, China
| | - Wenchao Kang
- Chengdu Medical Emergency Center, Chengdu, China
| | - Shiqiang Xiong
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, China
| | - Xia Huang
- Chengdu Medical Emergency Center, Chengdu, China
| | - Pei Chen
- Chengdu Medical Emergency Center, Chengdu, China
| | - Jinmin Huang
- Chengdu Medical Emergency Center, Chengdu, China
| | - Yufei Hou
- Chengdu Medical Emergency Center, Chengdu, China
| | - Lin Ma
- Chengdu Medical Emergency Center, Chengdu, China
| | - Tao Xiang
- Department of Emergency, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, No. 82 Qinglong Street, Chengdu, Sichuan, China.
| |
Collapse
|
5
|
Padroni M, Laudisi M, Azzini C, De Vito A, Casetta I. Stroke admissions during the COVID-19 pandemic: a single-center retrospective analysis. Neurol Sci 2022; 43:5169-5174. [PMID: 35718846 PMCID: PMC9206880 DOI: 10.1007/s10072-022-06207-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022]
Abstract
Background and aims The SARS-CoV-2 pandemic affected the organization of the healthcare system, and several studies analyzed the impact on hospitalization for non-COVID diseases, in particular during the first wave period. We sought to analyze the impact of the pandemic on stroke care in the province of Ferrara during a longer pandemic period and its different phases. Methods We retrospectively analyzed data of all patients with acute ischemic stroke admitted to the University Hospital of Ferrara from March 2020 to April 2021. Data were compared with nonpandemic reference periods (RP, March–April 2018 and 2019). Results We observed a 31% reduction in monthly admission rate for ischemic stroke (IRR 0.69; 95% CI 0.51–0.94) and monthly thrombolysis rate (IRR 0.3; 95% CI 0.15–0.66) during the first-COVID-wave (March–April 2020), as compared to RP. A nonsignificant difference was recorded for admission rate when comparing RP with subsequent pandemic phases, but the thrombolysis rate was confirmed reduced. A significant increase in onset to door time (OTD) was observed in the CP-I period (median 230 vs 120 in the RP; p < 0.05) with improvement in the subsequent phases but without returning to baseline. Nonsignificant differences in the thrombectomy rates were found over the study period. Conclusion These findings reflect changing patient attitudes during the COVID-19 pandemic or the success of health system and public health campaigns to reassure patients about the safety of seeking emergency care when needed, not only for more severe stroke symptoms.
Collapse
Affiliation(s)
- Marina Padroni
- Unità Operativa Di Neurologia, Azienda Ospedaliera-Universitaria Di Ferrara, via Aldo Moro 8, 44124, Ferrara, FE, Italy.
| | | | - Cristiano Azzini
- Unità Operativa Di Neurologia, Azienda Ospedaliera-Universitaria Di Ferrara, via Aldo Moro 8, 44124, Ferrara, FE, Italy
| | - Alesandro De Vito
- Unità Operativa Di Neurologia, Azienda Ospedaliera-Universitaria Di Ferrara, via Aldo Moro 8, 44124, Ferrara, FE, Italy
| | - Ilaria Casetta
- Clinica Neurologica, Università Di Ferrara, Ferrara, Italy
| |
Collapse
|
6
|
Drenck N, Grundtvig J, Christensen T, Iversen HK, Kruuse C, Truelsen T, Wienecke T, Christensen H. Stroke admissions and revascularization treatments in Denmark during COVID-19. Acta Neurol Scand 2022; 145:160-170. [PMID: 34605006 PMCID: PMC8653351 DOI: 10.1111/ane.13535] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 01/01/2023]
Abstract
Objective The aim of this study was to assess the number of stroke‐related admissions and acute treatments during the first two waves of COVID‐19 and lockdowns in the Capital Region of Denmark and the Region of Zealand. Materials & Methods The weekly numbers of admitted patients with stroke were retrieved from electronic patient records from January 2019 to February 2021 and analysed to reveal potential fluctuations in patient volumes during the pandemic. Results A total of 23,688 patients were included, of whom 2049 patients were treated with tissue‐type plasminogen activators (tPA) and 552 underwent endovascular thrombectomy (EVT). We found a transient decrease in the number of weekly admitted patients (pts/week) with all strokes (−9.8 pts/week, 95% CI: −19.4; −0.2, p = .046) and stroke mimics (−30.1 pts/week, 95% CI: −39.9; −20.3, p < .001) during the first lockdown compared to pre‐COVID‐19. The number of subarachnoid haemorrhage, intracerebral haemorrhage, and ischaemic stroke admissions showed insignificant declines. Analysing all COVID‐19 periods collectively revealed increased volumes of ischaemic stroke (+6.2 pts/week, 95% CI: +1.6; +10.7, p = .009) compared to pre‐COVID levels, while numbers of stroke mimics remained lower than pre‐COVID. Weekly tPA and EVT treatments remained constant throughout the study period. Conclusions Our results are comparable with other studies in finding reductions in stroke‐related admissions early in the pandemic. This is the first study to report increased stroke volumes following the first wave of the pandemic. The mechanisms behind the observed drop and subsequent rise in strokes are unclear and warrant further investigation.
Collapse
Affiliation(s)
- Nicolas Drenck
- Department of Neurology Copenhagen University Hospital–Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Josefine Grundtvig
- Department of Neurology Copenhagen University Hospital–Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Thomas Christensen
- Department of Neurology Copenhagen University Hospital–Nordsjællands Hospital Hillerød Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Helle Klingenberg Iversen
- Department of Neurology Copenhagen University Hospital–Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Christina Kruuse
- Department of Neurology Copenhagen University Hospital–Herlev Gentofte Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Thomas Truelsen
- Department of Neurology Copenhagen University Hospital–Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Troels Wienecke
- Department of Neurology Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Hanne Christensen
- Department of Neurology Copenhagen University Hospital–Bispebjerg and Frederiksberg Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| |
Collapse
|
7
|
You Y, Niu Y, Sun F, Zhang J, Huang S, Ding P, Wang X. Impact of COVID-19 pandemic on haemorrhagic stroke admissions: a systematic review and meta-analysis. BMJ Open 2021; 11:e050559. [PMID: 34907050 PMCID: PMC8671851 DOI: 10.1136/bmjopen-2021-050559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND PURPOSE COVID-19 pandemic, a global health crisis, is disrupting the present medical environment. This systematic review and meta-analysis aimed to evaluate the impact of the COVID-19 pandemic on stroke hospitalisations, especially haemorrhagic stroke. METHODS The EMBASE, PubMed, Web of Science, Elsevier, Medline, Cochrane Library and Google Scholar electronic databases were searched for all relevant studies. Two researchers independently screened the studies, extracted data and assessed the quality of the included studies. Odds ratio (OR), total events, OR and 95% CI were considered as the effect size. A fixed-effects model was used to pool the study-specific estimate. The present study was performed by using Review Manager (V.5.3.0) software. We assessed the risk of bias using the Newcastle-Ottawa Scale. RESULTS A total of 17 studies with 14 445 cases were included. Overall, the number of stroke admissions is lower in the pandemic period versus the control period (6252 vs 8193). The difference of haemorrhagic stroke is significant, with 1233 of 6252 cases in the pandemic group and 1621 of 8193 cases in the control group. Intracerebral haemorrhage is present in 461 of 1948 cases in the pandemic group and 618 of 2734 cases in the control group. As for subarachnoid haemorrhage, the difference between the two groups is significant, with 70 of 985 cases in the pandemic group and 202 of 1493 cases in the control group. CONCLUSIONS The number of stroke admissions is lower in the pandemic period compared with the control period. There is a higher rate of haemorrhagic stroke in the pandemic period. Subgroup analysis identifies a significant increase in the occurrence of intracerebral haemorrhage in the pandemic period. Due to limited data and the impact of a single article, the impact of COVID-19 pandemic on subarachnoid haemorrhage is unclear.
Collapse
Affiliation(s)
- Yijie You
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Yunlian Niu
- Department of Neurology, Shanghai Jiaotong University School of Medicine, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Fengbing Sun
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Jian Zhang
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Sheng Huang
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Peiyuan Ding
- Department of Neurosurgery, Shanghai Jiaotong University School of Medicine, Xinhua Hospital Chongming Branch, Shanghai, China
| | - Xuhui Wang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|