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Prognosis of recovery and death within 1–6 months of spontaneous cerebellar hemorrhage undergoing suboccipital craniotomy
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2025-04-01 DOI: 10.1016/j.hest.2024.05.005
Phuong Xuan Nguyen , Tung Duc Nguyen , Cuong Manh Tran , Tuan Cong Duong , Ha Thi-Ngoc Doan , Yen Trong Nguyen

Objective

Suboccipital craniotomy is a considerable surgical approach for large spontaneous cerebellar hemorrhage, but its prognostic has not been comprehensively addressed. This study aims to report the surgical outcomes and factors related to the prognosis of recovery and death within 1–6 months of patients with spontaneous cerebellar hemorrhage.

Methods

We retrospectively studied 37 patients who underwent craniotomy due to spontaneous cerebellar hemorrhage from January 2019 to April 2022.

Results

The disease occurs at a mean age of 62.86 years old, with a male/female ratio of 4.26/1. Hemorrhage is mainly in the cerebellar hemisphere. Hospital stays averaged 13.32 days, with significant reductions in hematoma diameter and volume after surgery. The hospital mortality rate was 5.41 %, increasing to 45.95 % at 1 month post-discharge. Prognostic factors for death within 1 month include low Glasgow score, small hematoma diameter, and low hematoma volume. Factors associated with recovery include young age, absence of ventricle hemorrhage, and high Glasgow score.

Conclusions

Suboccipital craniotomy demonstrates a high efficacy in resolving hematomas with decreased complication rates, lower mortality, and improved patient recovery outcomes. Optimal surgical outcomes would be achieved with early intervention, particularly in younger patients.
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引用次数: 0
Intracranial pressure monitoring and minimally invasive surgery for intracerebral hemorrhage: Current status, challenges, and future
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2025-04-01 DOI: 10.1016/j.hest.2025.03.001
Ping Zhang , Xinran Xu , Chao Pan , Yingxin Tang , Wenjie Liu , Zhouping Tang
With the continuous advancement of medical technology, the treatment for intracerebral hemorrhage (ICH) has shifted from traditional open surgery to more precise minimally invasive surgery (MIS). This article will discuss the combination of intracranial pressure (ICP) monitoring and MIS in ICH management, as well as explore future development directions.
{"title":"Intracranial pressure monitoring and minimally invasive surgery for intracerebral hemorrhage: Current status, challenges, and future","authors":"Ping Zhang ,&nbsp;Xinran Xu ,&nbsp;Chao Pan ,&nbsp;Yingxin Tang ,&nbsp;Wenjie Liu ,&nbsp;Zhouping Tang","doi":"10.1016/j.hest.2025.03.001","DOIUrl":"10.1016/j.hest.2025.03.001","url":null,"abstract":"<div><div>With the continuous advancement of medical technology, the treatment for intracerebral hemorrhage (ICH) has shifted from traditional open surgery to more precise minimally invasive surgery (MIS). This article will discuss the combination of intracranial pressure (ICP) monitoring and MIS in ICH management, as well as explore future development directions.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"6 2","pages":"Pages 61-63"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Step-down infusion of barbiturate improves neurofunction in a new rat model of rebleeding subarachnoid hemorrhage 降压输注巴比妥酸盐可改善蛛网膜下腔出血再出血新模型大鼠的神经功能
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2025-04-01 DOI: 10.1016/j.hest.2024.07.001
Sosho Kajiwara , Yu Hasegawa , Kana Fujimori , Motohiro Morioka

Objective

Rebleeding from a ruptured aneurysm is a risk factor for fatal prognosis in subarachnoid hemorrhage (SAH). A novel barbiturate treatment, step-down infusion of barbiturate (sd-B), was previously developed; it showed beneficial effects on patients with severe traumatic brain injuries. The present study established a rebleeding SAH model in rats and evaluated the effect of sd-B.

Methods

Fifty male Sprague-Dawley rats were divided into sham-operation with distilled water, sham-operation with barbiturate, SAH-rebleeding with distilled water, and SAH-rebleeding with barbiturate groups. For posttreatment with sd-B, thiamylal was intraperitoneally administered at 3 mg/kg/h on days 0–1, 2 mg/kg/h on days 1–2, and 1 mg/kg/h on days 2–3 after SAH using osmotic minipumps. We monitored neurofunction and case fatality as the primary endpoints and evaluated brain injuries, including brain edema and cortical neuronal cell death, as the secondary endpoints

Results

Posttreatment with sd-B improved the modified Garcia test, reduced the brain water content, and inhibited the loss of neuronal cells and microglial expressions in the rat model.

Conclusions

Our results revealed that sd-B ameliorated neurofunction and brain injuries on the rebleeding SAH model, suggesting that the novel treatment is a good candidate drug for patients with SAH with rebleeding.
{"title":"Step-down infusion of barbiturate improves neurofunction in a new rat model of rebleeding subarachnoid hemorrhage","authors":"Sosho Kajiwara ,&nbsp;Yu Hasegawa ,&nbsp;Kana Fujimori ,&nbsp;Motohiro Morioka","doi":"10.1016/j.hest.2024.07.001","DOIUrl":"10.1016/j.hest.2024.07.001","url":null,"abstract":"<div><h3>Objective</h3><div>Rebleeding from a ruptured aneurysm is a risk factor for fatal prognosis in subarachnoid hemorrhage (SAH). A novel barbiturate treatment, step-down infusion of barbiturate (sd-B), was previously developed; it showed beneficial effects on patients with severe traumatic brain injuries. The present study established a rebleeding SAH model in rats and evaluated the effect of sd-B.</div></div><div><h3>Methods</h3><div>Fifty male Sprague-Dawley rats were divided into sham-operation with distilled water, sham-operation with barbiturate, SAH-rebleeding with distilled water, and SAH-rebleeding with barbiturate groups. For posttreatment with sd-B, thiamylal was intraperitoneally administered at 3 mg/kg/h on days 0–1, 2 mg/kg/h on days 1–2, and 1 mg/kg/h on days 2–3 after SAH using osmotic minipumps. We monitored neurofunction and case fatality as the primary endpoints and evaluated brain injuries, including brain edema and cortical neuronal cell death, as the secondary endpoints</div></div><div><h3>Results</h3><div>Posttreatment with sd-B improved the modified Garcia test, reduced the brain water content, and inhibited the loss of neuronal cells and microglial expressions in the rat model.</div></div><div><h3>Conclusions</h3><div>Our results revealed that sd-B ameliorated neurofunction and brain injuries on the rebleeding SAH model, suggesting that the novel treatment is a good candidate drug for patients with SAH with rebleeding.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"6 2","pages":"Pages 64-68"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141701290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Immune cells in intracerebral hemorrhage
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2025-04-01 DOI: 10.1016/j.hest.2025.02.001
Irem Culha Taskin, Yao Yao
Intracerebral hemorrhage (ICH), the deadliest form of stroke, is characterized by bleeding into brain parenchyma and formation of hematoma. Currently, there is no treatment available for ICH. Inflammatory response is a key pathology of ICH and plays a dual role in ICH---contributing to both secondary brain injury and recovery processes. This review discusses different types (both brain-resident and infiltrated) of immune cells and their functions during inflammation processes following ICH. Specifically, the temporal dynamics, polarization, and function of microglia/macrophages, neutrophils, lymphocytes, and astrocytes in ICH are summarized in a cell-specific manner. In addition, we also discuss key challenges and unanswered questions that need to be addressed in the future. A thorough understanding of the functions of different immune cells in ICH will provide a strong foundation for future studies and lead to the identification of novel cellular/molecular targets for therapeutic development.
{"title":"Immune cells in intracerebral hemorrhage","authors":"Irem Culha Taskin,&nbsp;Yao Yao","doi":"10.1016/j.hest.2025.02.001","DOIUrl":"10.1016/j.hest.2025.02.001","url":null,"abstract":"<div><div>Intracerebral hemorrhage (ICH), the deadliest form of stroke, is characterized by bleeding into brain parenchyma and formation of hematoma. Currently, there is no treatment available for ICH. Inflammatory response is a key pathology of ICH and plays a dual role in ICH---contributing to both secondary brain injury and recovery processes. This review discusses different types (both brain-resident and infiltrated) of immune cells and their functions during inflammation processes following ICH. Specifically, the temporal dynamics, polarization, and function of microglia/macrophages, neutrophils, lymphocytes, and astrocytes in ICH are summarized in a cell-specific manner. In addition, we also discuss key challenges and unanswered questions that need to be addressed in the future. A thorough understanding of the functions of different immune cells in ICH will provide a strong foundation for future studies and lead to the identification of novel cellular/molecular targets for therapeutic development.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"6 2","pages":"Pages 86-94"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
No association of brain CT blend sign with functional outcomes in patients with spontaneous supratentorial intracerebral hemorrhage after craniotomy
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2025-04-01 DOI: 10.1016/j.hest.2024.08.001
Li Luo , Jinhua Yang , Lian He , Shiqi Lin , Desislava Doycheva , Siying Ren , Likun Wang

Objective

This study retrospectively analyzed the association of blend sign with long-term outcomes in patients who underwent craniotomy following spontaneous supratentorial intracerebral hemorrhage.

Methods

A retrospective analysis was conducted on a cohort comprising 259 patients. Initially, patients were stratified into two groups: the blend sign group and the non-blend sign group. Subsequently, the neurological status of these patients was assessed using the NIHSS, GCS, and mRS following craniotomy. Furthermore, at six months post-craniotomy, patients were categorized into either the “good outcome group” or the “poor outcome group”. A multivariate regression analysis was applied to ascertain the independent correlation between the CT blend sign and prognosis.

Results

No statistically significant disparities were observed in the proportion of patients experiencing favorable outcomes during the follow-up period between the two groups. Nevertheless, it is noteworthy that the incidence of the blend sign was higher among patients in the good outcome group compared to those in the poor outcome group. Multivariate regression analysis disclosed that poor outcomes following craniotomy was not associated with the blend sign.

Conclusions

The presence of the blend sign may not serve as a reliable predictor of functional outcomes in patients undergoing craniotomy for spontaneous supratentorial ICH.
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引用次数: 0
Utilizing neuroimaging visualization technology to enhance standardized neurosurgical training for Traditional Chinese Medicine residents: A neuroanatomical education study 利用神经影像可视化技术加强中医住院医师神经外科标准化培训:神经解剖学教育研究
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2025-04-01 DOI: 10.1016/j.hest.2024.07.005
Rongjun Zhang , Zhigang Gong , Wenbing Jiang , Zhaofeng Su

Objective

This study aims to address the difficulties encountered by Traditional Chinese Medicine (TCM) students in learning neuroanatomy during clinical training by utilizing neuroimaging visualization technology.

Methods

81 students were divided into a control group (40 students) and an observation group (41 students). The control group followed traditional teaching methods as prescribed by the curriculum, while the observation group received additional training with the neuroimaging visualization software DSI Studio. This included whole-brain neural fiber reconstruction and cortical spinal tract evaluation in the context of stroke. Upon completion of the training, both groups were assessed on neuroanatomical theory, case analysis, neurological examination, and clinical skills. The teaching effectiveness was compared based on assessment results and feedback from questionnaires administered to the observation group.

Results

The observation group significantly outperformed the control group in theoretical knowledge, case analysis, and physical examination (P < 0.05). Over 90 % of students in the observation group reported via questionnaire that the integration of neuroimaging visualization technology significantly enhanced their understanding of neuroanatomy and clinical reasoning skills.

Conclusion

The clinical teaching approach augmented with neuroimaging visualization technology significantly improves the standardized training outcomes for TCM neurosurgical residents.
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引用次数: 0
Immune System Perspective in Intracerebral Hemorrhage Research: A Focus on Monocytes and Macrophages 脑出血研究中的免疫系统视角:聚焦单核细胞和巨噬细胞
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.hest.2024.07.004
Hang Hang , Lei Huang , Yuanhong Mao , Guofeng Wu
Monocytes and macrophages are crucial elements of the immune system, having various roles in tissue balance, inflammation, and conditions like stroke. They exhibit significant functional diversity, particularly evident in the M1 and M2 phenotypes and their marker characteristics. The functions of monocytes and macrophages are crucial in stroke studies, notably those related to intracerebral hemorrhage (ICH). ICH is the most severe type of stroke, characterized by inflammation, oxidative stress, and neuronal death, significantly increasing patient mortality and morbidity. Monocytes and macrophages play key roles in the inflammatory processes following ICH, participating in hematoma clearance and tissue repair. Despite their potential dual roles in the pathophysiology of ICH, involving both harmful and protective effects, the specific mechanisms remain to be further elucidated. This review summarizes the latest research progress on monocyte and macrophage subsets, with a particular focus on their contributions to ICH. It covers the relationships and differences between monocytes and macrophages, the functional diversity of macrophages, cell phenotypes and functions, regulatory mediators, gene expression and transcriptome analysis, and the clinical prognosis associated with blood monocyte counts. These research advancements aim to provide new insights for improving the diagnosis and treatment strategies for ICH.
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引用次数: 0
Leakage sign based on contrast-enhanced CT is a predictive marker for hematoma expansion and poor prognosis in primary brainstem hemorrhage
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.hest.2024.10.003
Motohisa Koga, Yu Hasegawa, Jin Kikuchi, Aya Hashimoto, Keiichiro Furuta, Takehiro Makizono, Hidenobu Yoshitake, Kimihiko Orito, Motohiro Morioka

Objective

Although hematoma expansion is a poor prognostic factor in patients with intracerebral hemorrhage (ICH), its effect on primary brainstem hemorrhage (PBSH) remains unclear. Since we previously observed the “leakage sign” (LS) on computed tomography (CT) to be a significant predictor for hematoma expansion, we herein investigated the effect of LS in PBSH.

Methods

Between January 2013 and August 2023, 515 patients with ICH were admitted to our institute. Thirty-six patients with PBSHs met the inclusion criteria, who were then divided into LS-positive (LS+) and LS-negative (LS-) groups based on the presence of LS. We evaluated hematoma expansion and prognosis at discharge.

Results

Patients in the LS+ group had larger baseline hematoma volume and lower Glasgow Coma Scale scores on admission and significantly poor prognosis at discharge. Subgroup analysis revealed that LS was frequently observed within 100 min after the onset of symptoms in patients with a hematoma size of >10 mm3 on CT; additionally, patients in the LS+ group more frequently experienced hematoma expansion and had poor prognosis at discharge.

Conclusions

LS is a significant predictive marker for disease severity at admission, hematoma expansion, and poor prognosis at discharge.
{"title":"Leakage sign based on contrast-enhanced CT is a predictive marker for hematoma expansion and poor prognosis in primary brainstem hemorrhage","authors":"Motohisa Koga,&nbsp;Yu Hasegawa,&nbsp;Jin Kikuchi,&nbsp;Aya Hashimoto,&nbsp;Keiichiro Furuta,&nbsp;Takehiro Makizono,&nbsp;Hidenobu Yoshitake,&nbsp;Kimihiko Orito,&nbsp;Motohiro Morioka","doi":"10.1016/j.hest.2024.10.003","DOIUrl":"10.1016/j.hest.2024.10.003","url":null,"abstract":"<div><h3>Objective</h3><div>Although hematoma expansion is a poor prognostic factor in patients with intracerebral hemorrhage (ICH), its effect on primary brainstem hemorrhage (PBSH) remains unclear. Since we previously observed the “leakage sign” (LS) on computed tomography (CT) to be a significant predictor for hematoma expansion, we herein investigated the effect of LS in PBSH.</div></div><div><h3>Methods</h3><div>Between January 2013 and August 2023, 515 patients with ICH were admitted to our institute. Thirty-six patients with PBSHs met the inclusion criteria, who were then divided into LS-positive (LS+) and LS-negative (LS-) groups based on the presence of LS. We evaluated hematoma expansion and prognosis at discharge.</div></div><div><h3>Results</h3><div>Patients in the LS+ group had larger baseline hematoma volume and lower Glasgow Coma Scale scores on admission and significantly poor prognosis at discharge. Subgroup analysis revealed that LS was frequently observed within 100 min after the onset of symptoms in patients with a hematoma size of &gt;10 mm<sup>3</sup> on CT; additionally, patients in the LS+ group more frequently experienced hematoma expansion and had poor prognosis at discharge.</div></div><div><h3>Conclusions</h3><div>LS is a significant predictive marker for disease severity at admission, hematoma expansion, and poor prognosis at discharge.</div></div>","PeriodicalId":33969,"journal":{"name":"Brain Hemorrhages","volume":"6 1","pages":"Pages 19-23"},"PeriodicalIF":1.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bioinformatics analysis of potential pathogenesis and risk genes of neuroinflammation-promoted brain injury in intracerebral hemorrhage 脑出血神经炎症诱发脑损伤潜在发病机制和风险基因的生物信息学分析
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.hest.2024.07.007
Ilgiz Gareev , Ozal Beylerli , Elmar Musaev , Chunlei Wang , Valentin Pavlov
<div><h3>Objective</h3><div>Spontaneous (non-traumatic) intracerebral hemorrhage (ICH) is one of the major causes of global death. The purpose of our bioinformatics analysis was to detect viable pathophysiological targets and small-molecule drug candidates and to identify the precise secondary mechanisms of brain injury in ICH.</div></div><div><h3>Methods</h3><div>The GSE24265 dataset, consisting of data from four perihematomal brain tissues and seven contralateral brain tissues, was downloaded from the Gene Expression Omnibus (GEO) database and screened for differentially expressed genes (DEGs) in ICH. Online analysis tool GEO2R and Drug Susceptibility Assessment Module within the ACBI Bioinformation tool was used for data differential expression analysis. TargetScan, miRDB, and RNA22 were used to investigate the miRNAs regulating the DEGs. The functional annotation of DEGs was performed using Gene Ontology (GO) resources, and the cell signaling pathway analysis of DEGs was performed using the Kyoto Encyclopedia of Genes and Genomes (KEGG). DAVID is used to perform GO function enrichment analysis and KEGG pathway analysis of candidate target genes. Enrichment analysis was performed for delving the molecular mechanism of DEGs, and protein–protein interaction (PPI) networks and microRNA (miRNA)-messenger RNA (mRNA) networks were used to reveal the hub nodes and the related interaction relationships. Hub genes and miRNA-mRNA interaction of PPI network were identified by STRING version 12.0 online software and Cytoscape. Next, the DEGs were analyzed using the L1000CDS2 database to identify small-molecule compounds with potential therapeutic effects.</div></div><div><h3>Results</h3><div>A total of 325 upregulated genes and 103 downregulated genes associated with ICH were identified. The biological functions of DEGs associated with ICH are mainly involved in the inflammatory response, chemokine activity, and immune response. The KEGG analysis identified several pathways significantly associated with ICH, including but not limited to cytokine-cytokine receptor interaction and MAPK signaling pathway. A PPI network consisting of 188 nodes and 563 edges was constructed using STRING, and 27 hub genes were identified with Cytoscape software. The miRNA-mRNA network with high connectivity contained key 27 mRNAs (from C-C motif chemokine ligand 5 (CCL5), C-C motif chemokine ligand 8 (CCL8), …., to dishevelled-associated activator of morphogenesis 1 (DAAM1), and FRAT regulator of WNT signaling pathway 1 (FRAT1)) and 135 candidate miRNAs. These genes and miRNAs are closely related to secondary brain injury induced by ICH. In addition, a L1000CDS<sup>2</sup> analysis of six small-molecule compounds revealed their therapeutic potential.</div></div><div><h3>Conclusions</h3><div>Our study explores the pathogenesis of brain tissue injury promoted by neuroinflammation in ICH and extends the clinical utility of its key genes. At the same time, we constructed a miRNA-mR
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引用次数: 0
The evolution of brain surgery: Exploring the impact of continuum robotics
IF 1.3 Q4 CLINICAL NEUROLOGY Pub Date : 2025-02-01 DOI: 10.1016/j.hest.2024.11.002
Shreya Shah , Pearl Sheth , Rajvi Shah , Dhyey Shekhaliya , Manan Shah
Brain surgery requires at most accuracy and precision, yet current neurosurgical robots are limited in their ability to reach intracranial regions due to their rigid and inflexible nature. However, Continuum robots have great potential and are currently helping to change the face of neurosurgery as we know it. They overcome the challenges of conventional tools by providing much greater flexibility and control, consequently reducing recovery times and improving patient outcomes. Continuum robots are a class of robots characterized by their higher number of degrees of freedom. This flexibility and maneuverability lead to the possibility of minimally invasive procedures which were not possible with conventional methods. This paper profoundly reviews the major research done in the field of continuum robots in neurosurgery and to provide a comparative analysis along with a discussion of the same. The review discusses the state of neurosurgery before continuum robots, the limitations of conventional tools, and why continuum robots are looking so promising for the future of neurosurgery. A detailed comparative analysis of existing research is tabulated to highlight the current challenges and future scope in the development and application of continuum robots in brain surgery.
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引用次数: 0
期刊
Brain Hemorrhages
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