{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T00:48:51Z","timestamp":1780102131163,"version":"3.54.0"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,10]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Recent trials have shown the safety and benefits of fetoscopic treatment of myelomeningocele (MMC). The authors\u2019 aim was to report their preliminary results of prenatal fetoscopic treatment of MMC using a biocellulose patch, focusing on neurological outcomes, fetal and maternal complications, neonatal CSF leakage, postnatal hydrocephalus, and radiological outcomes.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Preoperative assessment included clinical examination, ultrasound imaging, and MRI of the fetus. Patients underwent purely fetoscopic in utero MMC repair, followed by postoperative in utero and postnatal MRI. All participants received multidisciplinary follow-up.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Five pregnant women carrying fetuses affected by MMC signed informed consent for the fetoscopic treatment of the defect. The mean MMC size was 30.4 mm (range 19\u201349 mm). Defect locations were L1 (2 cases), L5 (2 cases), and L4 (1 case). Hindbrain herniation and ventriculomegaly were documented in all cases. The mean gestational age at surgery was 28.2 weeks (range 27.8\u201328.8 weeks). Fetoscopic repair was performed in all cases. The mean gestational age at delivery was 33.9 weeks (range 29.3\u201337.4 weeks). After surgery, reversal of hindbrain herniation was documented in all cases. Three newborns developed signs of hydrocephalus requiring CSF diversion. Neurological outcomes in terms of motor level were favorable in all cases, but a premature newborn died due to CSF infection and sepsis.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The authors\u2019 preliminary results suggest that fetoscopic treatment of MMC is feasible, reproducible, and safe for mothers and their babies. Neurological outcomes were favorable and similar to those in the available literature. As known, prematurity was the greatest complication.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2019.8.focus19438","type":"journal-article","created":{"date-parts":[[2019,10,4]],"date-time":"2019-10-04T19:23:37Z","timestamp":1570217017000},"page":"E12","source":"Crossref","is-referenced-by-count":22,"title":["Minimally invasive fetal surgery for myelomeningocele: preliminary report from a single center"],"prefix":"10.3171","volume":"47","author":[{"given":"Giorgio","family":"Carrabba","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Macchini","sequence":"additional","affiliation":[{"name":"Pediatric Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Fabietti","sequence":"additional","affiliation":[{"name":"Obstetrics\u2014Fetal Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Schisano","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Meccariello","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolando","family":"Campanella","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Bertani","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Locatelli","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Boito","sequence":"additional","affiliation":[{"name":"Obstetrics\u2014Fetal Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuliana A.","family":"Porro","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Gabetta","sequence":"additional","affiliation":[{"name":"Pediatric Plastic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Odoardo","family":"Picciolini","sequence":"additional","affiliation":[{"name":"Pediatric Physiatry,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Cinnante","sequence":"additional","affiliation":[{"name":"Neuroradiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Triulzi","sequence":"additional","affiliation":[{"name":"Neuroradiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Ciralli","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milano, Italy; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Mosca","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milano, Italy; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise A.","family":"Lapa","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein Centro De Terapia Fetal, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Leva","sequence":"additional","affiliation":[{"name":"Pediatric Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Rampini","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Persico","sequence":"additional","affiliation":[{"name":"Obstetrics\u2014Fetal Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Semin Pediatr Surg","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1053\/j.sempedsurg.2012.10.003","article-title":"Fetal surgery for spina bifida: past, present, future","volume":"22","author":"Adzick NS","year":"2013","unstructured":"Adzick NS: Fetal surgery for spina bifida: past, present, future. Semin Pediatr Surg 22:10\u201317, 20132339514010.1053\/j.sempedsurg.2012.10.003"},{"key":"b2","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1056\/NEJMoa1014379","article-title":"A randomized trial of prenatal versus postnatal repair of myelomeningocele","volume":"364","author":"Adzick NS","year":"2011","unstructured":"Adzick NS, Thom EA, Spong CY, Brock JW III, Burrows PK, Johnson MP, : A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 364:993\u20131004, 20112130627710.1056\/NEJMoa1014379"},{"key":"b3","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1227\/00006123-199006000-00011","article-title":"The paralysis associated with myelomeningocele: clinical and experimental data implicating a preventable spinal cord injury","volume":"26","author":"Heffez DS","year":"1990","unstructured":"Heffez DS, Aryanpur J, Hutchins GM, Freeman JM: The paralysis associated with myelomeningocele: clinical and experimental data implicating a preventable spinal cord injury. Neurosurgery 26:987\u2013992, 1990236267610.1227\/00006123-199006000-00011"},{"key":"b4","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1007\/s00381-017-3440-z","article-title":"Prenatal surgery for myelomeningocele: review of the literature and future directions","volume":"33","author":"Heuer GG","year":"2017","unstructured":"Heuer GG, Moldenhauer JS, Scott Adzick N: Prenatal surgery for myelomeningocele: review of the literature and future directions. Childs Nerv Syst 33:1149\u20131155, 201710.1007\/s00381-017-3440-z28516217"},{"key":"b5","series-title":"Fetal Diagn Ther","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1159\/000479505","article-title":"Fetal surgery for myelomeningocele: a systematic review and meta-analysis of outcomes in fetoscopic versus open repair","volume":"43","author":"Kabagambe SK","year":"2018","unstructured":"Kabagambe SK, Jensen GW, Chen YJ, Vanover MA, Farmer DL: Fetal surgery for myelomeningocele: a systematic review and meta-analysis of outcomes in fetoscopic versus open repair. Fetal Diagn Ther 43:161\u2013174, 201810.1159\/00047950528910784"},{"key":"b6","series-title":"Minerva Pediatr","first-page":"341","article-title":"Fetal surgery for myelomeningocele: history, research, clinical trials, and future directions","volume":"67","author":"Keller BA","year":"2015","unstructured":"Keller BA, Farmer DL: Fetal surgery for myelomeningocele: history, research, clinical trials, and future directions. Minerva Pediatr 67:341\u2013356, 201525698128"},{"key":"b7","series-title":"Pediatr Surg Int","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1007\/s00383-016-4044-5","article-title":"Fetal surgery: a critical review","volume":"33","author":"Kitagawa H","year":"2017","unstructured":"Kitagawa H, Pringle KC: Fetal surgery: a critical review. Pediatr Surg Int 33:421\u2013433, 201710.1007\/s00383-016-4044-528058487"},{"key":"b8","series-title":"Surg Endosc","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1007\/s00464-008-0153-0","article-title":"Percutaneous fetoscopic patch closure of human spina bifida aperta: advances in fetal surgical techniques may obviate the need for early postnatal neurosurgical intervention","volume":"23","author":"Kohl T","year":"2009","unstructured":"Kohl T, Tchatcheva K, Merz W, Wartenberg HC, Heep A, M\u00fcller A, : Percutaneous fetoscopic patch closure of human spina bifida aperta: advances in fetal surgical techniques may obviate the need for early postnatal neurosurgical intervention. Surg Endosc 23:890\u2013895, 200910.1007\/s00464-008-0153-018818968"},{"key":"b9","series-title":"Nat Med","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1038\/nm0495-342","article-title":"utero surgery rescues neurological function at birth in sheep with spina bifida","volume":"1","author":"Meuli M","year":"1995","unstructured":"Meuli M, Meuli-Simmen C, Hutchins GM, Yingling CD, Hoffman KM, Harrison MR, : In utero surgery rescues neurological function at birth in sheep with spina bifida. Nat Med 1:342\u2013347, 1995758506410.1038\/nm0495-342"},{"key":"b10","series-title":"Am J Obstet Gynecol","doi-asserted-by":"publisher","first-page":"111.e1","DOI":"10.1016\/j.ajog.2015.09.065","article-title":"Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial","volume":"214","author":"Pedreira DA","year":"2016","unstructured":"Pedreira DA, Zanon N, Nishikuni K, Moreira de S\u00e1 RA, Acacio GL, Chmait RH, : Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial. Am J Obstet Gynecol 214:111.e1\u2013111.e11, 201610.1016\/j.ajog.2015.09.065"},{"key":"b11","series-title":"Curr Opin Obstet Gynecol","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1097\/GCO.0000000000000253","article-title":"Prenatal surgery for myelomeningocele","volume":"28","author":"Peranteau WH","year":"2016","unstructured":"Peranteau WH, Adzick NS: Prenatal surgery for myelomeningocele. Curr Opin Obstet Gynecol 28:111\u2013118, 201610.1097\/GCO.000000000000025326866841"},{"key":"b12","series-title":"Am J Obstet Gynecol","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/j.ajog.2005.08.032","article-title":"Screening for major structural abnormalities at the 11- to 14-week ultrasound scan","volume":"194","author":"Souka AP","year":"2006","unstructured":"Souka AP, Pilalis A, Kavalakis I, Antsaklis P, Papantoniou N, Mesogitis S, : Screening for major structural abnormalities at the 11- to 14-week ultrasound scan. Am J Obstet Gynecol 194:393\u2013396, 200610.1016\/j.ajog.2005.08.03216458635"},{"issue":"3 Suppl","key":"b13","series-title":"J Neurosurg","first-page":"213","article-title":"Fetal spina bifida in a mouse model: loss of neural function in utero","volume":"106","author":"Stiefel D","year":"2007","unstructured":"Stiefel D, Copp AJ, Meuli M: Fetal spina bifida in a mouse model: loss of neural function in utero. J Neurosurg 106 (3 Suppl):213\u2013221, 2007"},{"key":"b14","series-title":"Best Pract Res Clin Obstet Gynaecol","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.bpobgyn.2007.07.004","article-title":"Fetal surgery for neural tube defects","volume":"22","author":"Sutton LN","year":"2008","unstructured":"Sutton LN: Fetal surgery for neural tube defects. Best Pract Res Clin Obstet Gynaecol 22:175\u2013188, 20081771499710.1016\/j.bpobgyn.2007.07.004"},{"key":"b15","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1016\/S0140-6736(09)61922-X","article-title":"20-year survival of children born with congenital anomalies: a population-based study","volume":"375","author":"Tennant PW","year":"2010","unstructured":"Tennant PW, Pearce MS, Bythell M, Rankin J: 20-year survival of children born with congenital anomalies: a population-based study. Lancet 375:649\u2013656, 201010.1016\/S0140-6736(09)61922-X20092884"},{"key":"b16","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"613","DOI":"10.3171\/2015.7.PEDS15336","article-title":"Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement","volume":"16","author":"Tulipan N","year":"2015","unstructured":"Tulipan N, Wellons JC III, Thom EA, Gupta N, Sutton LN, Burrows PK, : Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. J Neurosurg Pediatr 16:613\u2013620, 20152636937110.3171\/2015.7.PEDS15336"},{"key":"b1","series-title":"Semin Pediatr Surg","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1053\/j.sempedsurg.2012.10.003","article-title":"Fetal surgery for spina bifida: past, present, future","volume":"22","author":"Adzick NS","year":"2013","unstructured":"Adzick NS: Fetal surgery for spina bifida: past, present, future. Semin Pediatr Surg 22:10\u201317, 20132339514010.1053\/j.sempedsurg.2012.10.003"},{"key":"b2","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1056\/NEJMoa1014379","article-title":"A randomized trial of prenatal versus postnatal repair of myelomeningocele","volume":"364","author":"Adzick NS","year":"2011","unstructured":"Adzick NS, Thom EA, Spong CY, Brock JW III, Burrows PK, Johnson MP, : A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Engl J Med 364:993\u20131004, 20112130627710.1056\/NEJMoa1014379"},{"key":"b3","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1227\/00006123-199006000-00011","article-title":"The paralysis associated with myelomeningocele: clinical and experimental data implicating a preventable spinal cord injury","volume":"26","author":"Heffez DS","year":"1990","unstructured":"Heffez DS, Aryanpur J, Hutchins GM, Freeman JM: The paralysis associated with myelomeningocele: clinical and experimental data implicating a preventable spinal cord injury. Neurosurgery 26:987\u2013992, 1990236267610.1227\/00006123-199006000-00011"},{"key":"b4","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1007\/s00381-017-3440-z","article-title":"Prenatal surgery for myelomeningocele: review of the literature and future directions","volume":"33","author":"Heuer GG","year":"2017","unstructured":"Heuer GG, Moldenhauer JS, Scott Adzick N: Prenatal surgery for myelomeningocele: review of the literature and future directions. Childs Nerv Syst 33:1149\u20131155, 201710.1007\/s00381-017-3440-z28516217"},{"key":"b5","series-title":"Fetal Diagn Ther","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1159\/000479505","article-title":"Fetal surgery for myelomeningocele: a systematic review and meta-analysis of outcomes in fetoscopic versus open repair","volume":"43","author":"Kabagambe SK","year":"2018","unstructured":"Kabagambe SK, Jensen GW, Chen YJ, Vanover MA, Farmer DL: Fetal surgery for myelomeningocele: a systematic review and meta-analysis of outcomes in fetoscopic versus open repair. Fetal Diagn Ther 43:161\u2013174, 201810.1159\/00047950528910784"},{"key":"b6","series-title":"Minerva Pediatr","first-page":"341","article-title":"Fetal surgery for myelomeningocele: history, research, clinical trials, and future directions","volume":"67","author":"Keller BA","year":"2015","unstructured":"Keller BA, Farmer DL: Fetal surgery for myelomeningocele: history, research, clinical trials, and future directions. Minerva Pediatr 67:341\u2013356, 201525698128"},{"key":"b7","series-title":"Pediatr Surg Int","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1007\/s00383-016-4044-5","article-title":"Fetal surgery: a critical review","volume":"33","author":"Kitagawa H","year":"2017","unstructured":"Kitagawa H, Pringle KC: Fetal surgery: a critical review. Pediatr Surg Int 33:421\u2013433, 201710.1007\/s00383-016-4044-528058487"},{"key":"b8","series-title":"Surg Endosc","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1007\/s00464-008-0153-0","article-title":"Percutaneous fetoscopic patch closure of human spina bifida aperta: advances in fetal surgical techniques may obviate the need for early postnatal neurosurgical intervention","volume":"23","author":"Kohl T","year":"2009","unstructured":"Kohl T, Tchatcheva K, Merz W, Wartenberg HC, Heep A, M\u00fcller A, : Percutaneous fetoscopic patch closure of human spina bifida aperta: advances in fetal surgical techniques may obviate the need for early postnatal neurosurgical intervention. Surg Endosc 23:890\u2013895, 200910.1007\/s00464-008-0153-018818968"},{"key":"b9","series-title":"Nat Med","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1038\/nm0495-342","article-title":"utero surgery rescues neurological function at birth in sheep with spina bifida","volume":"1","author":"Meuli M","year":"1995","unstructured":"Meuli M, Meuli-Simmen C, Hutchins GM, Yingling CD, Hoffman KM, Harrison MR, : In utero surgery rescues neurological function at birth in sheep with spina bifida. Nat Med 1:342\u2013347, 1995758506410.1038\/nm0495-342"},{"key":"b10","series-title":"Am J Obstet Gynecol","doi-asserted-by":"publisher","first-page":"111.e1","DOI":"10.1016\/j.ajog.2015.09.065","article-title":"Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial","volume":"214","author":"Pedreira DA","year":"2016","unstructured":"Pedreira DA, Zanon N, Nishikuni K, Moreira de S\u00e1 RA, Acacio GL, Chmait RH, : Endoscopic surgery for the antenatal treatment of myelomeningocele: the CECAM trial. Am J Obstet Gynecol 214:111.e1\u2013111.e11, 201610.1016\/j.ajog.2015.09.065"},{"key":"b11","series-title":"Curr Opin Obstet Gynecol","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1097\/GCO.0000000000000253","article-title":"Prenatal surgery for myelomeningocele","volume":"28","author":"Peranteau WH","year":"2016","unstructured":"Peranteau WH, Adzick NS: Prenatal surgery for myelomeningocele. Curr Opin Obstet Gynecol 28:111\u2013118, 201610.1097\/GCO.000000000000025326866841"},{"key":"b12","series-title":"Am J Obstet Gynecol","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/j.ajog.2005.08.032","article-title":"Screening for major structural abnormalities at the 11- to 14-week ultrasound scan","volume":"194","author":"Souka AP","year":"2006","unstructured":"Souka AP, Pilalis A, Kavalakis I, Antsaklis P, Papantoniou N, Mesogitis S, : Screening for major structural abnormalities at the 11- to 14-week ultrasound scan. Am J Obstet Gynecol 194:393\u2013396, 200610.1016\/j.ajog.2005.08.03216458635"},{"issue":"3 Suppl","key":"b13","series-title":"J Neurosurg","first-page":"213","article-title":"Fetal spina bifida in a mouse model: loss of neural function in utero","volume":"106","author":"Stiefel D","year":"2007","unstructured":"Stiefel D, Copp AJ, Meuli M: Fetal spina bifida in a mouse model: loss of neural function in utero. J Neurosurg 106 (3 Suppl):213\u2013221, 2007"},{"key":"b14","series-title":"Best Pract Res Clin Obstet Gynaecol","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.bpobgyn.2007.07.004","article-title":"Fetal surgery for neural tube defects","volume":"22","author":"Sutton LN","year":"2008","unstructured":"Sutton LN: Fetal surgery for neural tube defects. Best Pract Res Clin Obstet Gynaecol 22:175\u2013188, 20081771499710.1016\/j.bpobgyn.2007.07.004"},{"key":"b15","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1016\/S0140-6736(09)61922-X","article-title":"20-year survival of children born with congenital anomalies: a population-based study","volume":"375","author":"Tennant PW","year":"2010","unstructured":"Tennant PW, Pearce MS, Bythell M, Rankin J: 20-year survival of children born with congenital anomalies: a population-based study. Lancet 375:649\u2013656, 201010.1016\/S0140-6736(09)61922-X20092884"},{"key":"b16","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"613","DOI":"10.3171\/2015.7.PEDS15336","article-title":"Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement","volume":"16","author":"Tulipan N","year":"2015","unstructured":"Tulipan N, Wellons JC III, Thom EA, Gupta N, Sutton LN, Burrows PK, : Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement. J Neurosurg Pediatr 16:613\u2013620, 20152636937110.3171\/2015.7.PEDS15336"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/47\/4\/article-pE12.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/47\/4\/article-pE12.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/47\/4\/article-pE12.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T08:36:21Z","timestamp":1779525381000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/47\/4\/article-pE12.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10]]},"references-count":32,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2019.8.focus19438","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10]]}}}