{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:06:53Z","timestamp":1791893213211,"version":"4.3.4"},"reference-count":54,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T00:00:00Z","timestamp":1675123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>External ventricular drainage is often considered a life-saving treatment in acute hydrocephalus. Given the large number of discussion points, the ideal management of EVD has not been completely clarified. The objective of this study was to review the most relevant scientific evidence about the management of EVD in its main clinical scenarios. We reviewed the most recent and relevant articles about indications, timing, management, and complications of EVD in neurocritical care, with particular interest in patients with subarachnoid hemorrhage (SAH), severe traumatic brain injury (TBI), and intraventricular hemorrhage (IVH) using the following keywords alone or matching with one another: intracranial pressure, subarachnoid hemorrhage, traumatic brain injury, intraventricular hemorrhage, external ventricular drainage, cerebrospinal shunt, intracranial pressure monitoring, and ventriculoperitoneal shunt. In the management of EVD in SAH, the intermittent drainage strategy is burdened with an elevated risk of complications (e.g., clogged catheter, hemorrhage, and need for replacement). There seems to be more ventriculoperitoneal shunt dependency in rapid weaning approach-managed patients than in those treated with the gradual weaning approach. Although there is no evidence in favor of either strategy, it is conventionally accepted to adopt a continuous drainage approach in TBI patients. Less scientific evidence is available in the literature regarding the management of EVD in patients with severe TBI and intraparenchymal\/intraventricular hemorrhage. EVD placement is a necessary treatment in several clinical scenarios. However, further randomized clinical trials are needed to clarify precisely how EVD should be managed in different clinical scenarios.<\/jats:p>","DOI":"10.3390\/clinpract13010020","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T05:57:56Z","timestamp":1675231076000},"page":"219-229","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["External Ventricular Drainage: A Practical Guide for Neuro-Anesthesiologists"],"prefix":"10.3390","volume":"13","author":[{"given":"Alessandro","family":"Bertuccio","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, AON SS. Antonio e Biagio e Cesare Arrigo University Hospital, 15121 Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5132-4123","authenticated-orcid":false,"given":"Stefano","family":"Marasco","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AON SS. Antonio e Biagio e Cesare Arrigo University Hospital, 15121 Alessandria, Italy"},{"name":"Department of Neurosurgery, IRCCS S. Matteo University Hospital, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8831-1361","authenticated-orcid":false,"given":"Yaroslava","family":"Longhitano","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsiana","family":"Romenskaya","sequence":"additional","affiliation":[{"name":"Department of Physiology and Pharmacology, Sapienza University of Rome, P.le A. Moro 5, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Elia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AON SS. Antonio e Biagio e Cesare Arrigo University Hospital, 15121 Alessandria, Italy"},{"name":"Department of Neurosurgery, IRCCS S. Matteo University Hospital, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Mezzini","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AON SS. Antonio e Biagio e Cesare Arrigo University Hospital, 15121 Alessandria, Italy"},{"name":"Department of Neurosurgery, IRCCS S. Matteo University Hospital, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0480-2911","authenticated-orcid":false,"given":"Matteo","family":"Vitali","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AON SS. Antonio e Biagio e Cesare Arrigo University Hospital, 15121 Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Zanza","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA"},{"name":"Foundation \u201cOspedale Alba-Bra\u201d\u2014Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Barbanera","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, AON SS. Antonio e Biagio e Cesare Arrigo University Hospital, 15121 Alessandria, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"228","DOI":"10.3171\/2013.6.JNS121577","article-title":"The history of external ventricular drainage: Historical vignette","volume":"120","author":"Srinivasan","year":"2014","journal-title":"J. Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s12028-019-00712-9","article-title":"Primary External Ventricular Drainage Catheter Versus Intraparenchymal ICP Monitoring: Outcome Analysis","volume":"31","author":"Bales","year":"2019","journal-title":"Neurocritical Care"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Longhitano, Y., Iannuzzi, F., Bonatti, G., Zanza, C., Messina, A., Godoy, D., Dabrowski, W., Xiuyun, L., Czosnyka, M., and Pelosi, P. (2021). Cerebral Autoregulation in Non-Brain Injured Patients: A Systematic Review. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.732176"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s12028-017-0443-2","article-title":"External Ventricular Drains After Subarachnoid Hemorrhage: Is Less More?","volume":"28","author":"Chung","year":"2017","journal-title":"Neurocritical Care"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Stevens, A.R., Soon, W.C., Chowdhury, Y.A., Toman, E., Yim, S., Veenith, T., Chelvarajah, R., Belli, A., and Davies, D. (2022). External Lumbar Drainage for Refractory Intracranial Hypertension in Traumatic Brain Injury: A Systematic Review. Cureus, 14.","DOI":"10.7759\/cureus.30033"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s00701-016-2747-y","article-title":"Current practice of external ventricular drainage: A survey among neurosurgical departments in Germany","volume":"158","author":"Cinibulak","year":"2016","journal-title":"Acta Neurochir."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jocn.2011.04.026","article-title":"An outcome analysis of two different procedures of burr-hole trephine and external ventricular drainage in acute hydrocephalus","volume":"19","author":"Proescholdt","year":"2012","journal-title":"J. Clin. Neurosci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.clineuro.2014.09.026","article-title":"External ventricular drain placement in the intensive care unit versus operating room: Evaluation of complications and accuracy","volume":"128","author":"Foreman","year":"2015","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Altschul, D., Hamad, M.K., Kobets, A., Fluss, R., Lin, C., Boyke, E.A., Liu, J., Thomas, R., and Unda, S.R. (2020). A Retrospective Quality Analysis of External Ventricular Drain Infection Rates Following Stroke Diagnoses and Other Brain Injuries: Comparison of Emergency Room and ICU\/OR Setting. Cureus, 12.","DOI":"10.7759\/cureus.7173"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.wneu.2020.04.215","article-title":"Does the Setting of External Ventricular Drain Placement Affect Morbidity? A Systematic Literature Review Comparing Intensive Care Unit versus Operating Room Procedures","volume":"140","author":"Dawod","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e135","DOI":"10.1016\/j.wneu.2017.10.129","article-title":"Infection Incidence Associated with External Ventriculostomy Placement: A Comparison of Outcomes in the Emergency Department, Intensive Care Unit, and Operating Room","volume":"110","author":"Kohli","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/j.jocn.2013.09.002","article-title":"Efficacy of antibiotic-impregnated external ventricular drains in reducing ventriculostomy-associated infections","volume":"21","author":"Mikhaylov","year":"2014","journal-title":"J. Clin. Neurosci."},{"key":"ref_13","unstructured":"Telano, L.N., and Baker, S. (2021). Physiology, Cerebral Spinal Fluid, StatPearls Publishing."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1093\/neuros\/nyy522","article-title":"Systemic Antimicrobial Prophylaxis and Antimicrobial-Coated External Ventricular Drain Catheters for Preventing Ventriculostomy-Related Infections: A Meta-Analysis of 5242 Cases","volume":"86","author":"Sheppard","year":"2018","journal-title":"Neurosurgery"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/JNN.0000000000000487","article-title":"Intracranial Pressure Monitoring via External Ventricular Drain: Are We Waiting Long Enough Before Recording the Real Value?","volume":"52","author":"Liu","year":"2020","journal-title":"J. Neurosci. Nurs."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s10143-021-01627-w","article-title":"External ventricular drain management in subarachnoid haemorrhage: A systematic review and meta-analysis","volume":"45","author":"Palasz","year":"2021","journal-title":"Neurosurg. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1136\/jnnp.2007.117655","article-title":"Incidence of subarachnoid haemorrhage: A systematic review with emphasis on region, age, gender and time trends","volume":"78","author":"Linn","year":"2007","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Capion, T., Lilja-Cyron, A., Juhler, M., Mathiesen, T.I., and Wetterslev, J. (2019). Prompt closure versus gradual weaning of extraventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: A systematic review protocol with meta-analysis and trial sequential analysis. BMJ Open, 9.","DOI":"10.1136\/bmjopen-2019-029719"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"226","DOI":"10.3171\/jns.1973.39.2.0226","article-title":"The role of intracranial pressure in the arrest of hemorrhage in patients with ruptured intracranial aneurysm","volume":"39","author":"Nornes","year":"1973","journal-title":"J. Neurosurg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/j.wneu.2014.12.040","article-title":"External Ventricular Drains versus Intraparenchymal Intracranial Pressure Monitors in Traumatic Brain Injury: A Prospective Observational Study","volume":"83","author":"Liu","year":"2015","journal-title":"World Neurosurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s12028-010-9401-y","article-title":"Continuous and Intermittent CSF Diversion after Subarachnoid Hemorrhage: A Pilot Study","volume":"14","author":"Kim","year":"2011","journal-title":"Neurocritical Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"974","DOI":"10.3171\/2013.6.JNS122403","article-title":"Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage","volume":"119","author":"Olson","year":"2013","journal-title":"J. Neurosurg."},{"key":"ref_23","first-page":"144","article-title":"Alternative pathways for drainage of cerebrospinal fluid in the canine brain","volume":"22","author":"Leeds","year":"1989","journal-title":"Lymphology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1227\/NEU.0000000000001432","article-title":"Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition","volume":"80","author":"Carney","year":"2016","journal-title":"Neurosurgery"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"225","DOI":"10.3171\/jns.2004.100.2.0225","article-title":"Comparison of rapid and gradual weaning from external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage: A prospective randomized trial","volume":"100","author":"Klopfenstein","year":"2004","journal-title":"J. Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"194","DOI":"10.4103\/ajns.AJNS_320_16","article-title":"Secondary communicating hydrocephalus management by implantation of external ventricular shunt and minimal gradual increase of cerebrospinal fluid pressure","volume":"12","author":"Mostofi","year":"2017","journal-title":"Asian J. Neurosurg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1007\/s12028-021-01343-9","article-title":"Association of External Ventricular Drain Wean Strategy with Shunt Placement and Length of Stay in Subarachnoid Hemorrhage: A Prospective Multicenter Study","volume":"36","author":"Chung","year":"2021","journal-title":"Neurocritical Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1093\/ons\/opy009","article-title":"Gradual External Ventricular Drainage Weaning Reduces the Risk of Shunt Dependency After Aneurysmal Subarachnoid Hemorrhage: A Pooled Analysis","volume":"15","author":"Jabbarli","year":"2018","journal-title":"Oper. Neurosurg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1007\/s11910-019-1009-9","article-title":"Evidence-Based Management of External Ventricular Drains","volume":"19","author":"Chung","year":"2019","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Chau, C.Y.C., Craven, C.L., Rubiano, A.M., Adams, H., T\u00fcl\u00fc, S., Czosnyka, M., Servadei, F., Ercole, A., Hutchinson, P.J., and Kolias, A.G. (2019). The Evolution of the Role of External Ventricular Drainage in Traumatic Brain Injury. J. Clin. Med., 8.","DOI":"10.3390\/jcm8091422"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Zanza, C., Piccolella, F., Racca, F., Romenskaya, T., Longhitano, Y., Franceschi, F., Savioli, G., Bertozzi, G., De Simone, S., and Cipolloni, L. (2022). Ketamine in Acute Brain Injury: Current Opinion Following Cerebral Circulation and Electrical Activity. Healthcare, 10.","DOI":"10.3390\/healthcare10030566"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/PL00007792","article-title":"Treatment and outcome of severe intraventricular extension in patients with subarachnoid or intracerebral hemorrhage: A systematic review of the literature","volume":"247","author":"Nieuwkamp","year":"2000","journal-title":"J. Neurol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1007\/s00415-009-5323-z","article-title":"Massive intraventricular haemorrhage from aneurysmal rupture: Patient proportions and eligibility for intraventricular fibrinolysis","volume":"257","author":"Nieuwkamp","year":"2010","journal-title":"J. Neurol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1227\/01.NEU.0000108422.10842.60","article-title":"Intraventricular Thrombolysis Speeds Blood Clot Resolution: Results of a Pilot, Prospective, Randomized, Double-blind, Controlled Trial","volume":"54","author":"Naff","year":"2004","journal-title":"Neurosurgery"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"E550","DOI":"10.1093\/ons\/opaa266","article-title":"Letter: Craniometrics and Ventricular Access: A Review of Kocher\u2019s, Kaufman\u2019s, Paine\u2019s, Menovksy\u2019s, Tubbs\u2019, Keen\u2019s, Frazier\u2019s, Dandy\u2019s, and Sanchez\u2019s Points","volume":"19","author":"Burke","year":"2020","journal-title":"Oper. Neurosurg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e276","DOI":"10.1016\/j.wneu.2021.09.051","article-title":"External Ventricular Drainage Complication Risks and Accuracy Analysis","volume":"156","author":"Konovalov","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1007\/s00701-021-05007-7","article-title":"Factors which influence the complications of external ventricular cerebrospinal fluid drainage","volume":"164","author":"Kerry","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2174\/1574887117666220810121048","article-title":"Cerebral Vasospasm: Practical Review of Diagnosis and Management","volume":"17","author":"Romenskaya","year":"2022","journal-title":"Rev. Recent Clin. Trials"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Ramanan, M., Lipman, J., Shorr, A., and Shankar, A. (2015). A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections. BMC Infect. Dis., 15.","DOI":"10.1186\/s12879-014-0712-z"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s12028-013-9853-y","article-title":"Lumbar drainage for the treatment of severe bacterial meningitis","volume":"19","author":"Abulhasan","year":"2013","journal-title":"Neurocritical Care"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.neuchi.2021.05.004","article-title":"A review of external lumbar drainage for the management of intracranial hypertension in traumatic brain injury","volume":"68","author":"Ginalis","year":"2022","journal-title":"Neurochirurgie"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"859","DOI":"10.2217\/fmb-2019-0084","article-title":"Lumbar drainage for the treatment of refractory intracranial hypertension in HIV-negative cryptococcal meningitis","volume":"14","author":"Zhang","year":"2019","journal-title":"Future Microbiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1007\/s00134-019-05805-9","article-title":"A management algorithm for patients with intracranial pressure monitoring: The Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)","volume":"45","author":"Hawryluk","year":"2019","journal-title":"Intensive Care Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1136\/jnnp-2017-316415","article-title":"Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland","volume":"89","author":"Jamjoom","year":"2018","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_45","first-page":"282","article-title":"Neurologic outcome of posttraumatic refractory intracranial hypertension treated with external lumbar drainage","volume":"62","year":"2007","journal-title":"J. Trauma"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"453","DOI":"10.3171\/jns.1995.83.3.0453","article-title":"Controlled lumbar drainage in pediatric head injury","volume":"83","author":"Levy","year":"1995","journal-title":"J. Neurosurg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.wneu.2011.06.018","article-title":"A case for further investigating the use of controlled lumbar cerebrospinal fluid drainage for the control of intracranial pressure","volume":"77","author":"Murad","year":"2012","journal-title":"World Neurosurg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.3171\/2008.10.JNS08293","article-title":"Clinical evaluation of the safety and efficacy of lumbar cerebrospinal fluid drainage for the treatment of refractory increased intracranial pressure","volume":"110","author":"Tuettenberg","year":"2009","journal-title":"J. Neurosurg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"265","DOI":"10.4103\/sni.sni_98_17","article-title":"Refractory intracranial hypertension in traumatic brain injury: Proposal for a novel score to assess the safety of lumbar cerebrospinal fluid drainage","volume":"8","author":"Bauer","year":"2017","journal-title":"Surg. Neurol. Int."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1177\/0310057X1103900113","article-title":"Long-term follow-up of patients with post-traumatic refractory high intracranial pressure treated with lumbar drainage","volume":"39","author":"Abadal","year":"2011","journal-title":"Anaesth. Intensive Care."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"2003","DOI":"10.1007\/s00701-017-3290-1","article-title":"Using external lumbar CSF drainage to treat communicating external hydrocephalus in adult patients after acute traumatic or nontraumatic brain injury","volume":"159","author":"Manet","year":"2017","journal-title":"Acta Neurochir"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"229","DOI":"10.3171\/jns.2005.102.2.0229","article-title":"Bacterial meningitis caused by the use of ventricular or lumbar cerebrospinal fluid catheters","volume":"102","author":"Schade","year":"2005","journal-title":"J. Neurosurg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1136\/jnnp.67.4.468","article-title":"Bacterial meningitis associated with lumbar drains: A retrospective cohort study","volume":"67","author":"Coplin","year":"1999","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"468","DOI":"10.3171\/jns.2005.103.3.0468","article-title":"Ventriculostomy-related infections in critically ill patients: A 6-year experience","volume":"103","author":"Bota","year":"2005","journal-title":"J. Neurosurg."}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/13\/1\/20\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:19:34Z","timestamp":1760120374000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/13\/1\/20"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,31]]},"references-count":54,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["clinpract13010020"],"URL":"https:\/\/doi.org\/10.3390\/clinpract13010020","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,31]]}}}