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MacCormac O, Noonan P, Janatka M, Horgan CC, Bahl A, Qiu J, Elliot M, Trotouin T, Jacobs J, Patel S, Bergholt MS, Ashkan K, Ourselin S, Ebner M, Vercauteren T, Shapey J. Lightfield hyperspectral imaging in neuro-oncology surgery: an IDEAL 0 and 1 study. Front Neurosci 2023; 17:1239764. [PMID: 37790587 PMCID: PMC10544348 DOI: 10.3389/fnins.2023.1239764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Hyperspectral imaging (HSI) has shown promise in the field of intra-operative imaging and tissue differentiation as it carries the capability to provide real-time information invisible to the naked eye whilst remaining label free. Previous iterations of intra-operative HSI systems have shown limitations, either due to carrying a large footprint limiting ease of use within the confines of a neurosurgical theater environment, having a slow image acquisition time, or by compromising spatial/spectral resolution in favor of improvements to the surgical workflow. Lightfield hyperspectral imaging is a novel technique that has the potential to facilitate video rate image acquisition whilst maintaining a high spectral resolution. Our pre-clinical and first-in-human studies (IDEAL 0 and 1, respectively) demonstrate the necessary steps leading to the first in-vivo use of a real-time lightfield hyperspectral system in neuro-oncology surgery. Methods A lightfield hyperspectral camera (Cubert Ultris ×50) was integrated in a bespoke imaging system setup so that it could be safely adopted into the open neurosurgical workflow whilst maintaining sterility. Our system allowed the surgeon to capture in-vivo hyperspectral data (155 bands, 350-1,000 nm) at 1.5 Hz. Following successful implementation in a pre-clinical setup (IDEAL 0), our system was evaluated during brain tumor surgery in a single patient to remove a posterior fossa meningioma (IDEAL 1). Feedback from the theater team was analyzed and incorporated in a follow-up design aimed at implementing an IDEAL 2a study. Results Focusing on our IDEAL 1 study results, hyperspectral information was acquired from the cerebellum and associated meningioma with minimal disruption to the neurosurgical workflow. To the best of our knowledge, this is the first demonstration of HSI acquisition with 100+ spectral bands at a frame rate over 1Hz in surgery. Discussion This work demonstrated that a lightfield hyperspectral imaging system not only meets the design criteria and specifications outlined in an IDEAL-0 (pre-clinical) study, but also that it can translate into clinical practice as illustrated by a successful first in human study (IDEAL 1). This opens doors for further development and optimisation, given the increasing evidence that hyperspectral imaging can provide live, wide-field, and label-free intra-operative imaging and tissue differentiation.
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Affiliation(s)
- Oscar MacCormac
- School of Biomedical Engineering and Imaging Science, King's College London, London, United Kingdom
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Philip Noonan
- Hypervision Surgical Limited, London, United Kingdom
| | - Mirek Janatka
- Hypervision Surgical Limited, London, United Kingdom
| | | | - Anisha Bahl
- School of Biomedical Engineering and Imaging Science, King's College London, London, United Kingdom
| | - Jianrong Qiu
- School of Craniofacial and Regenerative Biology, King's College London, London, United Kingdom
| | - Matthew Elliot
- School of Biomedical Engineering and Imaging Science, King's College London, London, United Kingdom
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Théo Trotouin
- Hypervision Surgical Limited, London, United Kingdom
| | - Jaco Jacobs
- Hypervision Surgical Limited, London, United Kingdom
| | - Sabina Patel
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Mads S. Bergholt
- School of Craniofacial and Regenerative Biology, King's College London, London, United Kingdom
| | - Keyoumars Ashkan
- School of Biomedical Engineering and Imaging Science, King's College London, London, United Kingdom
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Science, King's College London, London, United Kingdom
- Hypervision Surgical Limited, London, United Kingdom
| | - Michael Ebner
- Hypervision Surgical Limited, London, United Kingdom
| | - Tom Vercauteren
- School of Biomedical Engineering and Imaging Science, King's College London, London, United Kingdom
- Hypervision Surgical Limited, London, United Kingdom
| | - Jonathan Shapey
- School of Biomedical Engineering and Imaging Science, King's College London, London, United Kingdom
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
- Hypervision Surgical Limited, London, United Kingdom
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Wijethilake N, MacCormac O, Vercauteren T, Shapey J. Imaging biomarkers associated with extra-axial intracranial tumors: a systematic review. Front Oncol 2023; 13:1131013. [PMID: 37182138 PMCID: PMC10167010 DOI: 10.3389/fonc.2023.1131013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Extra-axial brain tumors are extra-cerebral tumors and are usually benign. The choice of treatment for extra-axial tumors is often dependent on the growth of the tumor, and imaging plays a significant role in monitoring growth and clinical decision-making. This motivates the investigation of imaging biomarkers for these tumors that may be incorporated into clinical workflows to inform treatment decisions. The databases from Pubmed, Web of Science, Embase, and Medline were searched from 1 January 2000 to 7 March 2022, to systematically identify relevant publications in this area. All studies that used an imaging tool and found an association with a growth-related factor, including molecular markers, grade, survival, growth/progression, recurrence, and treatment outcomes, were included in this review. We included 42 studies, comprising 22 studies (50%) of patients with meningioma; 17 studies (38.6%) of patients with pituitary tumors; three studies (6.8%) of patients with vestibular schwannomas; and two studies (4.5%) of patients with solitary fibrous tumors. The included studies were explicitly and narratively analyzed according to tumor type and imaging tool. The risk of bias and concerns regarding applicability were assessed using QUADAS-2. Most studies (41/44) used statistics-based analysis methods, and a small number of studies (3/44) used machine learning. Our review highlights an opportunity for future work to focus on machine learning-based deep feature identification as biomarkers, combining various feature classes such as size, shape, and intensity. Systematic Review Registration: PROSPERO, CRD42022306922.
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Affiliation(s)
- Navodini Wijethilake
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Oscar MacCormac
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Tom Vercauteren
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Jonathan Shapey
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, United Kingdom
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Li P, Asad M, Horgan C, MacCormac O, Shapey J, Vercauteren T. Spatial gradient consistency for unsupervised learning of hyperspectral demosaicking: application to surgical imaging. Int J Comput Assist Radiol Surg 2023:10.1007/s11548-023-02865-7. [PMID: 36961613 DOI: 10.1007/s11548-023-02865-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/03/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE Hyperspectral imaging has the potential to improve intraoperative decision making if tissue characterisation is performed in real-time and with high-resolution. Hyperspectral snapshot mosaic sensors offer a promising approach due to their fast acquisition speed and compact size. However, a demosaicking algorithm is required to fully recover the spatial and spectral information of the snapshot images. Most state-of-the-art demosaicking algorithms require ground-truth training data with paired snapshot and high-resolution hyperspectral images, but such imagery pairs with the exact same scene are physically impossible to acquire in intraoperative settings. In this work, we present a fully unsupervised hyperspectral image demosaicking algorithm which only requires exemplar snapshot images for training purposes. METHODS We regard hyperspectral demosaicking as an ill-posed linear inverse problem which we solve using a deep neural network. We take advantage of the spectral correlation occurring in natural scenes to design a novel inter spectral band regularisation term based on spatial gradient consistency. By combining our proposed term with standard regularisation techniques and exploiting a standard data fidelity term, we obtain an unsupervised loss function for training deep neural networks, which allows us to achieve real-time hyperspectral image demosaicking. RESULTS Quantitative results on hyperspetral image datasets show that our unsupervised demosaicking approach can achieve similar performance to its supervised counter-part, and significantly outperform linear demosaicking. A qualitative user study on real snapshot hyperspectral surgical images confirms the results from the quantitative analysis. CONCLUSION Our results suggest that the proposed unsupervised algorithm can achieve promising hyperspectral demosaicking in real-time thus advancing the suitability of the modality for intraoperative use.
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Affiliation(s)
- Peichao Li
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Muhammad Asad
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Conor Horgan
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Oscar MacCormac
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Jonathan Shapey
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Tom Vercauteren
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Woodfield J, Hoeritzauer I, Jamjoom AA, Jung J, Lammy S, Pronin S, Hannan CJ, Watts A, Hughes L, Moon RD, Darwish S, Roy H, Copley PC, Poon MT, Thorpe P, Srikandarajah N, Grahovac G, Demetriades AK, Eames N, Sell PJ, Statham PF, Abdelsadg M, Abulaila MMS, Ahmed U, Ajmi Q, Al-Mahfoudh R, Ali C, Amarouche M, Andalib A, Arora M, Arora M, Awan M, Baig Mirza A, Bateman A, Bennett I, Bhatti I, Bodkin P, Bommireddy L, Bonanos G, Borg A, Boukas A, Bourne J, Brennan R, Brown J, Brown K, Burton O, Busby C, Chiverton N, Clark S, Copley PC, Cudlip S, Cunningham Y, Dardis R, Darwish S, Davies B, Demetriades AK, Deore S, Derham C, Dherijha M, Dobson G, Duncan J, Durnford A, Durst AZE, Dyson EW, Eames N, Edlmann E, Edwards-Bailey A, Elserius A, Elson B, Fadelalla M, Fountain DM, Gardner A, Ghosh A, Gill JR, Glasmacher SA, Gordon R, Grahovac G, Grenfell R, Habeebullah A, Haliasos N, Hammett T, Hannan CJ, Hill CS, Hoeritzauer I, Holmes D, Hossain-Ibrahim K, Hughes L, Hussain M, Hussain S, Ibrahim R, Jamjoom AAB, John B, Joshi S, Jung J, Kennion O, Khan M, Klejnotowska A, Kumaria A, LaCava R, Lammy S, Lawrence A, Lea M, Leung AHC, Liew I, Luo W, MacCormac O, Manfield J, Mannion R, Merola J, Mishra P, Mohmoud KA, Moon R, Morrison R, Murray O, Nader-Sepahi A, Nnandi C, Pandit A, Patel N, Philip A, Poon MTC, Prasad KSM, Pronin S, Pujara S, Purushothaman B, Rajwani K, Rasul FT, Roy H, Sadek AR, Schramm M, Scicluna G, Sell PJ, Shafafy R, Sharma H, Sheikh A, Sivasubramaniam V, Sofela A, Spink G, Srikandarajah N, Statham PFX, Stokes S, Strachan E, Thakar C, Thanabalasundaram G, Thorpe P, Ulbricht C, Watts A, Whitcher A, White D, Whitehouse K, Wilby M, Woodfield J, Zolnourian A. Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: A multi-centre prospective cohort study. Lancet Reg Health Eur 2023; 24:100545. [PMID: 36426378 PMCID: PMC9678980 DOI: 10.1016/j.lanepe.2022.100545] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. Findings In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Interpretation Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. Funding DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.
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MacCormac O, Edwards A, Forsyth M, Ti F, Deb S. Comparison of manual vacuum aspiration to traditional methods of managing early pregnancy miscarriage. Cogent Medicine 2018. [DOI: 10.1080/2331205x.2018.1484601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Oscar MacCormac
- Department of Gynaecology, Queen’s Medical Centre, Nottingham, Derby Road, Nottingham NG7 2UH, UK
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, St Marys Hospital, Praed Street, London W2 1NY, UK
| | - Alexandra Edwards
- Department of General Surgery, Torbay Hospital, Lowes Bridge, Torquay, Torbay TQ2 7AA, UK
| | - Murray Forsyth
- Department of Gynaecology, Queen’s Medical Centre, Nottingham, Derby Road, Nottingham NG7 2UH, UK
| | - Fanny Ti
- Department of Gynaecology, Queen’s Medical Centre, Nottingham, Derby Road, Nottingham NG7 2UH, UK
| | - Shilpa Deb
- Department of Gynaecology, Queen’s Medical Centre, Nottingham, Derby Road, Nottingham NG7 2UH, UK
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Shrestha P, Thapa S, Shrestha S, Lohani S, BK S, MacCormac O, Thapa L, Devkota UP. Renal impairment in stroke patients: A comparison between the haemorrhagic and ischemic variants. F1000Res 2017; 6:1531. [PMID: 29034081 PMCID: PMC5615769 DOI: 10.12688/f1000research.12117.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 02/03/2023] Open
Abstract
Background: Renal impairment is regularly seen in hospitalized stroke patients, affecting the outcome of patients, as well as causing difficulties in their management. A prospective cohort study was conducted to assess the trend of renal function in hospitalized ischemic and haemorrhagic stroke patients. The incidence of renal impairment in these subgroups, the contributing factors and the need for renal replacement in renal impaired patients was evaluated. Methods: Alternate day renal function testing was performed in hospitalized stroke patients. Estimated glomerular filtration rate (e-GFR) was calculated and the trend of renal function in the two stroke subgroups (haemorrhagic and ischemic) was assessed, with renal impairment defined as e-GFR < 60mL/ minute per 1.73m 2. Results: Among 52 patients, 25 had haemorrhagic stroke (mean age 59.81 ± 14.67) and 27 had ischemic stroke (mean age 56.12 ± 13.08). The mean e-GFR (mL/minute per 1.732m 2) at admission in the haemorrhagic stroke subgroup was 64.79 ± 25.85 compared to 86.04 ± 26.09 in the ischemic stroke subgroup (p=0.005). Sixteen out of 25 (64%) patients in the haemorrhagic stroke subgroup and 9 out of 27 (33.3%) patients in the ischemic subgroup developed renal impairment (p=0.27). The location of the bleed (p=0.8), volume of hematoma (p=0.966) and surgical intervention (p=0.4) did not predispose the patients to renal impairment. One out of 16 patients with haemorrhagic stroke (who eventually died), and 2 out of 9 patients with ischemic stroke required renal replacement. Conclusion: Renal impairment is commonly seen in stroke patients, more so in patients who suffered haemorrhagic strokes. The impairment, however, is transient and rarely requires renal replacement therapy.
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Affiliation(s)
- Pratyush Shrestha
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Shalima Thapa
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Shikher Shrestha
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Subash Lohani
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Suresh BK
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Oscar MacCormac
- Department of Neurosurgery, St Mary’s Hospital, London, W2 1NY, UK
| | - Lekhjung Thapa
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
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Shrestha P, Thapa S, Shrestha S, Lohani S, BK S, MacCormac O, Thapa L, Devkota UP. Renal impairment in stroke patients: A comparison between the haemorrhagic and ischemic variants. F1000Res 2017; 6:1531. [PMID: 29034081 PMCID: PMC5615769 DOI: 10.12688/f1000research.12117.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 01/24/2023] Open
Abstract
Background: Renal impairment is regularly seen in hospitalized stroke patients, affecting the outcome of patients, as well as causing difficulties in their management. A prospective cohort study was conducted to assess the trend of renal function in hospitalized ischemic and haemorrhagic stroke patients. The incidence of renal impairment in these subgroups, the contributing factors and the need for renal replacement in renal impaired patients was evaluated. Methods: Alternate day renal function testing was performed in hospitalized stroke patients. Estimated glomerular filtration rate (e-GFR) was calculated and the trend of renal function in the two stroke subgroups (haemorrhagic and ischemic) was assessed, with renal impairment defined as e-GFR < 60mL/ minute per 1.73m 2. Results: Among 52 patients, 25 had haemorrhagic stroke (mean age 59.81 ± 14.67) and 27 had ischemic stroke (mean age 56.12 ± 13.08). The mean e-GFR (mL/minute per 1.732m 2) at admission in the haemorrhagic stroke subgroup was 64.79 ± 25.85 compared to 86.04 ± 26.09 in the ischemic stroke subgroup (p=0.005). Sixteen out of 25 (64%) patients in the haemorrhagic stroke subgroup and 9 out of 27 (33.3%) patients in the ischemic subgroup developed renal impairment (p=0.027). The location of the bleed (p=0.8), volume of hematoma (p=0.966) and surgical intervention (p=0.4) did not predispose the patients to renal impairment. One out of 16 patients with haemorrhagic stroke (who eventually died), and 2 out of 9 patients with ischemic stroke required renal replacement. Conclusion: Renal impairment is commonly seen in stroke patients, more so in patients who suffered haemorrhagic strokes. The impairment, however, is transient and rarely requires renal replacement therapy.
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Affiliation(s)
- Pratyush Shrestha
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Shalima Thapa
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Shikher Shrestha
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Subash Lohani
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Suresh BK
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Oscar MacCormac
- Department of Neurosurgery, St Mary’s Hospital, London, W2 1NY, UK
| | - Lekhjung Thapa
- National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
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MacCormac O, Natalwala A, Dineen R, Vloeberghs M. Endoscopic management of an unusual and large suprasellar arachnoid cyst extending into the adjacent temporal lobe. Cogent Medicine 2017. [DOI: 10.1080/2331205x.2017.1392836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- O. MacCormac
- Department of Neurosurgery, Queen’s Medical Centre Nottingham, Derby Road, Nottingham, NG7 2UH, UK
| | - A. Natalwala
- Department of Neurosurgery, Queen’s Medical Centre Nottingham, Derby Road, Nottingham, NG7 2UH, UK
| | - R. Dineen
- Department of Radiology, Queen’s Medical Centre Nottingham, Derby Road, Nottingham, NG7 2UH, UK
| | - M. Vloeberghs
- Department of Neurosurgery, Queen’s Medical Centre Nottingham, Derby Road, Nottingham, NG7 2UH, UK
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