{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:15:17Z","timestamp":1792804517964,"version":"4.5.0"},"reference-count":84,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dystonia is a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both. It can be classified as primary or secondary. There is no cure for dystonia and the goal of treatment is to provide a better quality of life for the patient.<\/jats:p>\n                    <jats:p>Surgical intervention is considered for patients in whom an adequate trial of medical treatment has failed. Deep brain stimulation (DBS), specifically of the globus pallidus interna (GPi), has been shown to be extremely effective in primary generalized dystonia. There is much less evidence for the use of DBS in patients with secondary dystonia. However, given the large number of patients with secondary dystonia, the significant burden on the patients and their families, and the potential for DBS to improve their functional status and comfort level, it is important to continue to investigate the use of DBS in the realm of secondary dystonia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>The objective of this study is to review a series of cases involving patients with secondary dystonia who have been treated with pallidal DBS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review of 9 patients with secondary dystonia who received treatment with DBS between February 2011 and February 2013 was performed. Preoperative and postoperative videos were scored using the Barry-Albright Dystonia Scale (BADS) and Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) by a neurologist specializing in movement disorders. In addition, the patients' families completed a subjective questionnaire to assess the perceived benefit of DBS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The average age at DBS unit implantation was 15.1 years (range 6\u201320 years). The average time to follow-up for the BADS evaluation from battery implantation was 3.8 months (median 3 months). The average time to follow-up for the subjective benefit evaluation was 10.6 months (median 9.5 months). The mean BADS scores improved by 9% from 26.5 to 24 (p = 0.04), and the mean BFMDRS scores improved by 9.3% (p = 0.055). Of note, even in patients with minimal functional improvement, there seemed to be decreased contractures and spasms leading to improved comfort. There were no complications such as infections or hematoma in this case series. In the subjective benefit evaluation, 3 patients' families reported \u201cgood\u201d benefit, 4 reported \u201cminimal\u201d benefit, and 1 reported no benefit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These early results of GPi stimulation in a series of 9 patients suggest that DBS is useful in the treatment of secondary generalized dystonia in children and young adults. Objective improvements in BADS and BFMDRS scores are demonstrated in some patients with generalized secondary dystonia but not in others. Larger follow-up studies of DBS for secondary dystonia, focusing on patient age, history, etiology, and patterns of dystonia, are needed to learn which patients will respond best to DBS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2013.8.focus13300","type":"journal-article","created":{"date-parts":[[2013,11,1]],"date-time":"2013-11-01T05:09:19Z","timestamp":1383282559000},"page":"E7","source":"Crossref","is-referenced-by-count":73,"title":["Deep brain stimulation in children and young adults with secondary dystonia: the Children's Hospital Los Angeles experience"],"prefix":"10.3171","volume":"35","author":[{"given":"Joffre E.","family":"Olaya","sequence":"first","affiliation":[{"name":"Division of Neurosurgery and"},{"name":"Department of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eisha","family":"Christian","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery and"},{"name":"Department of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Ferman","sequence":"additional","affiliation":[{"name":"Division of Child Neurology, Children's Hospital Los Angeles; and"},{"name":"Division of Pediatric Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quyen","family":"Luc","sequence":"additional","affiliation":[{"name":"Division of Child Neurology, Children's Hospital Los Angeles; and"},{"name":"Division of Pediatric Neurology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D.","family":"Krieger","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery and"},{"name":"Department of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terence D.","family":"Sanger","sequence":"additional","affiliation":[{"name":"Division of Child Neurology, Children's Hospital Los Angeles; and"},{"name":"Division of Pediatric Neurology, and"},{"name":"Department of Biomedical Engineering and BioKinesiology, The Keck School of Medicine at USC, University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Liker","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery and"},{"name":"Department of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0350007","series-title":"J Neurosurg Pediatr","first-page":"566","article-title":"Deep brain stimulation in children: experience and technical pearls. Clinical article","volume":"8","author":"Air","year":"2011"},{"issue":"Suppl 1","key":"b2-0350007","series-title":"J Child Neurol","first-page":"S67","article-title":"Neurosurgical treatment of spasticity and other pediatric movement disorders","volume":"18","author":"Albright","year":"2003"},{"key":"b3-0350007","series-title":"Childs Nerv Syst","first-page":"1033","article-title":"Deep brain stimulation for torsion dystonia in children","volume":"23","author":"Alterman","year":"2007"},{"key":"b4-0350007","series-title":"Dev Med Child Neurol","first-page":"404","article-title":"Reliability and responsiveness of the Barry-Albright Dystonia Scale","volume":"41","author":"Barry","year":"1999"},{"key":"b5-0350007","series-title":"Neurosurgery","first-page":"754","article-title":"Risk factors for hemorrhage during microelectrode-guided deep brain stimulation and the introduction of an improved microelectrode design","volume":"64","author":"Ben-Haim","year":"2009"},{"key":"b6-0350007","series-title":"Brain Dev","first-page":"223","article-title":"Bilateral pallidal stimulation in children and adolescents with primary generalized dystonia\u2014report of six patients and literature-based analysis of predictive outcomes variables","volume":"32","author":"Borggraefe","year":"2010"},{"key":"b7-0350007","series-title":"Neurology","first-page":"73","article-title":"Validity and reliability of a rating scale for the primary torsion dystonias","volume":"35","author":"Burke","year":"1985"},{"key":"b8-0350007","series-title":"Adv Neurol","first-page":"423","article-title":"20-year follow-up study of the neurosurgical treatment of dystonia musculorum deformans","volume":"14","author":"Cooper","year":"1976"},{"key":"b9-0350007","series-title":"J Neurosurg","first-page":"189","article-title":"Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long-term results","volume":"101","author":"Coubes","year":"2004"},{"key":"b10-0350007","series-title":"Cerebellar Stimulation for Spasticity and Seizures","author":"Davis","year":"1984"},{"key":"b11-0350007","series-title":"J Neurosurg Sci","first-page":"153","article-title":"A survey of Italian cases of dystonia treated by deep brain stimulation","volume":"51","author":"Egidi","year":"2007"},{"key":"b12-0350007","series-title":"N Engl J Med","first-page":"2077","article-title":"Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease","volume":"362","author":"Follett","year":"2010"},{"key":"b13-0350007","series-title":"Pediatr Neurosurg","first-page":"146","article-title":"Deep brain stimulation in children with dystonia: experience from a tertiary care center","volume":"48","author":"Ghosh","year":"2012"},{"key":"b14-0350007","series-title":"Eur J Paediatr Neurol","first-page":"353","article-title":"Improvement in upper limb function in children with dystonia following deep brain stimulation","volume":"17","author":"Gimeno","year":"2013"},{"key":"b15-0350007","series-title":"Eur J Paediatr Neurol","first-page":"501","article-title":"Beyond the Burke-Fahn-Marsden Dystonia Rating Scale: deep brain stimulation in childhood secondary dystonia","volume":"16","author":"Gimeno","year":"2012"},{"key":"b16-0350007","series-title":"Adv Neurol","first-page":"645","article-title":"Efficacy of cervical cord stimulation in dystonia","volume":"50","author":"Goetz","year":"1988"},{"key":"b17-0350007","series-title":"Can J Anaesth","first-page":"88","article-title":"Venous air embolism during deep brain stimulation surgery in an awake child","volume":"57","author":"Gooden","year":"2010"},{"key":"b18-0350007","series-title":"Neurochirurgia (Stuttg)","first-page":"171","article-title":"Long term results of stereotaxic surgery for infantile dystonia and dyskinesia","volume":"19","author":"Gros","year":"1976"},{"key":"b19-0350007","series-title":"Neurosurgery","first-page":"738","article-title":"Pallidal deep brain stimulation for primary dystonia in children","volume":"68","author":"Haridas","year":"2011"},{"key":"b20-0350007","series-title":"Pediatr Neurol","first-page":"145","article-title":"Simultaneous bilateral pallidoansotomy for idiopathic dystonia musculorum deformans","volume":"14","author":"Iacono","year":"1996"},{"key":"b21-0350007","series-title":"J Korean Neurosurg Soc","first-page":"261","article-title":"Deep brain stimulation of the globus pallidus in a 7-year-old girl with DYT1 generalized dystonia","volume":"52","author":"Jin","year":"2012"},{"key":"b22-0350007","series-title":"Mov Disord","first-page":"647","article-title":"Effects of deep brain stimulation in dyskinetic cerebral palsy: a meta-analysis","volume":"28","author":"Koy","year":"2013"},{"issue":"2","key":"b23-0350007","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Current and future indications for deep brain stimulation in pediatric populations","volume":"29","author":"Lipsman","year":"2010"},{"key":"b24-0350007","series-title":"J Child Neurol","first-page":"840","article-title":"Pallidal stimulation in children: comparison between cerebral palsy and DYT1 dystonia","volume":"28","author":"Marks","year":"2013"},{"key":"b25-0350007","series-title":"Semin Pediatr Neurol","first-page":"90","article-title":"Deep brain stimulation for pediatric movement disorders","volume":"16","author":"Marks","year":"2009"},{"key":"b26-0350007","series-title":"Mov Disord","first-page":"1748","article-title":"Dystonia due to cerebral palsy responds to deep brain stimulation of the globus pallidus internus","volume":"26","author":"Marks","year":"2011"},{"key":"b27-0350007","series-title":"J Clin Anesth","first-page":"213","article-title":"Dexmedetomidine for deep brain stimulator placement in a child with primary generalized dystonia: case report and literature review","volume":"21","author":"Maurtua","year":"2009"},{"key":"b28-0350007","series-title":"J Child Neurol","first-page":"1355","article-title":"Early globus pallidus internus stimulation in pediatric patients with generalized primary dystonia: long-term efficacy and safety","volume":"25","author":"Mehrkens","year":"2010"},{"key":"b29-0350007","series-title":"Mov Disord","first-page":"693","article-title":"Pallidotomy for generalized dystonia","volume":"13","author":"Ondo","year":"1998"},{"key":"b30-0350007","series-title":"Neurosurgery","first-page":"86","article-title":"Deep brain stimulation in DYT1 dystonia: a 10-year experience","volume":"73","author":"Panov","year":"2013"},{"key":"b31-0350007","series-title":"Arch Dis Child","first-page":"708","article-title":"Deep brain stimulation in childhood: an effective treatment for early onset idiopathic generalised dystonia","volume":"92","author":"Parr","year":"2007"},{"key":"b32-0350007","series-title":"Childs Nerv Syst","first-page":"334","article-title":"Treatment of early-onset dystonia: update and a new perspective","volume":"16","author":"Roubertie","year":"2000"},{"key":"b33-0350007","series-title":"Mov Disord","first-page":"1538","article-title":"Definition and classification of hyperkinetic movements in childhood","volume":"25","author":"Sanger","year":"2010"},{"key":"b34-0350007","series-title":"Anesthesiol Res Pract","first-page":"401","article-title":"Anesthesia for pediatric deep brain stimulation","volume":"2010","author":"Sebeo","year":"2010"},{"key":"b35-0350007","series-title":"J Neurosurg","first-page":"488","article-title":"Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes","volume":"104","author":"Starr","year":"2006"},{"key":"b36-0350007","series-title":"J Neurol","first-page":"44","article-title":"An evaluation of rating scales utilized for deep brain stimulation for dystonia","volume":"257","author":"Susatia","year":"2010"},{"key":"b37-0350007","series-title":"Adv Neurol","first-page":"615","article-title":"Thalamotomy in generalized dystonia","volume":"50","author":"Tasker","year":"1988"},{"key":"b38-0350007","series-title":"J Neurosurg","first-page":"673","article-title":"Comparison of atlas- and magnetic resonance imaging\u2013based stereotactic targeting of the globus pallidus internus in the performance of deep brain stimulation for treatment of dystonia","volume":"96","author":"Vayssiere","year":"2002"},{"key":"b39-0350007","series-title":"J Neurosurg","first-page":"784","article-title":"Magnetic resonance imaging stereotactic target localization for deep brain stimulation in dystonic children","volume":"93","author":"Vayssiere","year":"2000"},{"key":"b40-0350007","series-title":"Lancet Neurol","first-page":"709","article-title":"Bilateral pallidal deep brain stimulation for the treatment of patients with dystonia-choreoathetosis cerebral palsy: a prospective pilot study","volume":"8","author":"Vidailhet","year":"2009"},{"key":"b41-0350007","series-title":"Pediatrics","first-page":"1220","article-title":"Trends in the prevalence of cerebral palsy in a population-based study","volume":"110","author":"Winter","year":"2002"},{"key":"b42-0350007","series-title":"Mov Disord","first-page":"1194","article-title":"Stimulation of the globus pallidus internus for childhood-onset dystonia","volume":"20","author":"Zorzi","year":"2005"},{"key":"b1-0350007","series-title":"J Neurosurg Pediatr","first-page":"566","article-title":"Deep brain stimulation in children: experience and technical pearls. Clinical article","volume":"8","author":"Air","year":"2011"},{"issue":"Suppl 1","key":"b2-0350007","series-title":"J Child Neurol","first-page":"S67","article-title":"Neurosurgical treatment of spasticity and other pediatric movement disorders","volume":"18","author":"Albright","year":"2003"},{"key":"b3-0350007","series-title":"Childs Nerv Syst","first-page":"1033","article-title":"Deep brain stimulation for torsion dystonia in children","volume":"23","author":"Alterman","year":"2007"},{"key":"b4-0350007","series-title":"Dev Med Child Neurol","first-page":"404","article-title":"Reliability and responsiveness of the Barry-Albright Dystonia Scale","volume":"41","author":"Barry","year":"1999"},{"key":"b5-0350007","series-title":"Neurosurgery","first-page":"754","article-title":"Risk factors for hemorrhage during microelectrode-guided deep brain stimulation and the introduction of an improved microelectrode design","volume":"64","author":"Ben-Haim","year":"2009"},{"key":"b6-0350007","series-title":"Brain Dev","first-page":"223","article-title":"Bilateral pallidal stimulation in children and adolescents with primary generalized dystonia\u2014report of six patients and literature-based analysis of predictive outcomes variables","volume":"32","author":"Borggraefe","year":"2010"},{"key":"b7-0350007","series-title":"Neurology","first-page":"73","article-title":"Validity and reliability of a rating scale for the primary torsion dystonias","volume":"35","author":"Burke","year":"1985"},{"key":"b8-0350007","series-title":"Adv Neurol","first-page":"423","article-title":"20-year follow-up study of the neurosurgical treatment of dystonia musculorum deformans","volume":"14","author":"Cooper","year":"1976"},{"key":"b9-0350007","series-title":"J Neurosurg","first-page":"189","article-title":"Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long-term results","volume":"101","author":"Coubes","year":"2004"},{"key":"b10-0350007","series-title":"Cerebellar Stimulation for Spasticity and Seizures","author":"Davis","year":"1984"},{"key":"b11-0350007","series-title":"J Neurosurg Sci","first-page":"153","article-title":"A survey of Italian cases of dystonia treated by deep brain stimulation","volume":"51","author":"Egidi","year":"2007"},{"key":"b12-0350007","series-title":"N Engl J Med","first-page":"2077","article-title":"Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease","volume":"362","author":"Follett","year":"2010"},{"key":"b13-0350007","series-title":"Pediatr Neurosurg","first-page":"146","article-title":"Deep brain stimulation in children with dystonia: experience from a tertiary care center","volume":"48","author":"Ghosh","year":"2012"},{"key":"b14-0350007","series-title":"Eur J Paediatr Neurol","first-page":"353","article-title":"Improvement in upper limb function in children with dystonia following deep brain stimulation","volume":"17","author":"Gimeno","year":"2013"},{"key":"b15-0350007","series-title":"Eur J Paediatr Neurol","first-page":"501","article-title":"Beyond the Burke-Fahn-Marsden Dystonia Rating Scale: deep brain stimulation in childhood secondary dystonia","volume":"16","author":"Gimeno","year":"2012"},{"key":"b16-0350007","series-title":"Adv Neurol","first-page":"645","article-title":"Efficacy of cervical cord stimulation in dystonia","volume":"50","author":"Goetz","year":"1988"},{"key":"b17-0350007","series-title":"Can J Anaesth","first-page":"88","article-title":"Venous air embolism during deep brain stimulation surgery in an awake child","volume":"57","author":"Gooden","year":"2010"},{"key":"b18-0350007","series-title":"Neurochirurgia (Stuttg)","first-page":"171","article-title":"Long term results of stereotaxic surgery for infantile dystonia and dyskinesia","volume":"19","author":"Gros","year":"1976"},{"key":"b19-0350007","series-title":"Neurosurgery","first-page":"738","article-title":"Pallidal deep brain stimulation for primary dystonia in children","volume":"68","author":"Haridas","year":"2011"},{"key":"b20-0350007","series-title":"Pediatr Neurol","first-page":"145","article-title":"Simultaneous bilateral pallidoansotomy for idiopathic dystonia musculorum deformans","volume":"14","author":"Iacono","year":"1996"},{"key":"b21-0350007","series-title":"J Korean Neurosurg Soc","first-page":"261","article-title":"Deep brain stimulation of the globus pallidus in a 7-year-old girl with DYT1 generalized dystonia","volume":"52","author":"Jin","year":"2012"},{"key":"b22-0350007","series-title":"Mov Disord","first-page":"647","article-title":"Effects of deep brain stimulation in dyskinetic cerebral palsy: a meta-analysis","volume":"28","author":"Koy","year":"2013"},{"issue":"2","key":"b23-0350007","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Current and future indications for deep brain stimulation in pediatric populations","volume":"29","author":"Lipsman","year":"2010"},{"key":"b24-0350007","series-title":"J Child Neurol","first-page":"840","article-title":"Pallidal stimulation in children: comparison between cerebral palsy and DYT1 dystonia","volume":"28","author":"Marks","year":"2013"},{"key":"b25-0350007","series-title":"Semin Pediatr Neurol","first-page":"90","article-title":"Deep brain stimulation for pediatric movement disorders","volume":"16","author":"Marks","year":"2009"},{"key":"b26-0350007","series-title":"Mov Disord","first-page":"1748","article-title":"Dystonia due to cerebral palsy responds to deep brain stimulation of the globus pallidus internus","volume":"26","author":"Marks","year":"2011"},{"key":"b27-0350007","series-title":"J Clin Anesth","first-page":"213","article-title":"Dexmedetomidine for deep brain stimulator placement in a child with primary generalized dystonia: case report and literature review","volume":"21","author":"Maurtua","year":"2009"},{"key":"b28-0350007","series-title":"J Child Neurol","first-page":"1355","article-title":"Early globus pallidus internus stimulation in pediatric patients with generalized primary dystonia: long-term efficacy and safety","volume":"25","author":"Mehrkens","year":"2010"},{"key":"b29-0350007","series-title":"Mov Disord","first-page":"693","article-title":"Pallidotomy for generalized dystonia","volume":"13","author":"Ondo","year":"1998"},{"key":"b30-0350007","series-title":"Neurosurgery","first-page":"86","article-title":"Deep brain stimulation in DYT1 dystonia: a 10-year experience","volume":"73","author":"Panov","year":"2013"},{"key":"b31-0350007","series-title":"Arch Dis Child","first-page":"708","article-title":"Deep brain stimulation in childhood: an effective treatment for early onset idiopathic generalised dystonia","volume":"92","author":"Parr","year":"2007"},{"key":"b32-0350007","series-title":"Childs Nerv Syst","first-page":"334","article-title":"Treatment of early-onset dystonia: update and a new perspective","volume":"16","author":"Roubertie","year":"2000"},{"key":"b33-0350007","series-title":"Mov Disord","first-page":"1538","article-title":"Definition and classification of hyperkinetic movements in childhood","volume":"25","author":"Sanger","year":"2010"},{"key":"b34-0350007","series-title":"Anesthesiol Res Pract","first-page":"401","article-title":"Anesthesia for pediatric deep brain stimulation","volume":"2010","author":"Sebeo","year":"2010"},{"key":"b35-0350007","series-title":"J Neurosurg","first-page":"488","article-title":"Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes","volume":"104","author":"Starr","year":"2006"},{"key":"b36-0350007","series-title":"J Neurol","first-page":"44","article-title":"An evaluation of rating scales utilized for deep brain stimulation for dystonia","volume":"257","author":"Susatia","year":"2010"},{"key":"b37-0350007","series-title":"Adv Neurol","first-page":"615","article-title":"Thalamotomy in generalized dystonia","volume":"50","author":"Tasker","year":"1988"},{"key":"b38-0350007","series-title":"J Neurosurg","first-page":"673","article-title":"Comparison of atlas- and magnetic resonance imaging\u2013based stereotactic targeting of the globus pallidus internus in the performance of deep brain stimulation for treatment of dystonia","volume":"96","author":"Vayssiere","year":"2002"},{"key":"b39-0350007","series-title":"J Neurosurg","first-page":"784","article-title":"Magnetic resonance imaging stereotactic target localization for deep brain stimulation in dystonic children","volume":"93","author":"Vayssiere","year":"2000"},{"key":"b40-0350007","series-title":"Lancet Neurol","first-page":"709","article-title":"Bilateral pallidal deep brain stimulation for the treatment of patients with dystonia-choreoathetosis cerebral palsy: a prospective pilot study","volume":"8","author":"Vidailhet","year":"2009"},{"key":"b41-0350007","series-title":"Pediatrics","first-page":"1220","article-title":"Trends in the prevalence of cerebral palsy in a population-based study","volume":"110","author":"Winter","year":"2002"},{"key":"b42-0350007","series-title":"Mov Disord","first-page":"1194","article-title":"Stimulation of the globus pallidus internus for childhood-onset dystonia","volume":"20","author":"Zorzi","year":"2005"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/35\/5\/article-pE7.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/35\/5\/article-pE7.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/35\/5\/article-pE7.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:21:08Z","timestamp":1780734068000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/35\/5\/article-pE7.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,11]]},"references-count":84,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2013.8.focus13300","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,11]]}}}