{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T10:25:05Z","timestamp":1794219905356,"version":"4.8.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>MRI-guided focused ultrasound (MRgFUS) thalamotomy is used to treat tremors. Identifying the correct area to ablate relies on subjective physician assessment of tremor improvement during treatment. To address this limitation, objective quantification of tremor severity during MRgFUS is needed. The aim of this study was to develop and evaluate an objective method for quantifying tremor progression during MRgFUS using an MRI-compatible accelerometer and tablet.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Forty patients (30 male, mean age 74.5 years) who underwent MRgFUS thalamotomy to treat tremor were included in this analysis. All patients were evaluated during the procedure using analysis of drawn Archimedean spirals and a pen-mounted accelerometer. The severity of the tremor was determined by analysis of the rhythmic oscillatory patterns present in the drawings and accelerometer recordings after each sonication delivered. The patient\u2019s drawings were evaluated by two movement disorder neurologists using the drawing subsection of The Essential Tremor Rating Assessment Scale (TETRAS), and subsequently compared with the TETRAS score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Using these methods, the mean \u00b1 standard error of the improvements in tremor after MRgFUS thalamotomy was 63.6% \u00b1 7% by accelerometer analysis, 72.4% \u00b1 9.9% by written spiral analysis, 68% \u00b1 6.7% by combining the accelerometer and written spiral analyses, and 33.6% \u00b1 3.1% by TETRAS analysis. When stratifying based on temperature, improvement was 22.8% \u00b1 4.4% at &lt; 50\u00b0C, 48.9% \u00b1 5.5% at 50\u00b0C\u201353\u00b0C, and 70.8% \u00b1 2.9% at &gt; 53\u00b0C.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The measurements from the accelerometer and written spiral analysis were comparable with expert analysis of TETRAS scores, but the accelerometer had greater sensitivity for subtle improvement in tremor. This system of analysis provides an objective and instantaneous measure of tremor improvement during MRgFUS, potentially making the procedure safer and more efficient.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.1.jns252047","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:40Z","timestamp":1780444840000},"page":"291-301","source":"Crossref","is-referenced-by-count":0,"title":["Combined accelerometry and writing analysis for quantifying tremor during focused ultrasound thalamotomy"],"prefix":"10.3171","volume":"145","author":[{"given":"Andrew E.","family":"Toader","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"},{"name":"School of Medicine, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nemanja","family":"Useinovic","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beck","family":"Shafie","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew C.","family":"Henn","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"Joyce","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haley D.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee E.","family":"Neilson","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oregon Health & Science University, Portland;"},{"name":"Department of Neurology, University of Iowa, Iowa City, Iowa; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delaram","family":"Safarpour","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oregon Health & Science University, Portland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M.","family":"Raslan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel R.","family":"Cleary","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon;"},{"name":"Department of Surgery, VA Portland Health Care, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"28","key":"b1","series-title":"Tremor Other Hyperkinet Mov (N Y)","article-title":"How common is essential tremor? Update on the worldwide prevalence of essential tremor","volume":"11","author":"Louis ED","year":"2021","unstructured":"Louis ED, McCreary M. How common is essential tremor? Update on the worldwide prevalence of essential tremor. Tremor Other Hyperkinet Mov (N Y). 2021;11:28. doi:10.5334\/tohm.632"},{"key":"b2","series-title":"Cerebellum Ataxias","first-page":"12","article-title":"Essential tremor: the most common form of cerebellar degeneration?","volume":"7","author":"Louis ED","year":"2020","unstructured":"Louis ED, Faust PL. Essential tremor: the most common form of cerebellar degeneration? Cerebellum Ataxias. 2020;7:12. doi:10.1186\/s40673-020-00121-1"},{"key":"b3","series-title":"Front Neurol","first-page":"891446","article-title":"Essential tremor patients experience significant burden beyond tremor: a systematic literature review","volume":"13","author":"Gerbasi ME","year":"2022","unstructured":"Gerbasi ME, Nambiar S, Reed S,  Essential tremor patients experience significant burden beyond tremor: a systematic literature review. Front Neurol. 2022;13:891446. doi:10.3389\/fneur.2022.891446"},{"issue":"5","key":"b4","series-title":"Acta Neurol Scand","first-page":"289","article-title":"Quality of life in a random sample of community dwelling older patients with essential tremor","volume":"116","author":"Nguyen HV","year":"2007","unstructured":"Nguyen HV, Ngian V, Cordato D, Shen Q, Chan DK. Quality of life in a random sample of community dwelling older patients with essential tremor. Acta Neurol Scand. 2007;116(5):289\u2013292. doi:10.1111\/j.1600-0404.2007.00863.x"},{"issue":"1","key":"b5","series-title":"Parkinsonism Relat Disord","first-page":"62","article-title":"Quality of life and its determinants in essential tremor","volume":"19","author":"Chandran V","year":"2013","unstructured":"Chandran V, Pal PK. Quality of life and its determinants in essential tremor. Parkinsonism Relat Disord. 2013;19(1):62\u201365. doi:10.1016\/j.parkreldis.2012.06.011"},{"issue":"9","key":"b6","series-title":"Mov Disord Clin Pract","first-page":"1317","article-title":"Stigma and social avoidance in adults with essential tremor","volume":"10","author":"O\u2019Suilleabhain P","year":"2023","unstructured":"O\u2019Suilleabhain P, Berry DS, Lundervold DA, Turner TH, Tovar M, Louis ED. Stigma and social avoidance in adults with essential tremor. Mov Disord Clin Pract. 2023;10(9):1317\u20131323. doi:10.1002\/mdc3.13774"},{"issue":"3","key":"b7","series-title":"J Neurol Neurosurg Psychiatry","first-page":"261","article-title":"Rest tremor in advanced essential tremor: a post-mortem study of nine cases","volume":"82","author":"Louis ED","year":"2011","unstructured":"Louis ED, Asabere N, Agnew A,  Rest tremor in advanced essential tremor: a post-mortem study of nine cases. J Neurol Neurosurg Psychiatry. 2011;82(3):261\u2013265. doi:10.1136\/jnnp.2010.215681"},{"issue":"19","key":"b8","series-title":"Neurology","first-page":"1752","article-title":"Evidence-based guideline update: treatment of essential tremor: report of the Quality Standards subcommittee of the American Academy of Neurology","volume":"77","author":"Zesiewicz TA","year":"2011","unstructured":"Zesiewicz TA, Elble RJ, Louis ED,  Evidence-based guideline update: treatment of essential tremor: report of the Quality Standards subcommittee of the American Academy of Neurology. Neurology. 2011;77(19):1752\u20131755. doi:10.1212\/WNL.0b013e318236f0fd"},{"issue":"1","key":"b9","series-title":"BMJ Neurol Open","first-page":"e000582","article-title":"Demographics of focused ultrasound thalamotomy for essential tremor and trends in deep brain stimulation surgery after its introduction in the USA","volume":"6","author":"Gautam D","year":"2024","unstructured":"Gautam D, Venkatraman V, Horns J,  Demographics of focused ultrasound thalamotomy for essential tremor and trends in deep brain stimulation surgery after its introduction in the USA. BMJ Neurol Open. 2024;6(1):e000582. doi:10.1136\/bmjno-2023-000582"},{"issue":"3","key":"b10","series-title":"J Neurosurg","first-page":"290","article-title":"Physiological study of presumed ventralis intermedius neurons in the human thalamus","volume":"50","author":"Ohye C","year":"1979","unstructured":"Ohye C, Narabayashi H. Physiological study of presumed ventralis intermedius neurons in the human thalamus. J Neurosurg. 1979;50(3):290\u2013297. doi:10.3171\/jns.1979.50.3.0290"},{"issue":"8","key":"b11","series-title":"N Engl J Med","first-page":"730","article-title":"A randomized trial of focused ultrasound thalamotomy for essential tremor","volume":"375","author":"Elias WJ","year":"2016","unstructured":"Elias WJ, Lipsman N, Ondo WG,  A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med. 2016;375(8):730\u2013739. doi:10.1056\/NEJMoa1600159"},{"issue":"9","key":"b12","series-title":"JAMA Neurol","first-page":"939","article-title":"Safety and efficacy of staged, bilateral focused ultrasound thalamotomy in essential tremor: an open-label clinical trial","volume":"81","author":"Kaplitt MG","year":"2024","unstructured":"Kaplitt MG, Krishna V, Eisenberg HM,  Safety and efficacy of staged, bilateral focused ultrasound thalamotomy in essential tremor: an open-label clinical trial. JAMA Neurol. 2024;81(9):939\u2013946. doi:10.1001\/jamaneurol.2024.2295"},{"issue":"5","key":"b13","series-title":"J Neurosurg","first-page":"1392","article-title":"Impact of skull density ratio on efficacy and safety of magnetic resonance-guided focused ultrasound treatment of essential tremor","volume":"132","author":"D\u2019Souza M","year":"2020","unstructured":"D\u2019Souza M, Chen KS, Rosenberg J,  Impact of skull density ratio on efficacy and safety of magnetic resonance-guided focused ultrasound treatment of essential tremor. J Neurosurg. 2020;132(5):1392\u20131397. doi:10.3171\/2019.2.JNS183517"},{"issue":"3","key":"b14","series-title":"J Neurosurg","first-page":"648","article-title":"Consistency is key: influence of skull density ratio distribution on the formation of clinically effective lesions and long-term tremor suppression following treatment with MR-guided focused ultrasound","volume":"140","author":"Kyle K","year":"2024","unstructured":"Kyle K, Maamary J, Jonker B,  Consistency is key: influence of skull density ratio distribution on the formation of clinically effective lesions and long-term tremor suppression following treatment with MR-guided focused ultrasound. J Neurosurg. 2024;140(3):648\u2013656. doi:10.3171\/2023.6.JNS231153"},{"issue":"5","key":"b15","series-title":"J Neurosurg","first-page":"1618","article-title":"What factors impact the clinical outcome of magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor?","volume":"134","author":"Fukutome K","year":"2021","unstructured":"Fukutome K, Kuga Y, Ohnishi H, Hirabayashi H, Nakase H. What factors impact the clinical outcome of magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor? J Neurosurg. 2021;134(5):1618\u20131623. doi:10.3171\/2020.2.JNS192814"},{"issue":"2","key":"b16","series-title":"Neurosurgery","first-page":"229","article-title":"Predictors of outcomes after focused ultrasound thalamotomy","volume":"87","author":"Krishna V","year":"2020","unstructured":"Krishna V, Sammartino F, Cosgrove R,  Predictors of outcomes after focused ultrasound thalamotomy. Neurosurgery. 2020;87(2):229\u2013237. doi:10.1093\/neuros\/nyz417"},{"issue":"1","key":"b17","series-title":"J Neurosurg","first-page":"38","article-title":"Cutoff values for the best management strategy for magnetic resonance-guided focused ultrasound ablation for essential tremor","volume":"138","author":"Torii J","year":"2022","unstructured":"Torii J, Maesawa S, Nakatsubo D,  Cutoff values for the best management strategy for magnetic resonance-guided focused ultrasound ablation for essential tremor. J Neurosurg. 2022;138(1):38\u201349. doi:10.3171\/2022.3.JNS212460"},{"key":"b18","series-title":"Front Neurol","first-page":"1370574","article-title":"Magnetic resonance-guided focused ultrasound thalamotomy for essential tremor patients with low skull density ratio: a case-matched analysis","volume":"15","author":"Ng PR","year":"2024","unstructured":"Ng PR, Blitz SE, Chua MMJ, Cosgrove GR. Magnetic resonance-guided focused ultrasound thalamotomy for essential tremor patients with low skull density ratio: a case-matched analysis. Front Neurol. 2024;15:1370574. doi:10.3389\/fneur.2024.1370574"},{"issue":"3","key":"b19","series-title":"Am Fam Physician","first-page":"180","article-title":"Tremor: sorting through the differential diagnosis","volume":"97","author":"Crawford P","year":"2018","unstructured":"Crawford P, Zimmerman EE. Tremor: sorting through the differential diagnosis. Am Fam Physician. 2018;97(3):180\u2013186."},{"issue":"5","key":"b20","series-title":"Parkinsonism Relat Disord","first-page":"541","article-title":"The spiral axis as a clinical tool to distinguish essential tremor from dystonia cases","volume":"20","author":"Michalec M","year":"2014","unstructured":"Michalec M, Hernandez N, Clark LN, Louis ED. The spiral axis as a clinical tool to distinguish essential tremor from dystonia cases. Parkinsonism Relat Disord. 2014;20(5):541\u2013544. doi:10.1016\/j.parkreldis.2014.01.021"},{"issue":"1","key":"b21","series-title":"Neuroepidemiology","first-page":"45","article-title":"Utility of the hand-drawn spiral as a tool in clinical-epidemiological research on essential tremor: data from four essential tremor cohorts","volume":"44","author":"Louis ED","year":"2015","unstructured":"Louis ED. Utility of the hand-drawn spiral as a tool in clinical-epidemiological research on essential tremor: data from four essential tremor cohorts. Neuroepidemiology. 2015;44(1):45\u201350. doi:10.1159\/000371850"},{"issue":"1","key":"b22","series-title":"Parkinsonism Relat Disord","first-page":"45","article-title":"Evaluating factors that can influence spirography ratings in patients with essential tremor","volume":"11","author":"Ondo WG","year":"2005","unstructured":"Ondo WG, Wang A, Thomas M, Vuong KD. Evaluating factors that can influence spirography ratings in patients with essential tremor. Parkinsonism Relat Disord. 2005;11(1):45\u201348. doi:10.1016\/j.parkreldis.2004.07.005"},{"issue":"8","key":"b23","series-title":"J Neurol Neurosurg Psychiatry","first-page":"868","article-title":"Assessing tremor severity","volume":"56","author":"Bain PG","year":"1993","unstructured":"Bain PG, Findley LJ, Atchison P,  Assessing tremor severity. J Neurol Neurosurg Psychiatry. 1993;56(8):868\u2013873. doi:10.1136\/jnnp.56.8.868"},{"issue":"11","key":"b24","series-title":"Mov Disord","first-page":"2073","article-title":"Validation of digital spiral analysis as outcome parameter for clinical trials in essential tremor","volume":"26","author":"Haubenberger D","year":"2011","unstructured":"Haubenberger D, Kalowitz D, Nahab FB,  Validation of digital spiral analysis as outcome parameter for clinical trials in essential tremor. Mov Disord. 2011;26(11):2073\u20132080. doi:10.1002\/mds.23808"},{"key":"b25","series-title":"Tremor Other Hyperkinet Mov","first-page":"50","article-title":"TETRAS spirals and handwriting samples: determination of optimal scoring examples","volume":"(N Y).","author":"Ondo WG","year":"2021","unstructured":"Ondo WG, Shukla AW, Ondo C. TETRAS spirals and handwriting samples: determination of optimal scoring examples. Tremor Other Hyperkinet Mov (N Y).2021;11:50. doi:10.5334\/tohm.665"},{"issue":"4","key":"b26","series-title":"J Neurosurg","first-page":"1088","article-title":"An intraoperative accelerometry and real-time analysis tool for magnetic resonance\u2013guided focused ultrasound thalamotomy","volume":"141","author":"Swytink-Binnema CA","year":"2024","unstructured":"Swytink-Binnema CA, Coreas A, Pichardo S, Pike GB, Kiss ZH. An intraoperative accelerometry and real-time analysis tool for magnetic resonance\u2013guided focused ultrasound thalamotomy. J Neurosurg. 2024;141(4):1088\u20131095. doi:10.3171\/2024.1.JNS231830"},{"key":"b27","series-title":"Front Neurol","first-page":"880814","article-title":"Clinical intervention using focused ultrasound (FUS) stimulation of the brain in diverse neurological disorders","volume":"13","author":"Baek H","year":"2022","unstructured":"Baek H, Lockwood D, Mason EJ,  Clinical intervention using focused ultrasound (FUS) stimulation of the brain in diverse neurological disorders. Front Neurol. 2022;13:880814. doi:10.3389\/fneur.2022.880814"},{"issue":"6","key":"b28","series-title":"Oper Neurosurg","first-page":"641","article-title":"Feasibility of magnetic resonance-compatible accelerometers to monitor tremor fluctuations during magnetic resonance-guided focused ultrasound thalamotomy: technical note","volume":"24","author":"Baek H","year":"2023","unstructured":"Baek H, Chen J, Lockwood D,  Feasibility of magnetic resonance-compatible accelerometers to monitor tremor fluctuations during magnetic resonance-guided focused ultrasound thalamotomy: technical note. Oper Neurosurg. 2023;24(6):641\u2013650. doi:10.1227\/ons.0000000000000638"},{"key":"b29","series-title":"IEEE J Transl Eng Health Med","first-page":"194","article-title":"Wearable accelerometer and gyroscope sensors for estimating the severity of essential tremor","volume":"12","author":"Ali SM","year":"2024","unstructured":"Ali SM, Arjunan SP, Peter J,  Wearable accelerometer and gyroscope sensors for estimating the severity of essential tremor. IEEE J Transl Eng Health Med. 2024;12:194\u2013203. doi:10.1109\/JTEHM.2023.3329344"},{"key":"b30","series-title":"Annu Int Conf IEEE Eng Med Biol Soc","first-page":"672","article-title":"Combined accelerometer and EMG analysis to differentiate essential tremor from Parkinson\u2019s disease","volume":"2016","author":"Ghassemi NH","year":"2016","unstructured":"Ghassemi NH, Marxreiter F, Pasluosta CF,  Combined accelerometer and EMG analysis to differentiate essential tremor from Parkinson\u2019s disease. Annu Int Conf IEEE Eng Med Biol Soc. 2016;2016:672\u2013675. doi:10.1109\/EMBC.2016.7590791"},{"issue":"4","key":"b31","series-title":"Parkinsonism Relat Disord","first-page":"288","article-title":"Rapid tremor frequency assessment with the iPhone accelerometer","volume":"17","author":"Joundi RA","year":"2011","unstructured":"Joundi RA, Brittain JS, Jenkinson N, Green AL, Aziz T. Rapid tremor frequency assessment with the iPhone accelerometer. Parkinsonism Relat Disord. 2011;17(4):288\u2013290. doi:10.1016\/j.parkreldis.2011.01.001"},{"issue":"6","key":"b32","series-title":"Methods Inf Med","first-page":"589","article-title":"Development of a system for measurement and analysis of tremor using a three-axis accelerometer","volume":"48","author":"Mamorita N","year":"2009","unstructured":"Mamorita N, Iizuka T, Takeuchi A, Shirataka M, Ikeda N. Development of a system for measurement and analysis of tremor using a three-axis accelerometer. Methods Inf Med. 2009;48(6):589\u2013594. doi:10.3414\/ME9243"},{"issue":"05","key":"b33","series-title":"Neurosci Med","first-page":"205","article-title":"Understanding tremor in rapid upper limb movements using 3D accelerometers data","volume":"05","author":"Pascoal-Faria P","year":"2014","unstructured":"Pascoal-Faria P, Patr\u00edcio M, Leal A,  Understanding tremor in rapid upper limb movements using 3D accelerometers data. Neurosci Med. 2014;05(05):205\u2013213. doi:10.4236\/nm.2014.55024"},{"issue":"1","key":"b34","series-title":"Int J Hyperthermia","first-page":"2481153","article-title":"Quantitative tremor monitoring before, during and after MR-guided focused ultrasound thalamotomy for essential tremor with MR compatible accelerometers","volume":"42","author":"Bancel T","year":"2025","unstructured":"Bancel T, Bashaiweth M, Manuel TJ,  Quantitative tremor monitoring before, during and after MR-guided focused ultrasound thalamotomy for essential tremor with MR compatible accelerometers. Int J Hyperthermia. 2025;42(1):2481153. doi:10.1080\/02656736.2025.2481153"},{"key":"b35","series-title":"Parkinson\u2019s Disease and Movement Disorders.","first-page":"271","article-title":"Clinical rating scale for tremor","author":"Fahn S","year":"1993","unstructured":"Fahn S, Tolosa E, Mar\u00edn C. Clinical rating scale for tremor. In: Jankovik J, Tolosa E, eds.Parkinson\u2019s Disease and Movement Disorders.2nd ed. Williams & Wilkins;1993:271-280."},{"issue":"4","key":"b36","series-title":"J Neurol Neuromed","first-page":"34","article-title":"The essential tremor rating assessment scale","volume":"1","author":"Elble RJ","year":"2016","unstructured":"Elble RJ. The essential tremor rating assessment scale. J Neurol Neuromed. 2016;1(4)34\u201338."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/145\/2\/article-p291.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/145\/2\/article-p291.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/145\/2\/article-p291.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T09:56:15Z","timestamp":1794218175000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/145\/2\/article-p291.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,1]]},"references-count":36,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2026.1.jns252047","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,1]]}}}