{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:42:30Z","timestamp":1792806150105,"version":"4.5.0"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Superficial temporal artery\u2013middle cerebral artery (STA-MCA) bypass is a common approach for treating moyamoya disease (MMD); however, the selection of recipient vessels is still controversial, and its relationship with postoperative cerebral hyperperfusion (CHP) has not been revealed. The aim of the study was to investigate the relationship between the hemodynamic sources of the recipient parasylvian cortical arteries (PSCAs) and the occurrence of postoperative CHP.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors retrospectively analyzed the clinical data from 68 adult patients (75 hemispheres) with MMD who underwent STA-MCA bypass. Based on their hemodynamic sources from the MCA and non-MCAs, the PSCAs were classified as M-PSCAs and non\u2013M-PSCAs, and their distributional characteristics were studied. Moreover, the patients\u2019 demographics, incidence of postoperative CHP, and post- and preoperative relative cerebral blood flow values were examined.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The digital subtraction angiography analysis demonstrated that 40% (30\/75) of the recipient PSCAs had no hemodynamic relationship with the MCA. The post- and preoperative relative cerebral blood flow values of the M-PSCA group were significantly higher than those of the non\u2013M-PSCA group (p < 0.001). Multivariate analysis revealed that the hemodynamic source of PSCAs from the MCA was significantly associated with the development of focal (p = 0.003) and symptomatic (p = 0.021) CHP. Twelve (85.7%) of the 14 patients with symptomatic CHP and all 4 (100%) patients with postoperative hemorrhage were from the M-PSCA group.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This study revealed that direct anastomoses of PSCAs with anterograde hemodynamic sources from the MCA had a high risk of postoperative CHP during STA-MCA bypass in adult patients with MMD.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2019.10.jns191207","type":"journal-article","created":{"date-parts":[[2019,12,27]],"date-time":"2019-12-27T20:46:43Z","timestamp":1577479603000},"page":"17-24","source":"Crossref","is-referenced-by-count":36,"title":["Hemodynamic analysis of the recipient parasylvian cortical arteries for predicting postoperative hyperperfusion during STA-MCA bypass in adult patients with moyamoya disease"],"prefix":"10.3171","volume":"134","author":[{"given":"Jianjian","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirui","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miki","family":"Fujimura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kohnan Hospital, Sendai, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsz Yeung","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lakeland Regional Hospital, University of South Florida, Lakeland, Florida; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miao","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanpei","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haibo","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenyuan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Li","sequence":"additional","affiliation":[{"name":"Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jincao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/j.surneu.2006.07.017","article-title":"Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease","volume":"67","author":"Fujimura M","year":"2007","unstructured":"Fujimura M, Kaneta T, Mugikura S, Shimizu H, Tominaga T: Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease. Surg Neurol 67:273\u2013282, 20071732063810.1016\/j.surneu.2006.07.017"},{"key":"b2","series-title":"Neurol Res","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1179\/1743132814Y.0000000432","article-title":"Quantitative analysis of early postoperative cerebral blood flow contributes to the prediction and diagnosis of cerebral hyperperfusion syndrome after revascularization surgery for moyamoya disease","volume":"37","author":"Fujimura M","year":"2015","unstructured":"Fujimura M, Niizuma K, Endo H, Sato K, Inoue T, Shimizu H, : Quantitative analysis of early postoperative cerebral blood flow contributes to the prediction and diagnosis of cerebral hyperperfusion syndrome after revascularization surgery for moyamoya disease. Neurol Res 37:131\u2013138, 201510.1179\/1743132814Y.0000000432"},{"key":"b3","series-title":"Neurosurgery","first-page":"957","article-title":"Significance of focal cerebral hyperperfusion as a cause of transient neurologic deterioration after extracranial-intracranial bypass for moyamoya disease: comparative study with non-moyamoya patients using N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography","volume":"68","author":"Fujimura M","year":"2011","unstructured":"Fujimura M, Shimizu H, Inoue T, Mugikura S, Saito A, Tominaga T: Significance of focal cerebral hyperperfusion as a cause of transient neurologic deterioration after extracranial-intracranial bypass for moyamoya disease: comparative study with non-moyamoya patients using N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography. Neurosurgery 68:957\u2013965, 201121221039"},{"key":"b4","series-title":"Tohoku J Exp Med","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1620\/tjem.236.45","article-title":"Current status of revascularization surgery for Moyamoya disease: special consideration for its \u2018internal carotid-external carotid (IC-EC) conversion\u2019 as the physiological reorganization system","volume":"236","author":"Fujimura M","year":"2015","unstructured":"Fujimura M, Tominaga T: Current status of revascularization surgery for Moyamoya disease: special consideration for its \u2018internal carotid-external carotid (IC-EC) conversion\u2019 as the physiological reorganization system. Tohoku J Exp Med 236:45\u201353, 20152597185910.1620\/tjem.236.45"},{"issue":"Suppl 2","key":"b5","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"S238","DOI":"10.1016\/S0303-8467(97)00082-6","article-title":"Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis (\u2018moyamoya\u2019 disease). Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan","volume":"99","author":"Fukui M","year":"1997","unstructured":"Fukui M: Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis (\u2018moyamoya\u2019 disease). Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan. Clin Neurol Neurosurg 99 (Suppl 2):S238\u2013S240, 199710.1016\/S0303-8467(97)00082-69409446"},{"key":"b6","series-title":"J Cereb Blood Flow Metab","doi-asserted-by":"publisher","first-page":"3446","DOI":"10.1177\/0271678X17702394","article-title":"Vascular territorial segmentation and volumetric blood flow measurement using dynamic contrast enhanced magnetic resonance angiography of the brain","volume":"37","author":"Geri O","year":"2017","unstructured":"Geri O, Shiran SI, Roth J, Artzi M, Ben-Sira L, Ben Bashat D: Vascular territorial segmentation and volumetric blood flow measurement using dynamic contrast enhanced magnetic resonance angiography of the brain. J Cereb Blood Flow Metab 37:3446\u20133456, 201710.1177\/0271678X1770239428393638"},{"key":"b7","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"927","DOI":"10.3171\/2009.4.JNS081649","article-title":"Clinical outcome after 450 revascularization procedures for moyamoya disease. Clinical article","volume":"111","author":"Guzman R","year":"2009","unstructured":"Guzman R, Lee M, Achrol A, Bell-Stephens T, Kelly M, Do HM, : Clinical outcome after 450 revascularization procedures for moyamoya disease. Clinical article. J Neurosurg 111:927\u2013935, 20091946304610.3171\/2009.4.JNS081649"},{"key":"b8","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1881","DOI":"10.1161\/01.STR.0000080936.36601.34","article-title":"Dynamic autoregulation testing in patients with middle cerebral artery stenosis","volume":"34","author":"Haubrich C","year":"2003","unstructured":"Haubrich C, Kruska W, Diehl RR, M\u00f6ller-Hartmann W, Kl\u00f6tzsch C: Dynamic autoregulation testing in patients with middle cerebral artery stenosis. Stroke 34:1881\u20131885, 200310.1161\/01.STR.0000080936.36601.3412843352"},{"key":"b9","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"73","DOI":"10.3171\/2010.4.PEDS09478","article-title":"Postoperative neurological deterioration in pediatric moyamoya disease: watershed shift and hyperperfusion","volume":"6","author":"Hayashi T","year":"2010","unstructured":"Hayashi T, Shirane R, Fujimura M, Tominaga T: Postoperative neurological deterioration in pediatric moyamoya disease: watershed shift and hyperperfusion. J Neurosurg Pediatr 6:73\u201381, 201010.3171\/2010.4.PEDS0947820593991"},{"issue":"Suppl 2","key":"b10","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"S142","DOI":"10.1016\/S0303-8467(97)00075-9","article-title":"Direct and indirect revascularization for moyamoya disease surgical techniques and peri-operative complications","volume":"99","author":"Houkin K","year":"1997","unstructured":"Houkin K, Ishikawa T, Yoshimoto T, Abe H: Direct and indirect revascularization for moyamoya disease surgical techniques and peri-operative complications. Clin Neurol Neurosurg 99 (Suppl 2):S142\u2013S145, 1997940942510.1016\/S0303-8467(97)00075-9"},{"key":"b11","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.wneu.2017.07.037","article-title":"Postoperative dilatation of superficial temporal artery associated with transient neurologic symptoms after direct bypass surgery for moyamoya angiopathy","volume":"106","author":"Ishii D","year":"2017","unstructured":"Ishii D, Okazaki T, Matsushige T, Shinagawa K, Ichinose N, Sakamoto S, : Postoperative dilatation of superficial temporal artery associated with transient neurologic symptoms after direct bypass surgery for moyamoya angiopathy. World Neurosurg 106:435\u2013441, 20172872052810.1016\/j.wneu.2017.07.037"},{"issue":"2","key":"b12","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E14","DOI":"10.3171\/2013.12.FOCUS13473","article-title":"Flow-based evaluation of cerebral revascularization using near-infrared indocyanine green videoangiography","volume":"36","author":"Januszewski J","year":"2014","unstructured":"Januszewski J, Beecher JS, Chalif DJ, Dehdashti AR: Flow-based evaluation of cerebral revascularization using near-infrared indocyanine green videoangiography. Neurosurg Focus 36(2):E14, 201410.3171\/2013.12.FOCUS1347324484252"},{"key":"b13","series-title":"J Cereb Blood Flow Metab","doi-asserted-by":"publisher","first-page":"2066","DOI":"10.1038\/jcbfm.2012.110","article-title":"Cerebral blood flow and metabolism of hyperperfusion after cerebral revascularization in patients with moyamoya disease","volume":"32","author":"Kaku Y","year":"2012","unstructured":"Kaku Y, Iihara K, Nakajima N, Kataoka H, Fukuda K, Masuoka J, : Cerebral blood flow and metabolism of hyperperfusion after cerebral revascularization in patients with moyamoya disease. J Cereb Blood Flow Metab 32:2066\u20132075, 20122285040610.1038\/jcbfm.2012.110"},{"key":"b14","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1093\/neuros\/nyx140","article-title":"Berlin grading system can stratify the onset and predict perioperative complications in adult moyamoya disease","volume":"81","author":"Kashiwazaki D","year":"2017","unstructured":"Kashiwazaki D, Akioka N, Kuwayama N, Houkin K, Czabanka M, Vajkoczy P, : Berlin grading system can stratify the onset and predict perioperative complications in adult moyamoya disease. Neurosurgery 81:986\u2013991, 20172860547110.1093\/neuros\/nyx140"},{"key":"b15","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"e388","DOI":"10.1016\/j.wneu.2018.02.190","article-title":"Cerebral hyperperfusion syndrome after revascularization surgery in moyamoya disease: region-symptom mapping and estimating a critical threshold","volume":"114","author":"Kazumata K","year":"2018","unstructured":"Kazumata K, Uchino H, Tokairin K, Ito M, Shiga T, Osanai T, : Cerebral hyperperfusion syndrome after revascularization surgery in moyamoya disease: region-symptom mapping and estimating a critical threshold. World Neurosurg 114:e388\u2013e395, 20182953070610.1016\/j.wneu.2018.02.190"},{"key":"b16","series-title":"Cerebrovasc Dis","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1159\/000132205","article-title":"Transient hyperperfusion after superficial temporal artery\/middle cerebral artery bypass surgery as a possible cause of postoperative transient neurological deterioration","volume":"25","author":"Kim JE","year":"2008","unstructured":"Kim JE, Oh CW, Kwon OK, Park SQ, Kim SE, Kim YK: Transient hyperperfusion after superficial temporal artery\/middle cerebral artery bypass surgery as a possible cause of postoperative transient neurological deterioration. Cerebrovasc Dis 25:580\u2013586, 20081848345810.1159\/000132205"},{"key":"b17","series-title":"Ultrasound Med Biol","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1016\/0301-5629(90)90040-J","article-title":"Relationship between pulsatility indices of Doppler flow signals and CO2-reactivity within the middle cerebral artery in extracranial occlusive disease","volume":"16","author":"Ley-Pozo J","year":"1990","unstructured":"Ley-Pozo J, Willmes K, Ringelstein EB: Relationship between pulsatility indices of Doppler flow signals and CO2-reactivity within the middle cerebral artery in extracranial occlusive disease. Ultrasound Med Biol 16:763\u2013772, 199010.1016\/0301-5629(90)90040-J2128862"},{"key":"b18","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"2279","DOI":"10.1161\/01.STR.0000086465.41263.06","article-title":"Collateral circulation","volume":"34","author":"Liebeskind DS","year":"2003","unstructured":"Liebeskind DS: Collateral circulation. Stroke 34:2279\u20132284, 200310.1161\/01.STR.0000086465.41263.0612881609"},{"key":"b19","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1161\/STROKEAHA.117.018635","article-title":"Factors associated with focal computed tomographic perfusion abnormalities in supratentorial transient ischemic attacks","volume":"49","author":"Meyer IA","year":"2018","unstructured":"Meyer IA, Cereda CW, Correia PN, Zerlauth JB, Puccinelli F, Rotzinger DC, : Factors associated with focal computed tomographic perfusion abnormalities in supratentorial transient ischemic attacks. Stroke 49:68\u201375, 20182921274510.1161\/STROKEAHA.117.018635"},{"key":"b20","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1161\/STROKEAHA.113.004386","article-title":"Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial","volume":"45","author":"Miyamoto S","year":"2014","unstructured":"Miyamoto S, Yoshimoto T, Hashimoto N, Okada Y, Tsuji I, Tominaga T, : Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial. Stroke 45:1415\u20131421, 201410.1161\/STROKEAHA.113.00438624668203"},{"key":"b21","series-title":"Neurosurg Rev","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1007\/s10143-012-0441-y","article-title":"Hemodynamics and changes after STA-MCA anastomosis in moyamoya disease and atherosclerotic cerebrovascular disease measured by micro-Doppler ultrasonography","volume":"36","author":"Morisawa H","year":"2013","unstructured":"Morisawa H, Kawamata T, Kawashima A, Hayashi M, Yamaguchi K, Yoneyama T, : Hemodynamics and changes after STA-MCA anastomosis in moyamoya disease and atherosclerotic cerebrovascular disease measured by micro-Doppler ultrasonography. Neurosurg Rev 36:411\u2013419, 201310.1007\/s10143-012-0441-y23192651"},{"key":"b22","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.surneu.2009.06.023","article-title":"Computed tomographic perfusion in assessing postoperative revascularization in moyamoya disease","volume":"73","author":"Nair AK","unstructured":"Nair AK, Drazin D, Yamamoto J, Boulos AS: Computed tomographic perfusion in assessing postoperative revascularization in moyamoya disease. World Neurosurg 73:93\u201399, e13, 201010.1016\/j.surneu.2009.06.02320860934"},{"key":"b23","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1161\/01.STR.29.3.625","article-title":"Effectiveness of superficial temporal artery-middle cerebral artery anastomosis in adult moyamoya disease: cerebral hemodynamics and clinical course in ischemic and hemorrhagic varieties","volume":"29","author":"Okada Y","year":"1998","unstructured":"Okada Y, Shima T, Nishida M, Yamane K, Yamada T, Yamanaka C: Effectiveness of superficial temporal artery-middle cerebral artery anastomosis in adult moyamoya disease: cerebral hemodynamics and clinical course in ischemic and hemorrhagic varieties. Stroke 29:625\u2013630, 1998950660310.1161\/01.STR.29.3.625"},{"key":"b24","series-title":"Neurol Med Chir (Tokyo)","first-page":"245","article-title":"Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis: Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis)","volume":"52","year":"2012","unstructured":"Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis: Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis). Neurol Med Chir (Tokyo) 52:245\u2013266, 201222870528"},{"key":"b25","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1056\/NEJMra0804622","article-title":"Moyamoya disease and moyamoya syndrome","volume":"360","author":"Scott RM","year":"2009","unstructured":"Scott RM, Smith ER: Moyamoya disease and moyamoya syndrome. N Engl J Med 360:1226\u20131237, 200910.1056\/NEJMra080462219297575"},{"key":"b26","series-title":"Arch Neurol","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1001\/archneur.1969.00480090076012","article-title":"Cerebrovascular \"moyamoya\" disease. Disease showing abnormal net-like vessels in base of brain","volume":"20","author":"Suzuki J","year":"1969","unstructured":"Suzuki J, Takaku A: Cerebrovascular \"moyamoya\" disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 20:288\u2013299, 1969577528310.1001\/archneur.1969.00480090076012"},{"key":"b27","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"2610","DOI":"10.1161\/STROKEAHA.112.654723","article-title":"Predictors and clinical features of postoperative hyperperfusion after surgical revascularization for moyamoya disease: a serial single photon emission CT\/positron emission tomography study","volume":"43","author":"Uchino H","year":"2012","unstructured":"Uchino H, Kuroda S, Hirata K, Shiga T, Houkin K, Tamaki N: Predictors and clinical features of postoperative hyperperfusion after surgical revascularization for moyamoya disease: a serial single photon emission CT\/positron emission tomography study. Stroke 43:2610\u20132616, 201210.1161\/STROKEAHA.112.65472322871684"},{"key":"b28","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1930","DOI":"10.1161\/STROKEAHA.116.013304","article-title":"Edaravone reduces hyperperfusion-related neurological deficits in adult moyamoya disease: historical control study","volume":"47","author":"Uchino H","year":"2016","unstructured":"Uchino H, Nakayama N, Kazumata K, Kuroda S, Houkin K: Edaravone reduces hyperperfusion-related neurological deficits in adult moyamoya disease: historical control study. Stroke 47:1930\u20131932, 201610.1161\/STROKEAHA.116.01330427174526"},{"key":"b29","series-title":"Curr Neurovasc Res","doi-asserted-by":"publisher","first-page":"68","DOI":"10.2174\/1567202612666151027151239","article-title":"Cyclooxygenase-2 and prostaglandin E2 are associated with middle cerebral artery occlusion and hemorrhage in patients with moyamoya disease","volume":"13","author":"Zhang J","year":"2016","unstructured":"Zhang J, Xiong Z, Wang S, He Y, Sun S, Wu X, : Cyclooxygenase-2 and prostaglandin E2 are associated with middle cerebral artery occlusion and hemorrhage in patients with moyamoya disease. Curr Neurovasc Res 13:68\u201374, 201610.2174\/156720261266615102715123926503024"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/134\/1\/article-p17.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/134\/1\/article-p17.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/134\/1\/article-p17.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:15:57Z","timestamp":1792804557000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/134\/1\/article-p17.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":29,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2019.10.jns191207","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1]]}}}