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Xie Y, Tian H, Xiang B, Liu J, Xiang H. Woven EndoBridge device for the treatment of ruptured intracranial aneurysms: A systematic review of clinical and angiographic results. Interv Neuroradiol 2021; 28:240-249. [PMID: 34159820 DOI: 10.1177/15910199211026712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The clinical outcome and angiographic outcome data of Woven EndoBridge (WEB) device for the treatment of ruptured intracranial aneurysms (IAs) are limited. We conducted a meta-analysis of the latest literature on the WEB device in the treatment of ruptured IAs. METHODS A comprehensive literature search of 4 databases (PubMed, Web of Science, Cochrane library, and Embase) was conducted for studies published from January 1, 2010 to December 31, 2020. Two reviewers independently extracted variables (aneurysm and patient characteristics) using a prespecified data-collection sheet. Outcomes studied included initial and latest follow-up angiographic outcomes, technical success rate, perioperative mortality, retreated rate, perioperative re-bleeding, complication, intraoperative rupture, favorable neurologic outcome at discharge. We used random-effects model to pool the data. RESULTS We finally presented the results of 7 articles including 276 patients with 283 aneurysms. Initial complete and adequate occlusion rate were 38% (95% CI, 25%-50%) and 98% (95% CI, 95%-100%), respectively. Latest follow-up complete and adequate occlusion rate were 61% (95% CI, 46%-75%) and 91% (95% CI, 84%-98%), respectively.Technical success rate was 99% (95% CI, 98%-100%). Perioperative mortality rates and perioperative re-bleeding rate were 9% (95% CI, 3%-15%) and 1% (95% CI, 0%-2%), respectively. Retreated rate was 6% (95% CI, 3%-10%). Overall and WEB treatment-related thromboembolic complication was 10% (95% CI, 6%-13%) and 7% (95% CI, 2%-12%), respectively. Intraoperative rupture rate was 3% (95% CI, 0%-6%). CONCLUSION Endovascular treatment of ruptured IAs with the WEB device has a good safety profile and an acceptable aneurysm occlusion rate.
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Affiliation(s)
- Yong Xie
- Department of Interventional Radiology and Vascular Surgery, the First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Huan Tian
- Department of Radiology, the Second Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bin Xiang
- Department of Interventional Radiology and Vascular Surgery, the First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jian Liu
- Department of Interventional Radiology and Vascular Surgery, the First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Hua Xiang
- Department of Interventional Radiology and Vascular Surgery, the First Affiliated Hospital of Hunan Normal University, Changsha, China
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Suzuki T, Genkai N, Nomura T, Abe H. Assessing the Hemodynamics in Residual Cavities of Intracranial Aneurysm after Coil Embolization with Combined Computational Flow Dynamics and Silent Magnetic Resonance Angiography. J Stroke Cerebrovasc Dis 2020; 29:105290. [PMID: 32992205 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Metal artifacts limit computational fluid dynamics analysis after coil embolization. Silent magnetic resonance angiography reduces metal artifacts and improves visualization of the residual cavity of coil-embolized aneurysms. This study investigated the flow dynamics of the residual cavity after coil embolization using silent magnetic resonance angiography and computational fluid dynamics to elucidate the hemodynamic characteristics of recanalization. METHODS Twenty internal carotid-posterior communicating aneurysm cases treated with coil embolization and without stent assistance were followed up (mean±standard deviation, 13.0±6.1 months) and assessed using silent magnetic resonance angiography. The hemodynamic characteristics of the residual cavities in both types of aneurysms were compared between neck remnants, which persisted for >12 months (NR group), and those treated with coil compaction-induced body filling (BF group). Computational fluid dynamics analysis of each aneurysm was performed using morphological data obtained from silent magnetic resonance angiography. Pressure, pressure difference, normalized wall shear stress, and flow velocity were measured. RESULTS The residual cavity was well-visualized using silent magnetic resonance angiography and compared with those imaged using conventional time-of-flight magnetic resonance angiography, and eight internal carotid-posterior communicating aneurysms with neck remnants and body filling were investigated. The maximum pressure area was localized to the aneurysm wall in the NR group (n=4) and to sides of the coil surface in the BF group (n=4). No significant differences were observed for each hemodynamic parameter. CONCLUSIONS Combination of silent magnetic resonance angiography and computational fluid dynamics helps to understand the hemodynamic characteristics of residual cavity in coil- embolized aneurysms. The flow-impingement zone at the coil surface (maximum pressure area) may influence the risk for future coil compaction.
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Affiliation(s)
- Tomoaki Suzuki
- Department of Neurosurgery, Tachikawa General Hospital, 1-24 Asahioka, Nagaoka 940-8621, Japan; Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-Dori, Niigata 951-8585, Japan.
| | - Nobuyuki Genkai
- Department of Neurosurgery, Tachikawa General Hospital, 1-24 Asahioka, Nagaoka 940-8621, Japan
| | - Toshiharu Nomura
- Department of Neurosurgery, Tachikawa General Hospital, 1-24 Asahioka, Nagaoka 940-8621, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Tachikawa General Hospital, 1-24 Asahioka, Nagaoka 940-8621, Japan
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Imamura H, Sakai N, Satow T, Iihara K. Factors related to adverse events during endovascular coil embolization for ruptured cerebral aneurysms. J Neurointerv Surg 2020; 12:605-609. [PMID: 31980542 DOI: 10.1136/neurintsurg-2019-015459] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE The risk factors for adverse events for example, intraprocedural rupture (IPR), ischemic complication within 24 hours, and rebleeding after endovascular coil embolization for a ruptured cerebral aneurysm remain unclear. The aim of this study was to identify significant associated risk factors. METHODS We retrospectively evaluated data from 5358 patients listed on the Japanese Registry of Neuroendovascular Therapy 3 during 2010-2014. RESULTS IPR, ischemic complications, and rebleeding occurred during or after 221 (4.1%), 226 (4.2%), and 63 (1.2%) treatments, respectively. All of the adverse events were significantly associated with the patients' poor outcomes at 30 days. Multivariate analysis revealed the factors independently related to these adverse events as follows: (1) for IPR: female sex, bifurcation type, <5 mm aneurysm, emergent surgery, local anesthesia, a balloon-assisted technique; (2) for an ischemic complication: poor World Federation World Federation of Neurological Societies (WFNS) grade, wide neck, and stent-assisted technique; (3) for rebleeding: poor WFNS grade, bifurcation type, wide neck, and body filling as the initial result. CONCLUSIONS Knowledge of the risk factors of endovascular coil embolization and paying attention to them are essential for patients' safe treatment and good outcomes.
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Affiliation(s)
- Hirotoshi Imamura
- Neurosurgery, Kobe City Medical Center General Hospital, Kobe-city, Hyogo, Japan
| | - Nobuyuki Sakai
- Neurosurgery, Kobe City Medical Center General Hospital, Kobe-city, Hyogo, Japan
| | - Tetsu Satow
- Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji Iihara
- Neurosurgery, Kyushu University Faculty of Medicine Graduate School of Medical Sciences, Fukuoka, Japan
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Risk and Prognostic Factors for Rupture of Intracranial Aneurysms During Endovascular Embolization. World Neurosurg 2019; 129:e641-e649. [PMID: 31158537 DOI: 10.1016/j.wneu.2019.05.233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Intraoperative aneurysm rupture (IPR) always results in a poor prognosis for the patient. However, the risk factors of IPR are unclear. In this article, the risk factors are explored, a nomogram model for predicting IPR is established, and the prognostic factors for patients with IPR are analyzed. METHODS A total of 549 patients with aneurysm, which were embolized from September 2011 to September 2015, were enrolled for analysis. Univariate and multivariate logistic regression were performed to explore the risk factors for IPR, and a nomogram was established. A nonparametric Mann-Whitney U test was performed to analyze prognostic factors for patients with IPR. RESULTS Twenty-one patients (4.4%) experienced IPR. In univariate analysis, Hunt-Hess grade (P = 0.002), time from hospitalization to treatment (P = 0.08) and subarachnoid hemorrhage (SAH) to treatment (P = 0.08), aneurysm neck (P = 0.08), assistive technique (P = 0.03), and intraoperative cerebral vasospasm (P < 0.001) were significantly associated with IPR. In multivariate analysis, Hunt-Hess grade (odds ratio [OR], 8.177; 95% confidence interval [CI], 1.714-39.012; P = 0.008), aneurysm neck (OR, 5.629; 95% CI, 1.149-27.575; P = 0.033), assistive technique (OR, 1.393; 95% CI, 0.961-2.018; P = 0.080), and intraoperative cerebral vasospasm (OR, 4.280; 95% CI, 1.081-16.947; P = 0.038) were independent risk factors for IPR. Hydrocephalus (P = 0.069), history of SAH (P = 0.10), ≥2 SAH (P = 0.051), location of aneurysm (P = 0.09), and number of aneurysms (P = 0.025) were associated with the bad outcome. CONCLUSIONS Hunt-Hess grading, aneurysm neck, intraoperative assistive technology, and vasospasm were independent risk factors for IPR. Hydrocephalus requiring surgical intervention, times of rupture, location of aneurysm, and the number of aneurysms were relevant to the prognosis of patients.
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Choi E, Lee JY, Jeon HJ, Cho BM, Yoon DY. A hybrid operating room for combined surgical and endovascular procedures for cerebrovascular diseases: a clinical experience at a single centre. Br J Neurosurg 2019; 33:490-494. [PMID: 31092005 DOI: 10.1080/02688697.2019.1617403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose: To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR). Material and methods: A single-plane DSA system with 3-dimensional rotational angiography (3DRA), cone-beam computed tomography, and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of neurovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorised into five subcategorical procedures according to the dominance of surgical and/or endovascular procedures: intraoperative angiographic evaluation, combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, surgical approach for interventional procedure, and frameless stereotaxic operation. Results: Intraoperative angiography revealed unsatisfactory clipping of intracranial aneurysms in 6 (13.6%) patients and remnant AVMs in 1 (16.7%) patient, which were determined as complete surgical outcome via indocyanine green videoangiography. Four cases of blood blister aneurysms and a ruptured posterior inferior cerebellar artery aneurysm were treated using bypass surgery and endovascular trapping. Eight cases of ruptured aneurysm with intracranial haemorrhage (ICH) were treated by partial embolisation and surgical clipping. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolisation. In 1 (0.8%) complicated case of 103 intra-arterial (IA) thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. Direct puncture of the common carotid artery or vertebral artery was performed to achieve interventional access to treat aneurysm or recanalise vessel occlusions in 7 cases. In 27 cases of ICH, frameless stereotaxic haematoma aspiration was performed using XperGuide® system. All procedures were performed in single sessions without any procedural complications. Conclusion: Hybrid OR with a fully equipped DSA system could provide safe and precise treatment for neurovascular diseases. Hybrid procedures for neurovascular diseases in hybrid OR are a promising new trend.
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Affiliation(s)
- Euidon Choi
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
| | - Jong Young Lee
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
| | - Hong Jun Jeon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
| | - Byung-Moon Cho
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
| | - Dae Young Yoon
- Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Seoul , Korea
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Jeon HJ, Lee JY, Cho BM, Yoon DY, Oh SM. Four-Year Experience Using an Advanced Interdisciplinary Hybrid Operating Room : Potentials in Treatment of Cerebrovascular Disease. J Korean Neurosurg Soc 2018; 62:35-45. [PMID: 30630294 PMCID: PMC6328792 DOI: 10.3340/jkns.2018.0203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/13/2018] [Indexed: 12/22/2022] Open
Abstract
Objective To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR). Methods A single-plane DSA system with 3-dimensional rotational angiography, cone-beam computed tomography (CBCT), and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of cerebrovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorized into three subcategorical procedures : combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, and frameless stereotaxic operation. Results Forty-nine of 191 procedures were performed using hybrid techniques. Four cases of blood blister aneurysms and a ruptured posterior inferior cerebellar artery aneurysm were treated using bypass surgery and endovascular trapping. Eight cases of ruptured aneurysm with intracranial hemorrhage (ICH) were treated by partial embolization and surgical clipping. Six cases of ruptured arteriovenous malformation with ICH were treated by Onyx embolization of nidus and subsequent surgical removal of nidus and ICH. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolization. In one (0.8%) complicated case of 103 intra-arterial thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. In 27 cases of ICH, frameless stereotaxic hematoma aspiration was performed using XperGuide® system (Philips Medical Systems, Best, the Netherlands). All procedures were performed in single sessions without any procedural complications. Conclusion Hybrid OR with a fully equipped DSA system could provide precise and safe treatment strategies for cerebrovascular diseases. Especially, we could suggest a strategy to cope flexibly in complex lesions or unexpected situations in hybrid OR. CBCT with real-time navigation software could augment the usefulness of hybrid OR.
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Affiliation(s)
- Hong Jun Jeon
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong Young Lee
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Byung-Moon Cho
- Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Dae Young Yoon
- Department of Radiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sae-Moon Oh
- Health Insurance Review and Assessment Service, Seoul, Korea
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Cagnazzo F, di Carlo DT, Cappucci M, Lefevre PH, Costalat V, Perrini P. Acutely Ruptured Intracranial Aneurysms Treated with Flow-Diverter Stents: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2018; 39:1669-1675. [PMID: 30049721 DOI: 10.3174/ajnr.a5730] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/25/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND The implantation of flow-diverter stents for the treatment of ruptured intracranial aneurysms required further investigation. PURPOSE Our aim was to analyze the outcomes after flow diversion of ruptured intracranial aneurysms. DATA SOURCES A systematic search of 3 databases was performed for studies published from 2006 to 2018. STUDY SELECTION According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies (from 2010 to 2018) reporting acutely ruptured intracranial aneurysms treated with flow diversion. DATA ANALYSIS Random-effects meta-analysis was used to pool the following: aneurysm occlusion rate, complications, rebleeding, and factors influencing the studied outcomes. DATA SYNTHESIS We included 20 studies evaluating 223 patients with acutely ruptured intracranial aneurysms treated with flow-diverter stents. Immediate angiographic occlusion was obtained in 32% (29/86; 95% CI, 15.4%-48%; I2 = 79.6%) of aneurysms, whereas long-term complete/near-complete aneurysm occlusion was 88.9% (162/189; 95% CI, 84%-93.5%; I2 = 20.9%) (mean radiologic follow-up of 9.6 months). The treatment-related complication rate was 17.8% (42/223; 95% CI, 11%-24%; I2 = 52.6%). Complications were higher in the posterior circulation (16/72 = 27%; 95% CI, 14%-40%; I2 = 66% versus 18/149 = 11.7%; 95% CI, 7%-16%; I2 = 0%) (P = .004) and after treatment with multiple stents (14/52 = 26%; 95% CI, 14%-45%; I2 = 59%) compared with a single stent (20/141 = 10%; 95% CI, 5%-15%; I2 = 0%) (P = .004). Aneurysm rebleeding after treatment was 4% (5/223; 95% CI, 1.8%-7%; I2 = 0%) and was higher in the first 72 hours. LIMITATIONS Small and retrospective series. CONCLUSIONS Flow-diversion treatment of ruptured intracranial aneurysms yields a high rate of long-term angiographic occlusion with a relatively low rate of aneurysm rebleeding. However, treatment is associated with a complication rate of 18%. When coiling or microsurgical clipping are not feasible strategies, anterior circulation ruptured aneurysms can be effectively treated with a flow-diversion technique, minimizing the number of stents deployed. Given the 27% rate of complications, flow diversion for ruptured posterior circulation aneurysms should be considered only in selected cases not amenable to other treatments.
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Affiliation(s)
- F Cagnazzo
- From the Department of Neurosurgery (F.C., D.T.d.C., P.P.), University of Pisa, Pisa, Italy
| | - D T di Carlo
- From the Department of Neurosurgery (F.C., D.T.d.C., P.P.), University of Pisa, Pisa, Italy
| | - M Cappucci
- Radiology Department (M.C.), University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - P-H Lefevre
- Neuroradiology Department (P.-H.L., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - V Costalat
- Neuroradiology Department (P.-H.L., V.C.), University Hospital Güi-de-Chauliac, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - P Perrini
- From the Department of Neurosurgery (F.C., D.T.d.C., P.P.), University of Pisa, Pisa, Italy
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Li K, Guo Y, Zhao Y, Xu B, Xu K, Yu J. Acute rerupture after coil embolization of ruptured intracranial saccular aneurysms: A literature review. Interv Neuroradiol 2017; 24:117-124. [PMID: 29231793 DOI: 10.1177/1591019917747245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acute rerupture after coil embolization is defined as rerupture within three days after treatment; its prognosis is worse than that of rebleeding at other time periods. However, to date, little is known about complications during the acute phase. Therefore, we used the PubMed database to perform a review of acute rerupture after coil embolization of ruptured intracranial saccular aneurysms and increase our understanding. After reviewing the complications, we found that the cause of acute rerupture is unclear, but the following risk factors are involved: incomplete occlusion of the initial aneurysm, the presence of a hematoma adjacent to a ruptured aneurysm, an aneurysmal outpouching, poor Hunt-Hess grade at the time of treatment, and the location of the aneurysm in an anterior communicating artery. In addition, intraoperative rupture is a non-negligible cause. Acute rerupture after coil embolization mainly occurs within the first 24 hours after the procedure. Brain computed tomography is the gold standard for diagnosing acute rebleeding of a coiled aneurysm. For acute rerupture after coil embolization, prevention is critical, and complete occlusion of the aneurysm in the first session is the best protection against acute rebleeding. In addition, a restricted postembolization anticoagulation strategy is recommended for patients with high-risk aneurysms. For patients with an adjacent hematoma, surgical clipping is recommended. Most patients present no changes immediately after acute rebleeding because of their poor condition. However, surgical or endovascular treatments can be attempted if the patient is in an acceptable condition. Even so, the outcomes are typically unsatisfactory.
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Affiliation(s)
- Kailing Li
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Yunbao Guo
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Ying Zhao
- 2 Department of Training, The First Hospital of Jilin University, Changchun, China
| | - Baofeng Xu
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Kan Xu
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jinlu Yu
- 1 Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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