{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:33:27Z","timestamp":1792172007645,"version":"4.4.0"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Despite the controversy surrounding brain invasion (BI) as the sole indicator used to diagnose atypical meningioma, this criterion was still incorporated in the 2021 WHO classification scheme. In this study, the authors investigated the reproducibility of this prognostic effect and the impact of BI on the prognosis in otherwise benign meningioma (benign meningioma with BI).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Patients (n = 1006) with a pathological diagnosis of benign or atypical meningioma according to the latest WHO classification criteria were enrolled in this study. In patients with atypical meningioma, the cases were further categorized as benign meningioma with BI and classical atypical meningioma. Clinical, pathological, and follow-up data were collected. Kaplan-Meier curves were compared with a log-rank test, and univariate and multivariate analyses were performed.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The study patient cohort included 282 (28.0%) individuals who were pathologically confirmed as having BI among all 1006 patients with benign or atypical meningioma. A significant difference in recurrence-free survival was observed between patients who had benign meningioma with BI and those who had classical atypical meningioma (p &lt; 0.001), as well as between patients with benign meningiomas and those without BI (p = 0.003). Multivariate Cox analysis indicated that BI was independently associated with increased risk of relapse in the entire population (HR 1.46, 95% CI 1.01\u20132.12, p = 0.049) and in the atypical meningioma subcohort (HR 2.21, 95% CI 1.32\u20133.71, p = 0.003), as well as the benign meningioma with and without BI subcohorts (HR 1.89, 95% CI 1.01\u20133.56, p = 0.049). Moreover, patients with classical atypical meningiomas had a risk of relapse four times higher than those who had benign meningioma with BI (p &lt; 0.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The findings demonstrate that benign meningioma with BI typically has an intermediate prognosis and can be differentiated from benign meningioma and classical atypical meningioma, which suggests that the importance of the diagnostic effect of BI is insufficiently accounted for in grading of atypical meningioma. Increased emphasis on the presence of BI in patients with atypical meningioma may be helpful in postsurgical decision-making and facilitating improvements in individual therapy.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.2.jns222751","type":"journal-article","created":{"date-parts":[[2023,4,1]],"date-time":"2023-04-01T00:14:32Z","timestamp":1680308072000},"page":"953-964","source":"Crossref","is-referenced-by-count":13,"title":["Is brain invasion sufficient as a stand-alone criterion for grading atypical meningioma?"],"prefix":"10.3171","volume":"139","author":[{"given":"Hao-Yi","family":"Li","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"National Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Zhe","family":"Ying","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"National Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dao","family":"Zheng","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"National Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ge-Hong","family":"Dong","sequence":"additional","affiliation":[{"name":"Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guo-Bin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"National Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang-Ming","family":"Liu","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"National Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song","family":"Lin","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"National Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Hui","family":"Ren","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"National Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhong-Li","family":"Jiang","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"National Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Cancer","first-page":"102","article-title":"Trends in central nervous system tumor incidence relative to other common cancers in adults, adolescents, and children in the United States, 2000 to 2010","volume":"121","author":"Gittleman HR","year":"2015","unstructured":"Gittleman HR, Ostrom QT, Rouse CD,  Trends in central nervous system tumor incidence relative to other common cancers in adults, adolescents, and children in the United States, 2000 to 2010. Cancer. 2015;121(1):102\u2013112."},{"issue":"suppl 4","key":"b2","series-title":"Neuro Oncol","first-page":"iv1","article-title":"CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2011\u20132015","volume":"20","author":"Ostrom QT","year":"2018","unstructured":"Ostrom QT, Gittleman H, Truitt G, Boscia A, Kruchko C, Barnholtz-Sloan JS. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2011\u20132015. Neuro Oncol. 2018;20(suppl 4):iv1\u2013iv86."},{"issue":"5 suppl 5","key":"b3","series-title":"Neuro Oncol","first-page":"v1","article-title":"CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2012\u20132016","volume":"21","author":"Ostrom QT","year":"2019","unstructured":"Ostrom QT, Cioffi G, Gittleman H,  CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2012\u20132016. Neuro Oncol. 2019;21(5 suppl 5):v1\u2013v100."},{"issue":"6","key":"b4","series-title":"Acta Neuropathol","first-page":"803","article-title":"The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary","volume":"131","author":"Louis DN","year":"2016","unstructured":"Louis DN, Perry A, Reifenberger G,  The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016;131(6):803\u2013820."},{"issue":"9","key":"b5","series-title":"Lancet Oncol","first-page":"e383","article-title":"EANO guidelines for the diagnosis and treatment of meningiomas","volume":"17","author":"Goldbrunner R","year":"2016","unstructured":"Goldbrunner R, Minniti G, Preusser M,  EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol. 2016;17(9):e383\u2013e391."},{"issue":"2","key":"b6","series-title":"Radiother Oncol","first-page":"260","article-title":"Adjuvant postoperative high-dose radiotherapy for atypical and malignant meningioma: a phase-II parallel non-randomized and observation study (EORTC 22042-26042)","volume":"128","author":"Weber DC","year":"2018","unstructured":"Weber DC, Ares C, Villa S,  Adjuvant postoperative high-dose radiotherapy for atypical and malignant meningioma: a phase-II parallel non-randomized and observation study (EORTC 22042-26042). Radiother Oncol. 2018;128(2):260\u2013265."},{"issue":"1","key":"b7","series-title":"J Neurooncol","first-page":"125","article-title":"Survival impacts of extent of resection and adjuvant radiotherapy for the modern management of high-grade meningiomas","volume":"145","author":"Li D","year":"2019","unstructured":"Li D, Jiang P, Xu S,  Survival impacts of extent of resection and adjuvant radiotherapy for the modern management of high-grade meningiomas. J Neurooncol. 2019;145(1):125\u2013134."},{"issue":"5","key":"b8","series-title":"Neurooncol Pract","first-page":"346","article-title":"Hypofractionated stereotactic radiotherapy for intracranial meningioma: a systematic review","volume":"6","author":"Nguyen EK","year":"2019","unstructured":"Nguyen EK, Nguyen TK, Boldt G, Louie AV, Bauman GS. Hypofractionated stereotactic radiotherapy for intracranial meningioma: a systematic review. Neurooncol Pract. 2019;6(5):346\u2013353."},{"issue":"11","key":"b9","series-title":"Neuro Oncol","first-page":"1821","article-title":"EANO guideline on the diagnosis and management of meningiomas","volume":"23","author":"Goldbrunner R","year":"2021","unstructured":"Goldbrunner R, Stavrinou P, Jenkinson MD,  EANO guideline on the diagnosis and management of meningiomas. Neuro Oncol. 2021;23(11):1821\u20131834."},{"issue":"2","key":"b10","series-title":"Acta Neuropathol","first-page":"97","article-title":"The 2007 WHO classification of tumours of the central nervous system","volume":"114","author":"Louis DN","year":"2007","unstructured":"Louis DN, Ohgaki H, Wiestler OD,  The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114(2):97\u2013109."},{"key":"b11","series-title":"WHO Classification of Tumours of the Central Nervous System","first-page":"309","article-title":"Meningiomas","author":"Louis DN","year":"2007","unstructured":"Louis DN, Ohgaki H, Wiestler OD,  Meningiomas. In: Bosman FT, Jaffe ES, Lakhani SR, Ohgak H, eds.WHO Classification of Tumours of the Central Nervous System. 4th ed. International Agency for Research on Cancer; 2007:309."},{"issue":"8","key":"b12","series-title":"Neuro Oncol","first-page":"1231","article-title":"The 2021 WHO Classification of Tumors of the Central Nervous System: a summary","volume":"23","author":"Louis DN","year":"2021","unstructured":"Louis DN, Perry A, Wesseling P,  The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol. 2021;23(8):1231\u20131251."},{"issue":"12","key":"b13","series-title":"Am J Surg Pathol","first-page":"1455","article-title":"Meningioma grading: an analysis of histologic parameters","volume":"21","author":"Perry A","year":"1997","unstructured":"Perry A, Stafford SL, Scheithauer BW, Suman VJ, Lohse CM. Meningioma grading: an analysis of histologic parameters. Am J Surg Pathol. 1997;21(12):1455\u20131465."},{"issue":"9","key":"b14","series-title":"Cancer","first-page":"2046","article-title":"\"Malignancy\" in meningiomas: a clinicopathologic study of 116 patients, with grading implications","volume":"85","author":"Perry A","year":"1999","unstructured":"Perry A, Scheithauer BW, Stafford SL, Lohse CM, Wollan PC. \"Malignancy\" in meningiomas: a clinicopathologic study of 116 patients, with grading implications. Cancer. 1999;85(9):2046\u20132056."},{"key":"b15","series-title":"Pathology and Genetics of Tumours of the Nervous System","first-page":"314","author":"Kleihues P","year":"2000","unstructured":"Kleihues P, Cavenee WK. Pathology and Genetics of Tumours of the Nervous System. 2nd ed. IARC Press;2000:314."},{"issue":"3","key":"b16","series-title":"Acta Neuropathol","first-page":"479","article-title":"Brain invasion in otherwise benign meningiomas does not predict tumor recurrence","volume":"132","author":"Baumgarten P","year":"2016","unstructured":"Baumgarten P, Gessler F, Schittenhelm J,  Brain invasion in otherwise benign meningiomas does not predict tumor recurrence. Acta Neuropathol. 2016;132(3):479\u2013481."},{"issue":"1","key":"b17","series-title":"Neurosurgery","first-page":"E42","article-title":"Necrosis and brain invasion predict radio-resistance and tumor recurrence in atypical meningioma: a retrospective cohort study","volume":"88","author":"Garcia-Segura ME","year":"2020","unstructured":"Garcia-Segura ME, Erickson AW, Jairath R, Munoz DG, Das S. Necrosis and brain invasion predict radio-resistance and tumor recurrence in atypical meningioma: a retrospective cohort study. Neurosurgery. 2020;88(1):E42\u2013E48."},{"issue":"2","key":"b18","series-title":"Brain Tumor Pathol","first-page":"81","article-title":"Prognostic significance of brain invasion in meningiomas: systematic review and meta-analysis","volume":"38","author":"Nakasu S","year":"2021","unstructured":"Nakasu S, Nakasu Y. Prognostic significance of brain invasion in meningiomas: systematic review and meta-analysis. Brain Tumor Pathol. 2021;38(2):81\u201395."},{"issue":"3","key":"b19","series-title":"Brain Pathol","first-page":"255","article-title":"The new WHO classification of brain tumours","volume":"3","author":"Kleihues P","year":"1993","unstructured":"Kleihues P, Burger PC, Scheithauer BW. The new WHO classification of brain tumours. Brain Pathol. 1993;3(3):255\u2013268."},{"issue":"6","key":"b20","series-title":"Neuropathol Appl Neurobiol","first-page":"724","article-title":"The prognostic significance of clinicopathological features in meningiomas: microscopic brain invasion can predict patient outcome in otherwise benign meningiomas","volume":"47","author":"Banan R","year":"2021","unstructured":"Banan R, Abbetmeier-Basse M, Hong B,  The prognostic significance of clinicopathological features in meningiomas: microscopic brain invasion can predict patient outcome in otherwise benign meningiomas. Neuropathol Appl Neurobiol. 2021;47(6):724\u2013735."},{"issue":"4","key":"b21","series-title":"Neurosurgery","first-page":"1124","article-title":"Mitotic count, brain invasion, and location are independent predictors of recurrence-free survival in primary atypical and malignant meningiomas: a study of 86 patients","volume":"67","author":"Vranic A","year":"2010","unstructured":"Vranic A, Popovic M, C\u00f6r A, Prestor B, Pizem J. Mitotic count, brain invasion, and location are independent predictors of recurrence-free survival in primary atypical and malignant meningiomas: a study of 86 patients. Neurosurgery. 2010;67(4):1124\u20131132."},{"issue":"3","key":"b22","series-title":"J Neurosurg","first-page":"551","article-title":"The Simpson grading revisited: aggressive surgery and its place in modern meningioma management","volume":"125","author":"Gousias K","year":"2016","unstructured":"Gousias K, Schramm J, Simon M. The Simpson grading revisited: aggressive surgery and its place in modern meningioma management. J Neurosurg. 2016;125(3):551\u2013560."},{"issue":"3","key":"b23","series-title":"J Neurooncol","first-page":"469","article-title":"Microscopic brain invasion in meningiomas previously classified as WHO grade I is not associated with patient outcome","volume":"145","author":"Biczok A","year":"2019","unstructured":"Biczok A, Jungk C, Egensperger R,  Microscopic brain invasion in meningiomas previously classified as WHO grade I is not associated with patient outcome. J Neurooncol. 2019;145(3):469\u2013477."},{"issue":"1","key":"b24","series-title":"J Neurol Neurosurg Psychiatry","first-page":"22","article-title":"The recurrence of intracranial meningiomas after surgical treatment","volume":"20","author":"Simpson D","year":"1957","unstructured":"Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry. 1957;20(1):22\u201339."},{"issue":"10","key":"b25","series-title":"Neuro Oncol","first-page":"1298","article-title":"Brain invasion in meningiomas\u2014clinical considerations and impact of neuropathological evaluation: a systematic review","volume":"19","author":"Brokinkel B","year":"2017","unstructured":"Brokinkel B, Hess K, Mawrin C. Brain invasion in meningiomas\u2014clinical considerations and impact of neuropathological evaluation: a systematic review. Neuro Oncol. 2017;19(10):1298\u20131307."},{"issue":"1","key":"b26","series-title":"Neuro Oncol","first-page":"26","article-title":"Proposed response assessment and endpoints for meningioma clinical trials: report from the Response Assessment in Neuro-Oncology Working Group","volume":"21","author":"Huang RY","year":"2019","unstructured":"Huang RY, Bi WL, Weller M,  Proposed response assessment and endpoints for meningioma clinical trials: report from the Response Assessment in Neuro-Oncology Working Group. Neuro Oncol. 2019;21(1):26\u201336."},{"issue":"1","key":"b27","series-title":"J Neurosurg","first-page":"4","article-title":"Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review","volume":"122","author":"Rogers L","year":"2015","unstructured":"Rogers L, Barani I, Chamberlain M,  Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review. J Neurosurg. 2015;122(1):4\u201323."},{"issue":"5","key":"b28","series-title":"Clin Neuropathol","first-page":"354","article-title":"Brain invasion assessability in meningiomas is related to meningioma size and grade, and can be improved by extensive sampling of the surgically removed meningioma specimen","volume":"33","author":"Pizem J","year":"2014","unstructured":"Pizem J, Velnar T, Prestor B, Mlakar J, Popovic M. Brain invasion assessability in meningiomas is related to meningioma size and grade, and can be improved by extensive sampling of the surgically removed meningioma specimen. Clin Neuropathol. 2014;33(5):354\u2013363."},{"key":"b29","series-title":"World Neurosurg","first-page":"346","article-title":"Brain invasion in meningiomas: incidence and correlations with clinical variables and prognosis","volume":"93","author":"Spille DC","year":"2016","unstructured":"Spille DC, He\u00df K, Sauerland C,  Brain invasion in meningiomas: incidence and correlations with clinical variables and prognosis. World Neurosurg. 2016;93:346\u2013354."},{"issue":"34","key":"b30","series-title":"J Clin Oncol","first-page":"3839","article-title":"Integrated molecular-morphologic meningioma classification: a multicenter retrospective analysis, retrospectively and prospectively validated","volume":"39","author":"Maas SLN","year":"2021","unstructured":"Maas SLN, Stichel D, Hielscher T,  Integrated molecular-morphologic meningioma classification: a multicenter retrospective analysis, retrospectively and prospectively validated. J Clin Oncol. 2021;39(34):3839\u20133852."},{"issue":"7874","key":"b31","series-title":"Nature","first-page":"119","article-title":"A clinically applicable integrative molecular classification of meningiomas","volume":"597","author":"Nassiri F","year":"2021","unstructured":"Nassiri F, Liu J, Patil V,  A clinically applicable integrative molecular classification of meningiomas. Nature. 2021;597(7874):119\u2013125."},{"issue":"5","key":"b32","series-title":"Neuro Oncol","first-page":"783","article-title":"Associations of meningioma molecular subgroup and tumor recurrence","volume":"23","author":"Youngblood MW","year":"2021","unstructured":"Youngblood MW, Miyagishima DF, Jin L,  Associations of meningioma molecular subgroup and tumor recurrence. Neuro Oncol. 2021;23(5):783\u2013794."},{"issue":"17","key":"b33","series-title":"Cancers (Basel)","first-page":"4163","article-title":"Updated systematic review on the role of brain invasion in intracranial meningiomas: what, when, why?","volume":"14","author":"Brunasso L","year":"2022","unstructured":"Brunasso L, Bonosi L, Costanzo R,  Updated systematic review on the role of brain invasion in intracranial meningiomas: what, when, why?. Cancers (Basel). 2022;14(17):4163."},{"issue":"13","key":"b34","series-title":"Cancers (Basel)","first-page":"3259","article-title":"Brain invasion in meningioma\u2014a prognostic potential worth exploring","volume":"13","author":"Behling F","year":"2021","unstructured":"Behling F, Hempel JM, Schittenhelm J. Brain invasion in meningioma\u2014a prognostic potential worth exploring. Cancers (Basel). 2021;13(13):3259."},{"issue":"2","key":"b35","series-title":"J Neurooncol","first-page":"107","article-title":"Extraneural metastases of primary brain tumors","volume":"53","author":"Schweitzer T","year":"2001","unstructured":"Schweitzer T, Vince GH, Herbold C, Roosen K, Tonn JC. Extraneural metastases of primary brain tumors. J Neurooncol. 2001;53(2):107\u2013114."},{"key":"b36","series-title":"J Clin Neurosci","first-page":"37","article-title":"Review of controversies in management of non-benign meningioma","volume":"31","author":"Paldor I","year":"2016","unstructured":"Paldor I, Awad M, Sufaro YZ, Kaye AH, Shoshan Y. Review of controversies in management of non-benign meningioma. J Clin Neurosci. 2016;31:37\u201346."},{"issue":"4","key":"b37","series-title":"Cancer","first-page":"734","article-title":"Gross total resection and adjuvant radiotherapy most significant predictors of improved survival in patients with atypical meningioma","volume":"124","author":"Rydzewski NR","year":"2018","unstructured":"Rydzewski NR, Lesniak MS, Chandler JP,  Gross total resection and adjuvant radiotherapy most significant predictors of improved survival in patients with atypical meningioma. Cancer. 2018;124(4):734\u2013742."},{"issue":"1","key":"b38","series-title":"Cancer","first-page":"47","article-title":"Diagnostic, therapeutic, and prognostic implications of the 2021 World Health Organization classification of tumors of the central nervous system","volume":"128","author":"Gritsch S","year":"2022","unstructured":"Gritsch S, Batchelor TT, Gonzalez Castro LN. Diagnostic, therapeutic, and prognostic implications of the 2021 World Health Organization classification of tumors of the central nervous system. Cancer. 2022;128(1):47\u201358."},{"key":"b39","series-title":"World Neurosurg","first-page":"614","article-title":"Brain invasion in meningiomas: the rising importance of a uniform neuropathologic assessment after the release of the 2016 World Health Organization Classification of Central Nervous System Tumors","volume":"95","author":"Brokinkel B","year":"2016","unstructured":"Brokinkel B, Stummer W. Brain invasion in meningiomas: the rising importance of a uniform neuropathologic assessment after the release of the 2016 World Health Organization Classification of Central Nervous System Tumors. World Neurosurg. 2016;95:614\u2013615."},{"issue":"12","key":"b40","series-title":"Cancers (Basel)","first-page":"3620","article-title":"CNS invasion in meningioma\u2014how the intraoperative assessment can improve the prognostic evaluation of tumor recurrence","volume":"12","author":"Behling F","year":"2020","unstructured":"Behling F, Fodi C, Gepfner-Tuma I,  CNS invasion in meningioma\u2014how the intraoperative assessment can improve the prognostic evaluation of tumor recurrence. Cancers (Basel). 2020;12(12):3620."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/139\/4\/article-p953.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/139\/4\/article-p953.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/139\/4\/article-p953.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T10:49:28Z","timestamp":1716029368000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/139\/4\/article-p953.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,1]]},"references-count":40,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2023.2.jns222751","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,1]]}}}