Pub Date : 2024-09-09DOI: 10.1227/ons.0000000000001350
Thomas M Zervos, Steve S Cho, Sathish Prabu Sathyamangalam Samiappan, Andrew S Little, Griffin D Santarelli, Jennifer S Ronecker, Jamal McClendon
{"title":"Endoscopic, Endonasal, Transsphenoidal, Transclival Approach for Resection of Odontoid Process: 2-Dimensional Operative Video.","authors":"Thomas M Zervos, Steve S Cho, Sathish Prabu Sathyamangalam Samiappan, Andrew S Little, Griffin D Santarelli, Jennifer S Ronecker, Jamal McClendon","doi":"10.1227/ons.0000000000001350","DOIUrl":"https://doi.org/10.1227/ons.0000000000001350","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.1227/ons.0000000000001351
Nasser M F El-Ghandour
{"title":"Commentary: Endoscopic, Endonasal, Transsphenoidal, Transclival Approach for Resection of Odontoid Process: 2-Dimensional Operative Video.","authors":"Nasser M F El-Ghandour","doi":"10.1227/ons.0000000000001351","DOIUrl":"https://doi.org/10.1227/ons.0000000000001351","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-03-05DOI: 10.1227/ons.0000000000001113
Kyriakos Papadimitriou, Eric T Quach, Danielle Golub, Athos Patsalides, Amir R Dehdashti
{"title":"Far Lateral Approach With C1 Hemilaminotomy for Excision of a Ruptured Fusiform Lateral Spinal Artery Aneurysm: 2-Dimensional Operative Video.","authors":"Kyriakos Papadimitriou, Eric T Quach, Danielle Golub, Athos Patsalides, Amir R Dehdashti","doi":"10.1227/ons.0000000000001113","DOIUrl":"10.1227/ons.0000000000001113","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-03-27DOI: 10.1227/ons.0000000000001118
Samuel Brehm, Miguel A Ruiz-Cardozo, Magalie Cadieux, Karma Barot, Karan Joseph, Tim Bui, Michael Ryan Kann, Sofia Lopez-Alviar, Gabriel Trevino, Alexander T Yahanda, Taryn E LeRoy, Julio J Jauregui, Nicholas A Pallotta, Camilo A Molina
Background and objective: There are many surgical approaches for execution of a thoracic corpectomy. In cases of challenging deformity, traditional posterior approaches might not be sufficient to complete the resection of the vertebral body. In this technical note, we describe indications and technique for a transdural multilevel high thoracic corpectomy.
Methods: A 25-year-old man with a history of neurofibromatosis type 1 presented with instrumentation failure after a previous T1-T12 posterior spinal fusion, extensive laminectomy, and tumor resection. The patient presented with progressive back pain, had broad dural ectasia, and a progressive kyphotic rotational and anteriorly translated spinal deformity. To resect the medial-most aspect of the vertebral body, a bilateral extracavitary approach was attempted, but was found insufficient. A transdural approach was subsequently performed. A left paramedian durotomy was made, followed by generous arachnoid dissection, bilateral dentate ligament division, and T4 rootlet sacrifice to mobilize the spinal cord. A ventral durotomy was then made and the ventral dura was reflected over the spinal cord to protect it while drilling. The corpectomy was then completed. The ventral and dorsal durotomies were closed primarily and reinforced with fibrin glue and fibrin sealant patch. The corpectomy defect was filled with nonstructural autograft.
Results: The focal kyphosis was corrected with a combination of rod contouring, compression, and in situ bending. During the surgery, the patient had stable neuromonitoring data, and postoperatively had no neurological deficits. On follow-up until 1 year, the patient presented with no signs of cerebrospinal spinal leaks, no motor or sensory deficits, minimal incisional pain, and significantly improved posture.
Conclusion: Complex high thoracic (T3-5) ventral pathology inaccessible via a bilateral extracavitary approach may be accessed via a transdural approach as opposed to an anterior/lateral transthoracic approach that requires mobilization of cardiovascular structures or scapula.
{"title":"Posterior Transdural Approach for Thoracic Corpectomies in the Setting of Complex Spine Deformity Reconstruction.","authors":"Samuel Brehm, Miguel A Ruiz-Cardozo, Magalie Cadieux, Karma Barot, Karan Joseph, Tim Bui, Michael Ryan Kann, Sofia Lopez-Alviar, Gabriel Trevino, Alexander T Yahanda, Taryn E LeRoy, Julio J Jauregui, Nicholas A Pallotta, Camilo A Molina","doi":"10.1227/ons.0000000000001118","DOIUrl":"10.1227/ons.0000000000001118","url":null,"abstract":"<p><strong>Background and objective: </strong>There are many surgical approaches for execution of a thoracic corpectomy. In cases of challenging deformity, traditional posterior approaches might not be sufficient to complete the resection of the vertebral body. In this technical note, we describe indications and technique for a transdural multilevel high thoracic corpectomy.</p><p><strong>Methods: </strong>A 25-year-old man with a history of neurofibromatosis type 1 presented with instrumentation failure after a previous T1-T12 posterior spinal fusion, extensive laminectomy, and tumor resection. The patient presented with progressive back pain, had broad dural ectasia, and a progressive kyphotic rotational and anteriorly translated spinal deformity. To resect the medial-most aspect of the vertebral body, a bilateral extracavitary approach was attempted, but was found insufficient. A transdural approach was subsequently performed. A left paramedian durotomy was made, followed by generous arachnoid dissection, bilateral dentate ligament division, and T4 rootlet sacrifice to mobilize the spinal cord. A ventral durotomy was then made and the ventral dura was reflected over the spinal cord to protect it while drilling. The corpectomy was then completed. The ventral and dorsal durotomies were closed primarily and reinforced with fibrin glue and fibrin sealant patch. The corpectomy defect was filled with nonstructural autograft.</p><p><strong>Results: </strong>The focal kyphosis was corrected with a combination of rod contouring, compression, and in situ bending. During the surgery, the patient had stable neuromonitoring data, and postoperatively had no neurological deficits. On follow-up until 1 year, the patient presented with no signs of cerebrospinal spinal leaks, no motor or sensory deficits, minimal incisional pain, and significantly improved posture.</p><p><strong>Conclusion: </strong>Complex high thoracic (T3-5) ventral pathology inaccessible via a bilateral extracavitary approach may be accessed via a transdural approach as opposed to an anterior/lateral transthoracic approach that requires mobilization of cardiovascular structures or scapula.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140295313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-03-07DOI: 10.1227/ons.0000000000001123
Christopher S Graffeo, Lea Scherschinski, Jacob F Baranoski, Visish M Srinivasan, Michael T Lawton
{"title":"Microsurgical Resection of a Lateral Pontine Arteriovenous Malformation Masquerading as a Cavernous Malformation: 2-Dimensional Operative Video.","authors":"Christopher S Graffeo, Lea Scherschinski, Jacob F Baranoski, Visish M Srinivasan, Michael T Lawton","doi":"10.1227/ons.0000000000001123","DOIUrl":"10.1227/ons.0000000000001123","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-03-18DOI: 10.1227/ons.0000000000001117
Sophie Peeters, Ulrich Batzdorf, Langston T Holly
{"title":"C4 to C7 Laminoplasty for Resection of an Intradural Intramedullary Ependymoma: 2-Dimensional Operative Video.","authors":"Sophie Peeters, Ulrich Batzdorf, Langston T Holly","doi":"10.1227/ons.0000000000001117","DOIUrl":"10.1227/ons.0000000000001117","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-03-29DOI: 10.1227/ons.0000000000001136
Mariagrazia Nizzola, Edoardo Pompeo, Fabio Torregrossa, Luciano César P C Leonel, Pietro Mortini, Michael J Link, Maria Peris-Celda
Background and objectives: The retrosigmoid approach with transtentorial extension (RTA) allows us to address posterior cranial fossa pathologies that extend through the tentorium into the supratentorial space. Incision of the tentorium cerebelli is challenging, especially for the risk of injury of the cranial nerve (CN) IV. We describe a tentorial incision technique and relevant anatomic landmarks.
Methods: The RTA was performed stepwise on 5 formalin-fixed (10 sides), latex-injected cadaver heads. The porus trigeminus's midpoint, the lateral border of the suprameatal tubercle (SMT)'s base, and cerebellopontine fissure were assessed as anatomic landmarks for the CN IV tentorial entry point, and relative measurements were collected. A clinical case was presented.
Results: The tentorial opening was described in 4 different incisions. The first is curved and starts in the posterior aspect of the tentorium. It has 2 limbs: a medial one directed toward the tentorium's free edge and a lateral one that extends toward the superior petrosal sinus (SPS). The second incision turns inferiorly, medially, and parallel to the SPS down to the SMT. At that level, the second incision turns perpendicular toward the tentorium's free edge and ends 1 cm from it. The third incision proceeds posteriorly, parallel to the free edge. At the cerebellopontine fissure, the incision can turn toward and cut the tentorium-free edge (fourth incision). On average, the CN IV tentorial entry point was 12.7 mm anterior to the SMT base's lateral border and 20.2 mm anterior to the cerebellopontine fissure. It was located approximately in the same coronal plane as the porus trigeminus's midpoint, on average 1.9 mm anterior.
Conclusion: The SMT and the cerebellopontine fissure are consistently located posterior to the CN IV tentorial entry point. They can be used as surgical landmarks for RTA, reducing the risk of injury to the CN IV.
背景和目的:经脑室延伸的后颅窝入路(RTA)使我们能够处理通过脑室触角延伸到脑室上腔的后颅窝病变。切开大脑触角具有挑战性,尤其是有可能损伤颅神经(CN)IV。我们描述了一种触脑切口技术和相关的解剖标志:在 5 个福尔马林固定(10 面)、注射乳胶的尸体头部逐步进行 RTA。三叉孔中点、蝶骨上结节(SMT)基底外侧缘和小脑幕裂被评估为 CN IV 触体切入点的解剖标志,并收集了相对测量值。结果:结果:触角开口被描述为 4 个不同的切口。第一个切口呈弧形,从触角后方开始。它有两个肢体:一个内侧肢体指向触角游离缘,另一个外侧肢体指向上瓣窦(SPS)。第二个切口转向下侧、内侧,与 SPS 平行,直至 SMT。在这一水平,第二个切口转向垂直于触骨游离缘,并在距离触骨游离缘 1 厘米处结束。第三个切口向后延伸,与游离缘平行。在小脑脑裂处,切口可转向无触角边缘并切开(第四切口)。平均而言,CN IV 触体切入点位于 SMT 基底外侧缘前方 12.7 毫米处,小脑幕裂前方 20.2 毫米处。它与三叉孔的中点大致位于同一冠状面上,平均靠前 1.9 mm:结论:SMT 和小脑幕裂始终位于 CN IV 触体进入点的后方。结论:SMT 和小脑幕裂始终位于 CN IV 触体进入点的后方,可作为 RTA 的手术地标,降低 CN IV 受伤的风险。
{"title":"Surgical Anatomy of the Retrosigmoid Approach With Transtentorial Extension: Protecting the 4th Cranial Nerve.","authors":"Mariagrazia Nizzola, Edoardo Pompeo, Fabio Torregrossa, Luciano César P C Leonel, Pietro Mortini, Michael J Link, Maria Peris-Celda","doi":"10.1227/ons.0000000000001136","DOIUrl":"10.1227/ons.0000000000001136","url":null,"abstract":"<p><strong>Background and objectives: </strong>The retrosigmoid approach with transtentorial extension (RTA) allows us to address posterior cranial fossa pathologies that extend through the tentorium into the supratentorial space. Incision of the tentorium cerebelli is challenging, especially for the risk of injury of the cranial nerve (CN) IV. We describe a tentorial incision technique and relevant anatomic landmarks.</p><p><strong>Methods: </strong>The RTA was performed stepwise on 5 formalin-fixed (10 sides), latex-injected cadaver heads. The porus trigeminus's midpoint, the lateral border of the suprameatal tubercle (SMT)'s base, and cerebellopontine fissure were assessed as anatomic landmarks for the CN IV tentorial entry point, and relative measurements were collected. A clinical case was presented.</p><p><strong>Results: </strong>The tentorial opening was described in 4 different incisions. The first is curved and starts in the posterior aspect of the tentorium. It has 2 limbs: a medial one directed toward the tentorium's free edge and a lateral one that extends toward the superior petrosal sinus (SPS). The second incision turns inferiorly, medially, and parallel to the SPS down to the SMT. At that level, the second incision turns perpendicular toward the tentorium's free edge and ends 1 cm from it. The third incision proceeds posteriorly, parallel to the free edge. At the cerebellopontine fissure, the incision can turn toward and cut the tentorium-free edge (fourth incision). On average, the CN IV tentorial entry point was 12.7 mm anterior to the SMT base's lateral border and 20.2 mm anterior to the cerebellopontine fissure. It was located approximately in the same coronal plane as the porus trigeminus's midpoint, on average 1.9 mm anterior.</p><p><strong>Conclusion: </strong>The SMT and the cerebellopontine fissure are consistently located posterior to the CN IV tentorial entry point. They can be used as surgical landmarks for RTA, reducing the risk of injury to the CN IV.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-07-05DOI: 10.1227/ons.0000000000001264
Long Wang, Ao Pei, Dong Zhang
{"title":"Letter: Frontotemporal Approach for Spheno-Orbital Meningioma and Orbital Compartment Resection: Technical Case Instruction: 2-Dimensional Operative Video.","authors":"Long Wang, Ao Pei, Dong Zhang","doi":"10.1227/ons.0000000000001264","DOIUrl":"10.1227/ons.0000000000001264","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-03-07DOI: 10.1227/ons.0000000000001121
Sravani Kondapavulur, Justin K Scheer, Michael M Safaee, Aaron J Clark
Background and objectives: Adjacent segment disease is a relatively common late complication after lumbar fusion. If symptomatic, certain patients require fusion of the degenerated adjacent segment. Currently, there are no posterior completely minimally invasive techniques described for fusion of the adjacent segment above or below a previous fusion. We describe here a novel minimally invasive technique for both implant removal (MIS-IR) and adjacent level transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar stenosis.
Methods: Demographic, surgical, and radiographic outcome data were collected for patients with lumbar stenosis and previous lumbar fusion, who were treated with MIS-IR and MIS-TLIF through the same incision. Radiographic outcomes were assessed postoperatively and complications were assessed at the primary end point of 3 months.
Results: A total of 14 patients (7 female and 7 male), with average age 64.6 years (SD 13.4), were included in this case series. Nine patients had single-level MIS-IR with single-level MIS-TLIF. Three patients had 2-level MIS-IR with single-level MIS-TLIF. Two patients had single-level MIS-IR with 2-level MIS-TLIF. Only 1 patient had a postoperative complication-hematoma requiring same-day evacuation. There were no other complications at the primary end point and no fusion failure at the hardware removal levels to date (average follow-up, 11 months). Average increases in posterior disk height and foraminal height after MIS-TLIF were 4.44, and 2.18 mm, respectively.
Conclusion: Minimally invasive spinal IR can be successfully completed along with adjacent level TLIF through the same incisions, via an all-posterior approach.
{"title":"Completely Minimally Invasive Implant Removal and Transforaminal Lumbar Interbody Fusion for Adjacent Segment Disease: Case Series and Operative Video.","authors":"Sravani Kondapavulur, Justin K Scheer, Michael M Safaee, Aaron J Clark","doi":"10.1227/ons.0000000000001121","DOIUrl":"10.1227/ons.0000000000001121","url":null,"abstract":"<p><strong>Background and objectives: </strong>Adjacent segment disease is a relatively common late complication after lumbar fusion. If symptomatic, certain patients require fusion of the degenerated adjacent segment. Currently, there are no posterior completely minimally invasive techniques described for fusion of the adjacent segment above or below a previous fusion. We describe here a novel minimally invasive technique for both implant removal (MIS-IR) and adjacent level transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar stenosis.</p><p><strong>Methods: </strong>Demographic, surgical, and radiographic outcome data were collected for patients with lumbar stenosis and previous lumbar fusion, who were treated with MIS-IR and MIS-TLIF through the same incision. Radiographic outcomes were assessed postoperatively and complications were assessed at the primary end point of 3 months.</p><p><strong>Results: </strong>A total of 14 patients (7 female and 7 male), with average age 64.6 years (SD 13.4), were included in this case series. Nine patients had single-level MIS-IR with single-level MIS-TLIF. Three patients had 2-level MIS-IR with single-level MIS-TLIF. Two patients had single-level MIS-IR with 2-level MIS-TLIF. Only 1 patient had a postoperative complication-hematoma requiring same-day evacuation. There were no other complications at the primary end point and no fusion failure at the hardware removal levels to date (average follow-up, 11 months). Average increases in posterior disk height and foraminal height after MIS-TLIF were 4.44, and 2.18 mm, respectively.</p><p><strong>Conclusion: </strong>Minimally invasive spinal IR can be successfully completed along with adjacent level TLIF through the same incisions, via an all-posterior approach.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-03-18DOI: 10.1227/ons.0000000000001133
Matías Baldoncini, Valeria Forlizzi, Juan F Villalonga, Carlos Castillo Rangel, Derek O Pipolo, Alvaro Campero
{"title":"Microsurgical Resection of a Medulla Oblongata Cavernoma: 3-Dimensional Operative Video.","authors":"Matías Baldoncini, Valeria Forlizzi, Juan F Villalonga, Carlos Castillo Rangel, Derek O Pipolo, Alvaro Campero","doi":"10.1227/ons.0000000000001133","DOIUrl":"10.1227/ons.0000000000001133","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}