{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T01:53:22Z","timestamp":1789955602418,"version":"4.0.1"},"reference-count":74,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2008,10]]},"abstract":"\n Object<\/jats:title>\n Cerebrovascular pressure reactivity is the ability of cerebral vessels to respond to changes in transmural pressure. A cerebrovascular pressure reactivity index (PRx) can be determined as the moving correlation coefficient between mean intracranial pressure (ICP) and mean arterial blood pressure.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n The authors analyzed a database consisting of 398 patients with head injuries who underwent continuous monitoring of cerebrovascular pressure reactivity. In 298 patients, the PRx was compared with a transcranial Doppler ultrasonography assessment of cerebrovascular autoregulation (the mean index [Mx]), in 17 patients with the PET\u2013assessed static rate of autoregulation, and in 22 patients with the cerebral metabolic rate for O\n 2<\/jats:sub>\n . Patient outcome was assessed 6 months after injury.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n There was a positive and significant association between the PRx and Mx (R\n 2<\/jats:sup>\n = 0.36, p < 0.001) and with the static rate of autoregulation (R\n 2<\/jats:sup>\n = 0.31, p = 0.02). A PRx > 0.35 was associated with a high mortality rate (> 50%). The PRx showed significant deterioration in refractory intracranial hypertension, was correlated with outcome, and was able to differentiate patients with good outcome, moderate disability, severe disability, and death. The graph of PRx compared with cerebral perfusion pressure (CPP) indicated a U\u2013shaped curve, suggesting that too low and too high CPP was associated with a disturbance in pressure reactivity. Such an optimal CPP was confirmed in individual cases and a greater difference between current and optimal CPP was associated with worse outcome (for patients who, on average, were treated below optimal CPP [R\n 2<\/jats:sup>\n = 0.53, p < 0.001] and for patients whose mean CPP was above optimal CPP [R\n 2<\/jats:sup>\n = \u22120.40, p < 0.05]). Following decompressive craniectomy, pressure reactivity initially worsened (median \u22120.03 [interquartile range \u22120.13 to 0.06] to 0.14 [interquartile range 0.12\u20130.22]; p < 0.01) and improved in the later postoperative course. After therapeutic hypothermia, in 17 (70.8%) of 24 patients in whom rewarming exceeded the brain temperature threshold of 37\u00b0C, ICP remained stable, but the average PRx increased to 0.32 (p < 0.0001), indicating significant derangement in cerebrovascular reactivity.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The PRx is a secondary index derived from changes in ICP and arterial blood pressure and can be used as a surrogate marker of cerebrovascular impairment. In view of an autoregulation\u2013guided CPP therapy, a continuous determination of a PRx is feasible, but its value has to be evaluated in a prospective controlled trial.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/foc.2008.25.10.e2","type":"journal-article","created":{"date-parts":[[2008,10,1]],"date-time":"2008-10-01T09:46:15Z","timestamp":1222854375000},"page":"E2","source":"Crossref","is-referenced-by-count":192,"title":["Continuous monitoring of cerebrovascular pressure reactivity in patients with head injury"],"prefix":"10.3171","volume":"25","author":[{"given":"Christian","family":"Zweifel","sequence":"first","affiliation":[{"name":"Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Lavinio","sequence":"additional","affiliation":[{"name":"Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luzius A.","family":"Steiner","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, University Hospital Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danila","family":"Radolovich","sequence":"additional","affiliation":[{"name":"Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Smielewski","sequence":"additional","affiliation":[{"name":"Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Timofeev","sequence":"additional","affiliation":[{"name":"Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Hiler","sequence":"additional","affiliation":[{"name":"Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcella","family":"Balestreri","sequence":"additional","affiliation":[{"name":"Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Kirkpatrick","sequence":"additional","affiliation":[{"name":"Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Pickard","sequence":"additional","affiliation":[{"name":"Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Hutchinson","sequence":"additional","affiliation":[{"name":"Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Czosnyka","sequence":"additional","affiliation":[{"name":"Academic Neurosurgical Unit, University of Cambridge Clinical School, Cambridge, United Kingdom; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0250002","series-title":"Stroke","first-page":"45","article-title":"Cerebral autoregulation dynamics in humans","volume":"20","author":"Aaslid","year":"1989"},{"key":"b2-0250002","series-title":"Acta Neurochir Suppl","first-page":"25","article-title":"Association between outcome, cerebral pressure reactivity and slow ICP waves following head injury","volume":"95","author":"Balestreri","year":"2005"},{"key":"b3-0250002","series-title":"J Neurol Neurosurg Psychiatry","first-page":"161","article-title":"Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years","volume":"75","author":"Balestreri","year":"2004"},{"key":"b4-0250002","series-title":"Neurocrit Care","first-page":"8","article-title":"Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury","volume":"4","author":"Balestreri","year":"2006"},{"key":"b5-0250002","series-title":"Acta Neurochir (Wien)","first-page":"131","article-title":"Intracranial hypertension: what additional information can be derived from ICP waveform after head injury?","volume":"146","author":"Balestreri","year":"2004"},{"key":"b6-0250002","series-title":"J Neurosurg","first-page":"685","article-title":"Cerebral circulation and metabolism after severe traumatic brain injury: The elusive role of ischemia","volume":"75","author":"Bouma","year":"1991"},{"key":"b7-0250002","series-title":"Acta Anaesthesiol Scand","first-page":"270","article-title":"Cerebral autoregulation in unconscious patients with brain injury","volume":"22","author":"Cold","year":"1978"},{"key":"b8-0250002","series-title":"Neurosurgery","first-page":"11","article-title":"Continuous assessment of the cerebral vasomotor reactivity in head injury","volume":"41","author":"Czosnyka","year":"1997"},{"key":"b9-0250002","series-title":"Stroke","first-page":"1829","article-title":"Monitoring of cerebral autoregulation in head-injured patients","volume":"27","author":"Czosnyka","year":"1996"},{"key":"b10-0250002","series-title":"J Neurosurg","first-page":"11","article-title":"Hemodynamic characterization of intracranial pressure plateau waves in head-injury patients","volume":"91","author":"Czosnyka","year":"1999"},{"key":"b11-0250002","series-title":"J Neurosurg","first-page":"689","article-title":"Autoregulation and CO2 responses of cerebral blood flow in patients with acute severe head injury","volume":"48","author":"Enevoldsen","year":"1978"},{"key":"b12-0250002","series-title":"Intensive Care Med","first-page":"1637","article-title":"Hypothermia in the management of traumatic brain injury. A systematic review and meta-analysis","volume":"29","author":"Henderson","year":"2003"},{"key":"b13-0250002","series-title":"J Neurosurg","first-page":"731","article-title":"Predictive value of initial computerized tomography scan, intracranial pressure, and state of autoregulation in patients with traumatic brain injury","volume":"104","author":"Hiler","year":"2006"},{"key":"b14-0250002","series-title":"J Neurosurg","first-page":"943","article-title":"Cerebral oxygenation, vascular reactivity, and neurochemistry following decompressive craniectomy for severe traumatic brain injury","volume":"108","author":"Ho","year":"2008"},{"key":"b15-0250002","series-title":"J Neurosurg","first-page":"311","article-title":"Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma","volume":"102","author":"Howells","year":"2005"},{"key":"b16-0250002","series-title":"Acta Neurochir Suppl","first-page":"17","article-title":"Decompressive craniectomy in traumatic brain injury: the randomized multicenter RESCUEicp study (www.RESCUEicp.com)","volume":"96","author":"Hutchinson","year":"2006"},{"key":"b17-0250002","series-title":"Br J Neurosurg","first-page":"117","article-title":"A bedside method for investigating the integrity and critical thresholds of cerebral pressure autoregulation in severe traumatic brain injury patients","volume":"14","author":"Lang","year":"2000"},{"key":"b18-0250002","series-title":"New Horiz","first-page":"400","article-title":"Intracranial pressure and cerebral perfusion pressure pressure after severe head injury","volume":"3","author":"Lang","year":"1995"},{"key":"b19-0250002","series-title":"Br J Anaesth","first-page":"237","article-title":"Cerebrovascular reactivity during hypothermia and rewarming","volume":"99","author":"Lavinio","year":"2007"},{"key":"b20-0250002","series-title":"Acta Psychiatr Neurol Scand Suppl","first-page":"1","article-title":"Continuous recording and control of ventricular fluid pressure in neurosurgical practice","volume":"36","author":"Lundberg","year":"1960"},{"key":"b21-0250002","series-title":"Intensive Care Med","first-page":"202","article-title":"Cerebral blood flow and metabolism in severe brain injury: the role of pressure autoregulation during cerebral perfusion pressure management","volume":"26","author":"Mascia","year":"2000"},{"key":"b22-0250002","series-title":"Anaesthesia","first-page":"785","article-title":"Integrated approaches to academic anaesthesia \u2014the Cambridge experience","volume":"59","author":"Menon","year":"2004"},{"key":"b23-0250002","series-title":"J Neurosurg","first-page":"72","article-title":"Cerebral blood flow and metabolism in severely head-injured children. Part 2: autoregulation","volume":"71","author":"Muizelaar","year":"1989"},{"key":"b24-0250002","series-title":"J Neurosurg","first-page":"531","article-title":"Cerebral circulation after head injury. 1. Cerebral blood flow and its regulation after closed head injury with emphasis on clinical correlations","volume":"41","author":"Overgaard","year":"1974"},{"key":"b25-0250002","series-title":"Cerebrovasc Brain Metab Rev","first-page":"161","article-title":"Cerebral autoregulation","volume":"2","author":"Paulson","year":"1990"},{"key":"b26-0250002","series-title":"J Neurosurg","first-page":"666","article-title":"Cerebrospinal fluid pulse waveform as an indicator of cerebral autoregulation","volume":"56","author":"Portnoy","year":"1982"},{"key":"b27-0250002","series-title":"J Neurosurg","first-page":"871","article-title":"System analysis of cerebrovascular pressure transmission: an observational study in head injured patients","volume":"73","author":"Piper","year":"1990"},{"key":"b28-0250002","series-title":"J Neurosurg","first-page":"949","article-title":"Cerebral perfusion pressure: management protocol and clinical results","volume":"83","author":"Rosner","year":"1995"},{"key":"b29-0250002","series-title":"Acta Neurochir (Wien)","first-page":"435","article-title":"Arterio-jugular differences of oxygen (AVDO2) for bedside assessment of CO2-reactivity and autoregulation in the acute phase of severe head injury","volume":"138","author":"Sahuquillo","year":"1996"},{"key":"b30-0250002","series-title":"Acta Neurochir Suppl","first-page":"43","article-title":"ICM+: software for on-line analysis of bedside monitoring data after severe head trauma","volume":"95","author":"Smielewski","year":"2005"},{"key":"b31-0250002","series-title":"J Neurol Neurosurg Psychiatry","first-page":"765","article-title":"Cerebrovascular pressure reactivity is related to global cerebral oxygen metabolism after head injury","volume":"74","author":"Steiner","year":"2003"},{"key":"b32-0250002","series-title":"Stroke","first-page":"2404","article-title":"Assessment of cerebrovascular autoregulation in head-injured patients. A validation study","volume":"34","author":"Steiner","year":"2003"},{"key":"b33-0250002","series-title":"Crit Care Med","first-page":"733","article-title":"Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury","volume":"30","author":"Steiner","year":"2002"},{"key":"b34-0250002","series-title":"Stroke","first-page":"2236","article-title":"Slow rhythmic oscillations of blood pressure, intracranial pressure, microcirculation, and cerebral oxygenation. Dynamic interrelation and time course in humans","volume":"27","author":"Steinmeier","year":"1996"},{"key":"b35-0250002","series-title":"J Neurosurg","first-page":"66","article-title":"Effect of decompressive craniectomy on intracranial pressure and cerebrospinal compensation following traumatic brain injury","volume":"108","author":"Timofeev","year":"2008"},{"key":"b36-0250002","series-title":"Br J Neurosurg","first-page":"24","article-title":"Characterization of cerebrovascular reactivity after craniectomy for acute brain injury","volume":"20","author":"Wang","year":"2006"},{"key":"b37-0250002","series-title":"J Neurotrauma","first-page":"573","article-title":"Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use","volume":"15","author":"Wilson","year":"1998"},{"key":"b1-0250002","series-title":"Stroke","first-page":"45","article-title":"Cerebral autoregulation dynamics in humans","volume":"20","author":"Aaslid","year":"1989"},{"key":"b2-0250002","series-title":"Acta Neurochir Suppl","first-page":"25","article-title":"Association between outcome, cerebral pressure reactivity and slow ICP waves following head injury","volume":"95","author":"Balestreri","year":"2005"},{"key":"b3-0250002","series-title":"J Neurol Neurosurg Psychiatry","first-page":"161","article-title":"Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years","volume":"75","author":"Balestreri","year":"2004"},{"key":"b4-0250002","series-title":"Neurocrit Care","first-page":"8","article-title":"Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury","volume":"4","author":"Balestreri","year":"2006"},{"key":"b5-0250002","series-title":"Acta Neurochir (Wien)","first-page":"131","article-title":"Intracranial hypertension: what additional information can be derived from ICP waveform after head injury?","volume":"146","author":"Balestreri","year":"2004"},{"key":"b6-0250002","series-title":"J Neurosurg","first-page":"685","article-title":"Cerebral circulation and metabolism after severe traumatic brain injury: The elusive role of ischemia","volume":"75","author":"Bouma","year":"1991"},{"key":"b7-0250002","series-title":"Acta Anaesthesiol Scand","first-page":"270","article-title":"Cerebral autoregulation in unconscious patients with brain injury","volume":"22","author":"Cold","year":"1978"},{"key":"b8-0250002","series-title":"Neurosurgery","first-page":"11","article-title":"Continuous assessment of the cerebral vasomotor reactivity in head injury","volume":"41","author":"Czosnyka","year":"1997"},{"key":"b9-0250002","series-title":"Stroke","first-page":"1829","article-title":"Monitoring of cerebral autoregulation in head-injured patients","volume":"27","author":"Czosnyka","year":"1996"},{"key":"b10-0250002","series-title":"J Neurosurg","first-page":"11","article-title":"Hemodynamic characterization of intracranial pressure plateau waves in head-injury patients","volume":"91","author":"Czosnyka","year":"1999"},{"key":"b11-0250002","series-title":"J Neurosurg","first-page":"689","article-title":"Autoregulation and CO2 responses of cerebral blood flow in patients with acute severe head injury","volume":"48","author":"Enevoldsen","year":"1978"},{"key":"b12-0250002","series-title":"Intensive Care Med","first-page":"1637","article-title":"Hypothermia in the management of traumatic brain injury. A systematic review and meta-analysis","volume":"29","author":"Henderson","year":"2003"},{"key":"b13-0250002","series-title":"J Neurosurg","first-page":"731","article-title":"Predictive value of initial computerized tomography scan, intracranial pressure, and state of autoregulation in patients with traumatic brain injury","volume":"104","author":"Hiler","year":"2006"},{"key":"b14-0250002","series-title":"J Neurosurg","first-page":"943","article-title":"Cerebral oxygenation, vascular reactivity, and neurochemistry following decompressive craniectomy for severe traumatic brain injury","volume":"108","author":"Ho","year":"2008"},{"key":"b15-0250002","series-title":"J Neurosurg","first-page":"311","article-title":"Pressure reactivity as a guide in the treatment of cerebral perfusion pressure in patients with brain trauma","volume":"102","author":"Howells","year":"2005"},{"key":"b16-0250002","series-title":"Acta Neurochir Suppl","first-page":"17","article-title":"Decompressive craniectomy in traumatic brain injury: the randomized multicenter RESCUEicp study (www.RESCUEicp.com)","volume":"96","author":"Hutchinson","year":"2006"},{"key":"b17-0250002","series-title":"Br J Neurosurg","first-page":"117","article-title":"A bedside method for investigating the integrity and critical thresholds of cerebral pressure autoregulation in severe traumatic brain injury patients","volume":"14","author":"Lang","year":"2000"},{"key":"b18-0250002","series-title":"New Horiz","first-page":"400","article-title":"Intracranial pressure and cerebral perfusion pressure pressure after severe head injury","volume":"3","author":"Lang","year":"1995"},{"key":"b19-0250002","series-title":"Br J Anaesth","first-page":"237","article-title":"Cerebrovascular reactivity during hypothermia and rewarming","volume":"99","author":"Lavinio","year":"2007"},{"key":"b20-0250002","series-title":"Acta Psychiatr Neurol Scand Suppl","first-page":"1","article-title":"Continuous recording and control of ventricular fluid pressure in neurosurgical practice","volume":"36","author":"Lundberg","year":"1960"},{"key":"b21-0250002","series-title":"Intensive Care Med","first-page":"202","article-title":"Cerebral blood flow and metabolism in severe brain injury: the role of pressure autoregulation during cerebral perfusion pressure management","volume":"26","author":"Mascia","year":"2000"},{"key":"b22-0250002","series-title":"Anaesthesia","first-page":"785","article-title":"Integrated approaches to academic anaesthesia \u2014the Cambridge experience","volume":"59","author":"Menon","year":"2004"},{"key":"b23-0250002","series-title":"J Neurosurg","first-page":"72","article-title":"Cerebral blood flow and metabolism in severely head-injured children. Part 2: autoregulation","volume":"71","author":"Muizelaar","year":"1989"},{"key":"b24-0250002","series-title":"J Neurosurg","first-page":"531","article-title":"Cerebral circulation after head injury. 1. Cerebral blood flow and its regulation after closed head injury with emphasis on clinical correlations","volume":"41","author":"Overgaard","year":"1974"},{"key":"b25-0250002","series-title":"Cerebrovasc Brain Metab Rev","first-page":"161","article-title":"Cerebral autoregulation","volume":"2","author":"Paulson","year":"1990"},{"key":"b26-0250002","series-title":"J Neurosurg","first-page":"666","article-title":"Cerebrospinal fluid pulse waveform as an indicator of cerebral autoregulation","volume":"56","author":"Portnoy","year":"1982"},{"key":"b27-0250002","series-title":"J Neurosurg","first-page":"871","article-title":"System analysis of cerebrovascular pressure transmission: an observational study in head injured patients","volume":"73","author":"Piper","year":"1990"},{"key":"b28-0250002","series-title":"J Neurosurg","first-page":"949","article-title":"Cerebral perfusion pressure: management protocol and clinical results","volume":"83","author":"Rosner","year":"1995"},{"key":"b29-0250002","series-title":"Acta Neurochir (Wien)","first-page":"435","article-title":"Arterio-jugular differences of oxygen (AVDO2) for bedside assessment of CO2-reactivity and autoregulation in the acute phase of severe head injury","volume":"138","author":"Sahuquillo","year":"1996"},{"key":"b30-0250002","series-title":"Acta Neurochir Suppl","first-page":"43","article-title":"ICM+: software for on-line analysis of bedside monitoring data after severe head trauma","volume":"95","author":"Smielewski","year":"2005"},{"key":"b31-0250002","series-title":"J Neurol Neurosurg Psychiatry","first-page":"765","article-title":"Cerebrovascular pressure reactivity is related to global cerebral oxygen metabolism after head injury","volume":"74","author":"Steiner","year":"2003"},{"key":"b32-0250002","series-title":"Stroke","first-page":"2404","article-title":"Assessment of cerebrovascular autoregulation in head-injured patients. A validation study","volume":"34","author":"Steiner","year":"2003"},{"key":"b33-0250002","series-title":"Crit Care Med","first-page":"733","article-title":"Continuous monitoring of cerebrovascular pressure reactivity allows determination of optimal cerebral perfusion pressure in patients with traumatic brain injury","volume":"30","author":"Steiner","year":"2002"},{"key":"b34-0250002","series-title":"Stroke","first-page":"2236","article-title":"Slow rhythmic oscillations of blood pressure, intracranial pressure, microcirculation, and cerebral oxygenation. Dynamic interrelation and time course in humans","volume":"27","author":"Steinmeier","year":"1996"},{"key":"b35-0250002","series-title":"J Neurosurg","first-page":"66","article-title":"Effect of decompressive craniectomy on intracranial pressure and cerebrospinal compensation following traumatic brain injury","volume":"108","author":"Timofeev","year":"2008"},{"key":"b36-0250002","series-title":"Br J Neurosurg","first-page":"24","article-title":"Characterization of cerebrovascular reactivity after craniectomy for acute brain injury","volume":"20","author":"Wang","year":"2006"},{"key":"b37-0250002","series-title":"J Neurotrauma","first-page":"573","article-title":"Structured interviews for the Glasgow Outcome Scale and the extended Glasgow Outcome Scale: guidelines for their use","volume":"15","author":"Wilson","year":"1998"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/25\/4\/article-pE2.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/25\/4\/article-pE2.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/25\/4\/article-pE2.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T08:53:53Z","timestamp":1779526433000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/25\/4\/article-pE2.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,10]]},"references-count":74,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/foc.2008.25.10.e2","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,10]]}}}