Acta Neurochirurgica

, Volume 148, Issue 3, pp 235–253 | Cite as

Intra-operative 3D ultrasound in neurosurgery

  • G. Unsgaard
  • O. M. Rygh
  • T. Selbekk
  • T. B. Müller
  • F. Kolstad
  • F. Lindseth
  • T. A. Nagelhus Hernes
Review Article


In recent years there has been a considerable improvement in the quality of ultrasound (US) imaging. The integration of 3D US with neuronavigation technology has created an efficient and inexpensive tool for intra-operative imaging in neurosurgery. In this review we present the technological background and an overview of the wide range of different applications. The technology has so far mostly been applied to improve surgery of tumours in brain tissue, but it has also been found to be useful in other procedures such as operations for cavernous haemangiomas, skull base tumours, syringomyelia, medulla tumours, aneurysms, AVMs and endoscopy guidance.

Keywords: Intra-operative imaging; 3D ultrasound; brain shift; neuronavigation; neurosurgery; ultrasound. 


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  1. Albayrak, B, Samdani, AF, Black, PM 2004Intra-operative magnetic resonance imaging in neurosurgery.Acta Neurochir (Wien)146543556; discussion 57CrossRefGoogle Scholar
  2. Auer, LM, van Velthoven, V 1990Intraoperative ultrasound (US) imaging. Comparison of pathomorphological findings in US and CT.Acta Neurochir (Wien)1048495CrossRefGoogle Scholar
  3. Babcock, DS, Barr, LL, Crone, KR 1992Intraoperative uses of ultrasound in the pediatric neurosurgical patient.Pediatric Neurosurgery188491PubMedGoogle Scholar
  4. Barnett, GH, Miller, DW, Weisenberger, J 1999Frameless stereotaxy with scalp-applied fiducial markers for brain biopsy procedures: experience in 218 cases.J Neurosurg91569576PubMedGoogle Scholar
  5. Black, PM, Moriarty, T, Alexander, E, Stieg, P, Woodard, EJ, Langham Gleasom, P, Martin, CM, Kikinis, R, Schwartz, RB, Jolesz, FA 1997Development and implementation of intraoperative magnetic resonance imaging and its neurosurgical applications.Neurosurgery41831842CrossRefPubMedGoogle Scholar
  6. Bonsanto, MM, Metzner, R, Aschoff, A, Tronnier, V, Kunze, S, Wirtz, CR 20053D ultrasound navigation in syrinx surgery – a feasibility study.Acta Neurochir (Wien)147533541CrossRefGoogle Scholar
  7. Bonsanto, MM, Staubert, A, Wirtz, CR, Tronnier, V, Kunze, S 2001Initial experience with an ultrasound-integrated single-rack neuronavigation system.Acta Neurochir (Wien)14311271132CrossRefGoogle Scholar
  8. Broggi, G, Dones, I, Ferroli, P, Franzini, A, Servello, D, Duca, S 2000Image guided neuroendoscopy for third ventriculostomy.Acta Neurochir (Wien)142893898; discussion 8–9CrossRefGoogle Scholar
  9. Bucholz RD, Yeh DD, Trobaugh J, McDurmont LL, Sturm CD, Baumann C, Henderson JM, Levy A, Kessman P (1997) The correction of stereotactic inaccuracy caused by brain shift using an intraoperative ultrasound device, pp 459–466: Cvrmed-Mrcas’97.Google Scholar
  10. Chacko, AG, Kumar, NKS, Chacko, G, Athyal, R, Rajshekhar, V 2003Intraoperative ultrasound in determining the extent of resection of parenchymal brain tumours – a comparative study with computed tomography and histopathology.Acta Neurochir (Wien)145743748CrossRefGoogle Scholar
  11. Chandler, WF, Knake, JE, McGillicuddy, JE, Lillehei, KO, Silver, TM 1982Intraoperative use of real-time ultrasonography in neurosurgery.J Neurosurg57157163PubMedGoogle Scholar
  12. Comeau, RM, Fenster, A, Peters, TM 1998Intraoperative US in interactive image-guided neurosurgery.Radiographics1810191027PubMedGoogle Scholar
  13. Dempsey, RJ, Moftakhar, R, Pozniak, M 2004Intraciperative Doppler to measure cerebrovascular resistance as a guide to complete resection of arteriovenous malformations.Neurosurgery55155160PubMedGoogle Scholar
  14. Dohrmann GJ, Rubin JM (2001) History of intraoperative ultrasound in neurosurgery. Neurosurg Clin N Am 12: 155–166, ixGoogle Scholar
  15. Dorward, NL, Alberti, O, Zhao, J, Dijkstra, A, Buurman, J, Palmer, JD, Hawkes, D, Thomas, DG 1998Interactive image-guided neuroendoscopy: development and early clinical experience.Minim Invasive Neurosurg413134PubMedGoogle Scholar
  16. Germano, IM, Queenan, JV 1998Clinical experience with intracranial brain needle biopsy using frameless surgical navigation.Comput Aided Surg33339CrossRefPubMedGoogle Scholar
  17. Giorgi, C, Casolino, DS 1997Preliminary clinical experience with intraoperative stereotactic ultrasound imaging.Stereotact Funct Neurosurg685458PubMedGoogle Scholar
  18. Griffith, S, Pozniak, MA, Mitchell, CC, Ledwidge, ME, Dempsey, R, Peters, A, Taylor, E 2004Intraloperative sonography of intracranial arteriovenous malformations – How we do it.J Ultrasound Med2310651072PubMedGoogle Scholar
  19. Gronningsaeter, A, Lie, T, Kleven, A, Morland, T, Lango, T, Unsgard, G, Myhre, HO, Marvik, R 2000Initial experience with stereoscopic visualization of three-dimensional ultrasound data in surgery.Surg Endoscop other Interventional Techn1410741078Google Scholar
  20. Gronningsaeter, A, Unsgard, G, Ommedal, S, Angelsen, BAJ 1996Ultrasound-guided neurosurgery: a feasibility study in the 3–30 MHz frequency range.Brit J Neurosurg10161168Google Scholar
  21. Grunert, P, Hopf, N, Perneczky, A 1997Frame-based and frameless endoscopic procedures in the third ventricle.Stereotact Funct Neurosurg688089PubMedGoogle Scholar
  22. Grønningsæter, Å, Kleven, A, Ommedal, S, Årseth, TE, Lie, T, Lindseth, F, Langø, T, Unsgård, G 2000SonoWand, an ultrasound-based neuronavigation system.Neurosurgery4713731380PubMedGoogle Scholar
  23. Gumprecht, H, Trost, HA, Lumenta, CB 2000Neuroendoscopy combined with frameless neuronavigation.Br J Neurosurg14129131PubMedGoogle Scholar
  24. Haiden, N, Klebermass, K, Rucklinger, E, Berger, A, Prusa, AR, Rohrmeister, K, Wandl-Vergesslich, K, Kohlhauser-Vollmuth, C 20053-D ultrasonographic imaging of the cerebral ventricular system in very low birth weight infants.Ultrasound Med Biol31714CrossRefPubMedGoogle Scholar
  25. Hall, WA, Martin, AJ, Liu, H, Nussbaum, ES, Maxwell, RE, Truwit, CL 1999Brain biopsy using high-field strength interventional magnetic resonance imaging.Neurosurgery44807PubMedGoogle Scholar
  26. Hammoud, MA, Ligon, BL, elSouki, R, Shi, WM, Schomer, DF, Sawaya, R 1996Use of intraoperative ultrasound for localizing tumors and determining the extent of resection: a comparative study with magnetic resonance imaging.J Neurosurg84737741PubMedGoogle Scholar
  27. Hata, N, Dohi, T, Iseki, H, Takakura, K 1997Development of a frameless and armless stereotactic neuronavigation system with ultrasonographic registration.Neurosurgery41608613; discussion 13–14CrossRefPubMedGoogle Scholar
  28. Hentschel, SJ, Lang, FF 2003Current surgical management of glioblastoma.Cancer J9113125PubMedGoogle Scholar
  29. Hernes, TA, Ommedal, S, Lie, T, Lindseth, F, Lango, T, Unsgaard, G 2003Stereoscopic navigation-controlled display of preoperative MRI and intraoperative 3D ultrasound in planning and guidance of neurosurgery: new technology for minimally invasive image-guided surgery approaches.Minim Invasive Neurosurg46129137PubMedGoogle Scholar
  30. Hill, DL, Maurer, CR,Jr, Maciunas, RJ, Barwise, JA, Fitzpatrick, JM, Wang, MY 1998Measurement of intraoperative brain surface deformation under a craniotomy.Neurosurgery43514526; discussion 27–28PubMedGoogle Scholar
  31. Hirschberg, H, Unsgaard, G 1997Incorporation of ultrasonic imaging in an optically coupled frameless stereotactic system.Acta Neurochir [Suppl]687580Google Scholar
  32. Hopf, NJ, Grunert, P, Darabi, K, Busert, C, Bettag, M 1999Frameless neuronavigation applied to endoscopic neurosurgery.Minim Invasive Neurosurg42187193PubMedGoogle Scholar
  33. Jeremic, B, Milicic, B, Grujicic, D, Dagovic, A, Aleksandrovic, J, Nikolic, N 2004Clinical prognostic factors in patients with malignant glioma treated with combined modalfty approach.Am J Clin Oncol-Cancer Clin Trials27195204Google Scholar
  34. Jodicke, A, Deinsberger, W, Erbe, H, Kriete, A, Boker, DK 1998Intraoperative three-dimensional ultrasonography: an approach to register brain shift using multidimensional image processing.Minim Invasive Neurosurg411319PubMedCrossRefGoogle Scholar
  35. Jödicke, A, Accomazzi, V, Reiss, I, Böker, D-K 2003Virtual endoscopy of the cerebral ventricles based on 3-D ultrasonography.Ultrasound Med Biol29339345PubMedGoogle Scholar
  36. Keles, GE, Anderson, B, Berger, MS 1999The effect of extent of resection on time to tumor progression and survival in patients with glioblastoma multiforme of the cerebral hemisphere.Surg Neurol52371379PubMedGoogle Scholar
  37. Koivukangas, J, Louhisalmi, Y, Alakuijala, J, Oikarinen, J 1993Ultrasound-controlled neuronavigator-guided brain surgery.J Neurosurg793642PubMedGoogle Scholar
  38. Kurimoto, M, Hayashi, N, Kamiyama, H, Nagai, S, Shibata, T, Asahi, T, Matsumura, N, Hirashima, Y, Endo, S 2004Impact of neuronavigation and image-guided extensive resection for adult patients with supratentorial malignant astrocytomas: a single-institution retrospective study.Minimally Inv Neurosurg47278283Google Scholar
  39. Lacroix, M, Abi-Said, D, Fourney, DR, Gokaslan, ZL, Shi, W, DeMonte, F, Lang, FF, McCutcheon, IE, Hassenbusch, SJ, Holland, E, Hess, K, Michael, C, Miller, D, Sawaya, R 2001A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival.J Neurosurg95190198PubMedGoogle Scholar
  40. Lasio, G, Ferroli, P, Felisati, G, Broggi, G 2002Image-guided endoscopic transnasal removal of recurrent pituitary adenomas.Neurosurgery51132136; discussion 6–7CrossRefPubMedGoogle Scholar
  41. Laws, ER, Parney, IF, Huang, W, Anderson, F, Morris, AM, Asher, A, Lillehei, KO, Bernstein, M, Brem, H, Sloan, A, Berger, MS, Chang, S 2003Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the glioma outcomes project.J Neurosurg99467473PubMedGoogle Scholar
  42. Le Roux, PD, Berger, MS, Wang, K, Mack, LA, Ojemann, GA 1992Low grade gliomas: comparison of intraoperative ultrasound characteristics with preoperative imaging studies.J Neuro-Oncol13189198Google Scholar
  43. Letteboer, MM, Willems, PW, Viergever, MA, Niessen, WJ 2005Brain shift estimation in image-guided neurosurgery using 3-D ultrasound.IEEE Trans Biomed Eng52268276CrossRefPubMedGoogle Scholar
  44. Letteboer, MMJ, Willems, PWA, Viergever, MA, Niessen, WJ 2005Brain shift estimation in image-guided neurosurgery using 3-D ultrasound.IEEE Trans Biomed Eng52268276CrossRefPubMedGoogle Scholar
  45. Lindseth, F, Kaspersen, JH, Ommedal, S, Lango, T, Bang, J, Hokland, J, Unsgaard, G, Hernes, TA 2003Multimodal image fusion in ultrasound-based neuronavigation: improving overview and interpretation by integrating preoperative MRI with intraoperative 3D ultrasound.Comput Aided Surg84969PubMedGoogle Scholar
  46. Lindseth, F, Lango, T, Bang, J, Nagelhus Hernes, TA 2002Accuracy evaluation of a 3D ultrasound-based neuronavigation system.Comput Aided Surg7197222CrossRefPubMedGoogle Scholar
  47. Maurer, M, Becker, G, Wagner, R, Woydt, M, Hofmann, E, Puls, I, Lindner, A, Krone, A 2000Early postoperative transcranial sonography (TCS), CT; and MRI after resection of high grade glioma: evaluation of residual tumour and its influence on prognosis.Acta Neurochir (Wien)14210891097Google Scholar
  48. Moriarty, TM, Quinones-Hinojosa, A, Larson, PS, Alexander, E, Gleason, PL, Schwartz, RB, Jolesz, FA, Black, PM 2000Frameless stereotactic neurosurgery using intraoperative magnetic resonance imaging: stereotactic brain biopsy.Neurosurgery4711381146PubMedGoogle Scholar
  49. Muacevic, A, Muller, A 1999Image-guided endoscopic ventriculostomy with a new frameless armless neuronavigation system.Comput Aided Surg48792CrossRefPubMedGoogle Scholar
  50. Nabavi, A, Black, PM, Gering, DT, Westin, CF, Mehta, V, Pergolizzi, RS,Jr, Ferrant, M, Warfield, SK, Hata, N, Schwartz, RB, Wells, WM,3rd, Kikinis, R, Jolesz, FA 2001Serial intraoperative magnetic resonance imaging of brain shift.Neurosurgery48787797; discussion 97–98PubMedGoogle Scholar
  51. Nikas DC, Hartov A, Lunn K, Rick K, Paulsen K, Roberts DW (2003) Coregistered intraoperative ultrasonography in resection of malignant glioma. Neurosurg Focus 14: Article 6Google Scholar
  52. Nimsky, C, Ganslandt, O, Cerny, P, Hastreiter, P, Greiner, G, Fahlbush, R 2000Quantification of, visualization of, and compensating for brain shift using intraoperative magnetic resonance imaging.Neurosurgery4710701080PubMedGoogle Scholar
  53. Nimsky, C, Ganslandt, O, Hastreiter, P, Wang, RP, Benner, T, Sorensen, AG, Fahlbusch, R 2005Intraoperative diffusion-tensor MR imaging: shifting of white matter tracts during neurosurgical procedures – initial experience.Radiology234218225PubMedGoogle Scholar
  54. Nimsky, C, Ganslandt, O, von Keller, B, Romstock, J, Fahlbusch, R 2004Intraoperative high-field-strength MR imaging: implementation and experience in 200 patients.Radiology2336778PubMedGoogle Scholar
  55. Pennec, X, Cachier, P, Ayache, N 2003Tracking brain deformations in time sequences of 3D US images.Pattern Recognition Lett24801813CrossRefGoogle Scholar
  56. Quencer, RM 1988The injured spinal cord. Evaluation with magnetic resonance and intraoperative sonography.Radiol Clin North Am2610251045PubMedGoogle Scholar
  57. Recht, L, Glantz, M, Chamberlain, M, Hsieh, CC 2003Quantitative measurement of quality outcome in malignant glioma patients using an independent living score (ILS) – Assessment of a retrospective cohort.J Neuro-Oncol61127136CrossRefGoogle Scholar
  58. Regelsberger, J, Lohmann, F, Helmke, K, Westphal, M 2000Ultrasound-guided surgery of deep seated brain lesions.Eu J Ultras12115121Google Scholar
  59. Reid, MH 1978Ultrasonic visualization of a cervical cord cystic astrocytoma.AJR Am J Roentgenol131907908PubMedGoogle Scholar
  60. Reinges, MHT, Nguyen, HH, Krings, T, Hutter, BO, Rohde, V, Gilsbach, JM 2004Course of brain shift during microsurgical resection of supratentorial cerebral lesions: limits of conventional neuronavigation.Acta Neurochir (Wien)146369377CrossRefGoogle Scholar
  61. Rhoten, RL, Luciano, MG, Barnett, GH 1997Computer-assisted endoscopy for neurosurgical procedures: technical note.Neurosurgery40632637; discussion 638PubMedGoogle Scholar
  62. Riccabona, M, Nelson, TR, Weitzer, C, Resch, B, Pretorius, DP 2003Potential of three-dimensional ultrasound in neonatal and paediatric neurosonography.Eur Radiol1320822093PubMedGoogle Scholar
  63. Roberts, DW, Hartov, A, Kennedy, FE, Miga, MI, Paulsen, KD 1998Intraoperative brain shift and deformation: a quantitative analysis of cortical displacement in 28 cases.Neurosurgery43749758; discussion 58–60PubMedGoogle Scholar
  64. Roberts, DW, Miga, MI, Hartov, A, Eisner, S, Lemery, JM, Kennedy, FE, Paulsen, KD 1999Intraoperatively updated neuroimaging using brain modeling and sparse data.Neurosurgery4511991206; discussion 206–207CrossRefPubMedGoogle Scholar
  65. Rubin, JM, Dohrmann, GJ 1983Intraoperative neurosurgical ultrasound in the localization and characterization of intracranial masses.Radiology148519524PubMedGoogle Scholar
  66. Rubin, JM, Dohrmann, GJ 1985The spine and spinal cord during neurosurgical operations: real-time ultrasonography.Radiology155197200PubMedGoogle Scholar
  67. Samset, E, Hirschberg, H 1999Neuronavigation in Intraoperative MRI.Computer Aided Surg4200207Google Scholar
  68. Schwartz, RB, Hsu, L, Wong, TZ, Kacher, DF, Zamani, AA, Black, PM, Alexander, E,3rd, Stieg, PE, Moriarty, TM, Martin, CA, Kikinis, R, Jolesz, FA 1999Intraoperative MR imaging guidance for intracranial neurosurgery: experience with the first 200 cases.Radiology211477488PubMedGoogle Scholar
  69. Selbekk, T, Bang, J, Unsgaard, G 2005Strain processing of intraoperative ultrasound images of brain tumours: initial results.Ultrasound Med Biol314551CrossRefPubMedGoogle Scholar
  70. Strowitzki, M, Moringlane, JR, Steudel, WI 2000Ultrasound-based navigation during intracranial burr hole procedures: experience in a series of 100 cases.Surg Neurol54134144PubMedGoogle Scholar
  71. Sure, U, Benes, L, Bozinov, O, Woydt, M, Tirakotai, W, Bertalanffy, H 2005Intraoperative landmarking of vascular anatomy by integration of duplex and Doppler ultrasonography in image-guided surgery. Technical note.Surg Neurol63133141PubMedGoogle Scholar
  72. Trantakis, C, Meixensberger, J, Lindner, D, Strauss, G, Grunst, G, Schmidtgen, A, Arnold, S 2002Iterative neuronavigation using 3D ultrasound. A feasibility study.Neurol Res24666670CrossRefPubMedGoogle Scholar
  73. Trantakis, C, Tittgemeyer, M, Schneider, JP, Lindner, D, Winkler, D, Strauss, G, Meixensberger, J 2003Investigation of time-dependency of intracranial brain shift and its relation to the extent of tumor removal using intra-operative MRI.Neurol Res25912CrossRefPubMedGoogle Scholar
  74. Trobaugh, JW, Richard, WD, Smith, KR, Bucholz, RD 1994Frameless stereotactic ultrasonography: method and applications.Comput Med Imaging Graph18235246PubMedGoogle Scholar
  75. Tronnier VM, Bonsanto MM, Staubert A, Knauth M, Kunze S, Wirtz CR (2001) Comparison of intraoperative MR imaging and 3D navigated ultrasonography in the detection and resection control of lesions. Neurosurg Focus 10Google Scholar
  76. Unsgaard, G, Gronningsaeter, A, Ommedal, S, Nagelhus Hernes, TA 2002Brain operations guided by real-time two-dimensional ultrasound: new possibilities as a result of improved image quality.Neurosurgery51402411; discussion 11–12PubMedGoogle Scholar
  77. Unsgaard, G, Ommedal, S, Muller, T, Gronningsaeter, A, Nagelhus Hernes, TA 2002Neuronavigation by intraoperative three-dimensional ultrasound: initial experience during brain tumor resection.Neurosurgery50804812; discussion 812CrossRefPubMedGoogle Scholar
  78. Unsgaard, G, Ommedal, S, Rygh, O, Lindseth, F 2005Operation of arteriovenous malformations assisted by stereoscopic navigation-controlled display of preoperative magnetic resonance angiography and intraoperative ultrasound angiography.Neurosurgery56281290CrossRefPubMedGoogle Scholar
  79. van Velthoven, V, Auer, LM 1990Practical application of intraoperative ultrasound imaging.Acta Neurochir (Wien)105513Google Scholar
  80. Wilberger, JE,Jr, Maroon, JC, Prostko, ER, Baghai, P, Beckman, I, Deeb, Z 1987Magnetic resonance imaging and intraoperative neurosonography in syringomyelia.Neurosurgery20599605PubMedGoogle Scholar
  81. Wirtz, CR, Albert, FK, Schwaderer, M, Heuer, C, Staubert, A, Tronnier, VM, Knauth, M, Kunze, S 2000The benefit of neuronavigation for neurosurgery analyzed by its impact on glioblastoma surgery.Neurol Res22354360PubMedGoogle Scholar
  82. Wirtz, CR, Bonsanto, MM, Knauth, M, Tronnier, VM, Albert, FK, Staubert, A, Kunze, S 1997Intraoperative magnetic resonance imaging to update interactive navigation in neurosurgery: method and preliminary experience.Computer Aided Surg2172179Google Scholar
  83. Wirtz, CR, Bonsanto, MM, Knauth, M, Tronnier, VM, Albert, FK, Staubert, A, Kunze, S 1997Intraoperative magnetic resonance imaging to update interactive navigation in neurosurgery: method and preliminary experience.Comput Aided Surg2172179CrossRefPubMedGoogle Scholar
  84. Woydt, M, Greiner, K, Perez, J, Krone, A, Roosen, K 1997Intraoperative color duplex sonography of basal arteries during aneurysm surgery.J Neuroimaging7203207PubMedGoogle Scholar
  85. Woydt, M, Kripfgans, OD, Fowlkes, BJ, Roosen, K, Carson, PL 2005Functional imaging with intraoperative ultrasound: detection of somatosensory cortex in dogs with color-duplex sonography.Neurosurgery56355363; discussion 363CrossRefPubMedGoogle Scholar
  86. Woydt, M, Krone, A, Soerensen, N, Roosen, K 2001Ultrasound-guided neuronavigation of deep-seated cavernous haemangiomas: clinical results and navigation techniques.Brit J Neurosurg15485495CrossRefGoogle Scholar
  87. Woydt, M, Perez, J, Meixensberger, J, Krone, A, Soerensen, N, Roosen, K 1998Intra-operative colour-duplex-sonography in the surgical management of cerebral AV-malformations.Acta Neurochir (Wien)140689698CrossRefGoogle Scholar
  88. Woydt, M, Vince, GH, Krauss, J, Krone, A, Soerensen, N, Roosen, K 2001New ultrasound techniques and their application in neurosurgical intra-operative sonography.Neurol Res23697705CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2005

Authors and Affiliations

  • G. Unsgaard
    • 1
    • 2
    • 4
  • O. M. Rygh
    • 1
    • 2
    • 4
  • T. Selbekk
    • 3
    • 4
  • T. B. Müller
    • 1
    • 4
  • F. Kolstad
    • 1
    • 2
    • 5
  • F. Lindseth
    • 3
    • 4
  • T. A. Nagelhus Hernes
    • 2
    • 3
    • 4
  1. 1.Department of NeurosurgerySt. Olav University HospitalTrondheimNorway
  2. 2.The Norwegian University of Science and TechnologyTrondheimNorway
  3. 3.SINTEF Health ResearchTrondheimNorway
  4. 4.National Centre for 3D ultrasound in Surgery, St. Olav University HospitalTrondheimNorway
  5. 5.National Centre of Spinal Disorders, St. Olav University HospitalTrondheimNorway

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