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Mansour MA, Tarek M. Meningioangiomatosis with Skull Erosion. World Neurosurg 2023; 176:199-201. [PMID: 37178916 DOI: 10.1016/j.wneu.2023.05.021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
Meningioangiomatosis (MA) is a rare, poorly studied brain hamartomatous lesion, the etiology of which is not fully elucidated. It typically involves the leptomeninges, extending to the underlying cortex, characterized by small vessel proliferation, perivascular cuffing, and scattered calcifications. Given its close proximity to, or direct involvement of, the cerebral cortex, MA lesions typically manifest in younger patients as recurrent episodes of refractory seizures, comprising approximately 0.6% of operated-on intractable epileptic lesions. Due to the absence of characteristic radiological features, MA lesions constitute a significant radiological challenge, making them easy to miss or misinterpret. Although MA lesions are rarely reported with still-unknown etiology, it is prudent to be aware of these lesions for prompt diagnosis and management to avoid morbidity and mortality associated with delayed diagnosis and treatment. We present a case of a young patient with a first-time seizure caused by a right parieto-occipital MA lesion that was successfully excised via an awake craniotomy, achieving 100% seizure control.
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Affiliation(s)
- Moustafa A Mansour
- Department of Neurology and Neurologic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Department of Emergency Medicine and Critical Care, Faculty of Medicine, Al-Azhar University, Cairo, Egypt; Division of Neuro-Intensive Care, Dar Al-Fouad Medical Corporation, Cairo, Egypt
| | - Mohamed Tarek
- Department of Neurology and Neurologic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
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2
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Zhang GB, Ying YZ, Huang HW, Yu WJ, Li HY, Zhang XK, Wang YG, Cui Y, Chen Y, Jiang ZL, Lin S. Pure and non-pure meningioangiomatosis of 36 Chinese patients: an analysis of clinical presentation, diagnosis, histopathology and prognosis. Neurosurg Rev 2022. [PMID: 36063221 DOI: 10.1007/s10143-022-01855-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/15/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
Meningioangiomatosis (MA) is a disease that is extremely rarely reported. Sporadic MA is occasionally combined with meningioma or other lesions (identified as non-pure MA). This retrospective study investigated the difference between pure MA and non-pure MA by exploring clinical manifestations, histopathology characteristics, and outcomes of MA after surgery. We reviewed the medical records of 36 histopathologically confirmed MA patients (18 pure MA and 18 non-pure MA) who received surgery at our institution between 2012 and 2021. We compared differences in demographic, clinical, imaging, pathological features, and surgical outcomes between pure MA and non-pure MA through descriptive statistics. Compared to non-pure MA, pure MA presented with a more prominent male predilection (5:1 vs. 1.57:1, P = 0.264), a higher seizure incidence (83.3% vs 50.0%, P = 0.038), a more seizure type of GTCS (14/15 vs 5/9, P = 0.047), a less prominent enhancement on MRI (27.8% vs 88.9%, P < 0.001) and a preference of temporal and frontal lobe (100% vs 44.4%, P < 0.001). The differences in clinical characteristics between pure MA and non-pure MA demonstrate their disparate biological natures. Pure MA seems to be a non-neoplastic lesion, while non-pure MA is commonly combined with meningioma, which is a neoplastic lesion. A correct differential diagnosis can be achieved via a triad of the type of seizure, the location of lesion and the radiological presentation. MA is curable and the prognosis is excellent as most patients are free of seizure and recurrence after surgical treatment.
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3
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Dono A, Pothiawala AZ, Lewis CT, Bhattacharjee MB, Ballester LY, Tandon N. Molecular Alterations in Meningioangiomatosis Causing Epilepsy. J Neuropathol Exp Neurol 2021; 80:1043–1051. [PMID: 34580720 DOI: 10.1093/jnen/nlab095] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Meningioangiomatosis (MA) is a rare process at the intersection of cerebral developmental and neoplastic disorders that often results in epilepsy. We evaluated molecular alterations in MA to characterize its biology and pathogenesis. We searched a comprehensive institutional database for patients with MA treated between 2004 and 2019. Demographic, clinical, surgical, and radiographical data were collected. MA and associated meningioma tissues were evaluated using a next-generation sequencing assay interrogating 1425 cancer-related genes. We studied 5 cases: 3 with MA and 2 with MA associated with a meningioma. Of the MAs associated with a meningioma, 1 had deletions in the NF2 gene in both the MA and the meningioma components, whereas the other had an NF2 deletion in only the MA component. Additional mutations were identified in the MA components, suggesting that MA arises from the meningioma rather than the meningioma resulting from a transformation of the MA. The 3 cases of pure MA showed variants of unknown significance with no alterations in known oncogenic drivers. Our findings provide a starting point to a better understanding of the pathogenesis of this rare lesion. Our study indicates that MA-meningiomas have a neoplastic nature that differs from the hamartomatous/developmental nature of pure MA.
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Affiliation(s)
- Antonio Dono
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.,Department of Pathology and Laboratory Medicine, McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
| | - Azim Z Pothiawala
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
| | - Cole T Lewis
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, Texas 77030, USA
| | - Meenakshi B Bhattacharjee
- Department of Pathology and Laboratory Medicine, McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.,Memorial Hermann Hospital-TMC, Houston, Texas 77030, USA
| | - Leomar Y Ballester
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.,Department of Pathology and Laboratory Medicine, McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.,Memorial Hermann Hospital-TMC, Houston, Texas 77030, USA
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.,Memorial Hermann Hospital-TMC, Houston, Texas 77030, USA
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Makary MS, Kobalka P, Giglio P, Slone HW. Meningioangiomatosis: Clinical, Imaging, and Histopathologic Characteristics. J Clin Imaging Sci 2020; 10:36. [PMID: 32637227 PMCID: PMC7332468 DOI: 10.25259/jcis_39_2020] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/26/2020] [Indexed: 11/04/2022] Open
Abstract
Meningioangiomatosis is a rare benign lesion involving the central nervous system. Radiographic appearance can be highly variable which makes pre-operative diagnosis difficult. In this report, we describe meningioangiomatosis in a previously healthy 17-year-old woman who presented with seizures and continued headache and dizziness. This patient presented with a predominately calcified lesion on imaging and eventually underwent near total resection. Meningioangiomatosis is difficult to preoperatively identify, but is an important consideration as prognosis with surgical resection is typically good.
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Affiliation(s)
- Mina S Makary
- Department of Radiology, Division of Neuroradiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Peter Kobalka
- Department of Pathology, Division of Neuropathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Pierre Giglio
- Department of Neurology, Division of Neuro-Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - H Wayne Slone
- Department of Radiology, Division of Neuroradiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
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Galloway L, Zilani G, Lammie A, Leach P. Meningioma with rhabdoid features combined with meningioangiomatosis in infancy: a novel combination. Childs Nerv Syst 2020; 36:1311-4. [PMID: 31897634 DOI: 10.1007/s00381-019-04486-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
Meningioangiomatosis is a rare histologically distinct abnormality that is occasionally associated with intracranial meningioma. The rhabdoid variant of meningioma is also uncommon and is classified as a World Health Organization Grade III tumour. We report a case of meningioangiomatosis in conjunction with a meningioma with prominent rhabdoid features, in an infant male who underwent complete surgical resection of the lesion. The patient has been followed up for 6 years with no disease recurrence. To our knowledge, this is the first report in the literature describing meningioangiomatosis combined with a meningioma with rhabdoid features.
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Coy S, Rashid R, Stemmer-Rachamimov A, Santagata S. An update on the CNS manifestations of neurofibromatosis type 2. Acta Neuropathol 2020; 139:643-665. [PMID: 31161239 PMCID: PMC7038792 DOI: 10.1007/s00401-019-02029-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/23/2019] [Accepted: 05/25/2019] [Indexed: 12/21/2022]
Abstract
Neurofibromatosis type II (NF2) is a tumor predisposition syndrome characterized by the development of distinctive nervous system lesions. NF2 results from loss-of-function alterations in the NF2 gene on chromosome 22, with resultant dysfunction of its protein product merlin. NF2 is most commonly associated with the development of bilateral vestibular schwannomas; however, patients also have a predisposition to development of other tumors including meningiomas, ependymomas, and peripheral, spinal, and cranial nerve schwannomas. Patients may also develop other characteristic manifestations such as ocular lesions, neuropathies, meningioangiomatosis, and glial hamartia. NF2 has a highly variable clinical course, with some patients exhibiting a severe phenotype and development of multiple tumors at an early age, while others may be nearly asymptomatic throughout their lifetime. Despite the high morbidity associated with NF2 in severe cases, management of NF2-associated lesions primarily consists of surgical resection and treatment of symptoms, and there are currently no FDA-approved systemic therapies that address the underlying biology of the syndrome. Refinements to the diagnostic criteria of NF2 have been proposed over time due to increasing understanding of clinical and molecular data. Large-population studies have demonstrated that some features such as the development of gliomas and neurofibromas, currently included as diagnostic criteria, may require further clarification and modification. Meanwhile, burgeoning insights into the molecular biology of NF2 have shed light on the etiology and highly variable severity of the disease and suggested numerous putative molecular targets for therapeutic intervention. Here, we review the clinicopathologic features of NF2, current understanding of the molecular biology of NF2, particularly with regard to central nervous system lesions, ongoing therapeutic studies, and avenues for further research.
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Affiliation(s)
- Shannon Coy
- Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Hale Building for Transformative Medicine, BTM8002P, 60 Fenwood Road, Boston, MA, 02115, USA
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rumana Rashid
- Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Hale Building for Transformative Medicine, BTM8002P, 60 Fenwood Road, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
- Laboratory for Systems Pharmacology, Harvard Program in Therapeutic Science, Boston, MA, USA
| | - Anat Stemmer-Rachamimov
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Sandro Santagata
- Division of Neuropathology, Department of Pathology, Brigham and Women's Hospital, Hale Building for Transformative Medicine, BTM8002P, 60 Fenwood Road, Boston, MA, 02115, USA.
- Department of Pathology, Boston Children's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Laboratory for Systems Pharmacology, Harvard Program in Therapeutic Science, Boston, MA, USA.
- Ludwig Center at Harvard, Boston, MA, USA.
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7
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Chan BYL, Merchant KZ, Teo JGC, Chang KTE, Low DCY, Low SYY. Sporadic Meningioangiomatosis Presenting as a Middle Cranial Fossa Arachnoid Cyst. World Neurosurg 2020; 137:247-251. [PMID: 32068171 DOI: 10.1016/j.wneu.2020.02.043] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Meningioangiomatosis is an extremely rare meningovascular disease of the central nervous system that is characterized by the proliferation of leptomeninges, cortical vessels, and perivascular spindled cells. Although it is a benign, neoplastic disorder that carries a good prognosis after surgical excision, initial diagnosis may be challenging as radiologic findings are often variable and nonspecific. CASE DESCRIPTION In this report, we describe an unusual presentation of meningioangiomatosis presenting as a symptomatic middle cranial fossa arachnoid cyst. CONCLUSIONS In view of the unexpected diagnosis and infrequency of this condition, the case is discussed in collaboration with current literature and management strategies.
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Affiliation(s)
- Brian Y L Chan
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Khurshid Z Merchant
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Jennifer G C Teo
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Kenneth T E Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - David C Y Low
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Neurosurgical Service, KK Women's and Children's Hospital, Singapore; Singhealth Duke-NUS Neuroscience Academic Clinical Program, Singapore
| | - Sharon Y Y Low
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Neurosurgical Service, KK Women's and Children's Hospital, Singapore; Singhealth Duke-NUS Neuroscience Academic Clinical Program, Singapore.
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Stilo S, Ugga L, Russo C, Guadagno E, Del Basso De Caro ML, D'Amico A, Elefante A. B-cell central nervous system lymphoma developing in a patient with cerebral meningioangiomatosis. Radiol Case Rep 2019; 14:538-543. [PMID: 30976365 PMCID: PMC6443910 DOI: 10.1016/j.radcr.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 11/16/2022] Open
Abstract
Meningioangiomatosis is a rare congenital hamartomatous malformation of the leptomeninges that can also involve the adjacent cerebral tissue, sometime arising in association with neurofibromatosis. Here we report the case of a 55-year-old man with neuroradiological evidence of meningioangiomatosis, known to be a well-defined malformative-dysplastic lesion, preceding the onset of central nervous system B-cell lymphoma. We describe for the first time this unusual association, highlighting how meningioangiomatosis could accompany different pathologies more frequently than thought.
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Affiliation(s)
- Salvatore Stilo
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II", Via Pansini, 5, 80131 Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II", Via Pansini, 5, 80131 Naples, Italy
| | - Camilla Russo
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II", Via Pansini, 5, 80131 Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Pathology Unit, University "Federico II", Naples, Italy
| | | | - Alessandra D'Amico
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II", Via Pansini, 5, 80131 Naples, Italy
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II", Via Pansini, 5, 80131 Naples, Italy
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9
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Tomkinson C, Lu JQ. Meningioangiomatosis: A review of the variable manifestations and complex pathophysiology. J Neurol Sci 2018; 392:130-6. [PMID: 30056201 DOI: 10.1016/j.jns.2018.07.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/13/2018] [Accepted: 07/22/2018] [Indexed: 11/24/2022]
Abstract
Meningioangiomatosis (MA) is a rare, complex and heterogeneous disease of meningovascular proliferation that is found primarily in the leptomeninges and cerebral cortex but can involve subcortical white matter and other brain regions such as the cerebellum and deep gray matter. MA may be found in pediatric or adult populations and may be sporadic or neurofibromatosis-associated. The presentation of MA is highly variable: it may be associated with other neurological diseases; clinically presents on a spectrum from asymptomatic to seizures or focal deficits; radiologically presents with multifocal, tumor-like, or cystic lesions, or may appear normal; and pathologically may have cellular or vascular predominance. In this article, we review the various manifestations of MA including neurofibromatosis-associated MA, multifocal MA, cystic MA, and MA associated with meningioma, other brain tumors, focal cortical dysplasia, neurodegenerative changes, and post-radiation changes. The treatment of MA is also reviewed. While the pathogenesis of MA remains elusive, we discuss the proposed theories such as developmental, dysplastic, hamartomatous or reactive ethology in given variants. It is important for physicians to be aware of MA as more research on this complex entity is needed and timely diagnosis may benefit outcomes in patients with MA.
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Marzi S, De Paulis D, Ricci A, Taddei G, Dehcordi SR, Coletti G, Maselli G, Galzio RJ. Meningioangiomatosis Without Neurofibromatosis Type 2. World J Oncol 2012; 3:127-133. [PMID: 29147294 PMCID: PMC5649792 DOI: 10.4021/wjon470w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2012] [Indexed: 12/03/2022] Open
Abstract
Meningioangiomatosis (MA) is a rare, benign hamartomatous lesion found in cerebral cortex and leptomeninges. It occurs mostly in 5 - 15 year old children in form isolated or diffuse; the diffuse form may be associated with neurofibromatosis type 2 (NF2). The sporadic type in the adults is less common.The patient was a 37 year-old man with a long history of frontal headache. In suspected sinusitis, the patient underwent cerebral MRI that showed hypointense lesion in the right frontal lobe with heterogeneous contrast enhancement after gadolinium administration. There were no stigmata or family history of neurofibromatosis. A right pterional approach with a supraorbital craniotomy was performed. The lesion was removed with complete remission of the headache in the postoperative time. MA enters into differential diagnosis with several other diseases and a correct diagnosis is mandatory. The total surgical removal is the treatment of choice, and the prognosis after surgery is usually excellent for the absence of recurrence in sporadic cases.
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Affiliation(s)
- Sara Marzi
- Department of Neurosurgery, San Salvatore Hospital, L'Aquila, Italy
| | - Danilo De Paulis
- Department of Neurosurgery, San Salvatore Hospital, L'Aquila, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore Hospital, L'Aquila, Italy
| | - Graziano Taddei
- Department of Neurosurgery, San Salvatore Hospital, L'Aquila, Italy
| | | | - Gino Coletti
- Department of Pathology, San Salvatore Hospital, L'Aquila, Italy
| | - Giuliano Maselli
- Department of Neurosurgery, San Salvatore Hospital, L'Aquila, Italy
| | - Renato J Galzio
- Department of Neurosurgery, San Salvatore Hospital, L'Aquila, Italy.,Department of Health Sciences, San Salvatore Hospital, L'Aquila, Italy
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