Awake Craniotomy: Cortical and Subcortical Mapping for Glioma Resection

  • Shawn L. Hervey-JumperEmail author
  • Mitchel S. Berger


Over 70,000 patients are diagnosed each year with a glioma, and the majority of these tumors are within areas of the brain with presumed functional significance. It has been well established that extent of tumor resection impacts both overall and progression-free survival. Direct stimulation of the cerebral cortex was first employed by Foerster in 1931 and later popularized by Penfield and Ojemann. Intraoperative mapping is the gold standard approach for the identification and preservation of functional areas of the brain. This chapter outlines the evidence supporting the extent of resection for low- and high-grade gliomas, including procedural steps and technical nuances to maximize success and minimize perioperative morbidity.


Glioma Glioblastoma Extent of resection Brain mapping DTI Diffusion tensor imaging Tractography 


  1. 1.
    Hervey-Jumper SL, Berger MS. Role of surgical resection in low- and high-grade gliomas. Curr Treat Options Neurol. 2014;16:284.CrossRefGoogle Scholar
  2. 2.
    De Witt Hamer PC, Robles SG, Zwinderman AH, Duffau H, Berger MS. Impact of intraoperative stimulation brain mapping on glioma surgery outcome: a meta-analysis. J Clin Oncol. 2012;30:2559–65.CrossRefGoogle Scholar
  3. 3.
    Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, Demonte F, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 2001;95:190–8.CrossRefGoogle Scholar
  4. 4.
    Lote K, Egeland T, Hager B, Stenwig B, Skullerud K, Berg-Johnsen J, et al. Survival, prognostic factors and therapeutic efficacy in low-grade glioma: a retrospective study in 379 patients. J Clin Oncol. 1997;15:3129–40.CrossRefGoogle Scholar
  5. 5.
    Nakamura M, Konishi N, Tsunoda S, Nakase H, Tsuzuki T, Aoki H, et al. Analysis of prognostic and survival factors related to treatment of low-grade astrocytomas in adults. Oncology. 2000;58:108–16.CrossRefGoogle Scholar
  6. 6.
    Nicolato A, Gerosa MA, Fina P, Iuzzolino P, Giorgiutti F, Bricolo A. Prognostic factors in low-grade supratentorial astrocytomas: a uni-multivariate statistical analysis in 76 surgically treated adult patients. Surg Neurol. 1995;44:208–21. discussion, 21–23.CrossRefGoogle Scholar
  7. 7.
    Scerrati M, Roselli R, Iacoangeli M, Pompucci A, Rossi GF. Prognostic factors in low grade (WHO grade II) gliomas of the cerebral hemispheres: the role of surgery. J Neurol Neurosurg Psychiatry. 1996;61:291–6.CrossRefGoogle Scholar
  8. 8.
    Yan H, Parsons DW, Jin G, Mclendon R, Rasheed BA, Yuan W, et al. IDH1 and IDH2 mutations in gliomas. N Engl J Med. 2009;360:765–73.CrossRefGoogle Scholar
  9. 9.
    Eckel-Passow JE, Lachance DH, Molinaro AM, Walsh KM, Decker PA, Sicotte H, et al. Glioma groups based on 1p/19q, IDH, and TERT promoter mutations in tumors. N Engl J Med. 2015;372:2499–508.CrossRefGoogle Scholar
  10. 10.
    Keles GE, Chang EF, Lamborn KR, Tihan T, Chang CJ, Chang SM, et al. Volumetric extent of resection and residual contrast enhancement on initial surgery as predictors of outcome in adult patients with hemispheric anaplastic astrocytoma. J Neurosurg. 2006;105:34–40.CrossRefGoogle Scholar
  11. 11.
    Smith JS, Chang EF, Lamborn KR, Chang SM, Prados MD, Cha S, et al. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol. 2008;26:1338–45.CrossRefGoogle Scholar
  12. 12.
    Snyder LA, Wolf AB, Oppenlander ME, Bina R, Wilson JR, Ashby L, et al. The impact of extent of resection on malignant transformation of pure oligodendrogliomas. J Neurosurg. 2014;120:309–14.CrossRefGoogle Scholar
  13. 13.
    Bauman G, Fisher B, Watling C, Cairncross JG, Macdonald D. Adult supratentorial low-grade glioma: long-term experience at a single institution. Int J Radiat Oncol Biol Phys. 2009;75:1401–7.CrossRefGoogle Scholar
  14. 14.
    Claus EB, Horlacher A, Hsu L, Schwartz RB, Dello-Iacono D, Talos F, et al. Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance. Cancer. 2005;103:1227–33.CrossRefGoogle Scholar
  15. 15.
    Incekara F, Olubiyi O, Ozdemir A, Lee T, Rigolo L, Golby A. The value of pre- and intraoperative adjuncts on the extent of resection of hemispheric low-grade gliomas: a retrospective analysis. J Neurol Surg A Cent Eur Neurosurg. 2016;77:79–87.PubMedGoogle Scholar
  16. 16.
    Ito S, Chandler KL, Prados MD, Lamborn K, Wynne J, Malec MK, et al. Proliferative potential and prognostic evaluation of low-grade astrocytomas. J Neuro-Oncol. 1994;19:1–9.CrossRefGoogle Scholar
  17. 17.
    Johannesen TB, Langmark F, Lote K. Progress in long-term survival in adult patients with supratentorial low-grade gliomas: a population-based study of 993 patients in whom tumors were diagnosed between 1970 and 1993. J Neurosurg. 2003;99:854–62.CrossRefGoogle Scholar
  18. 18.
    Karim AB, Maat B, Hatlevoll R, Menten J, Rutten EH, Thomas DG, et al. A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European organization for research and treatment of cancer (EORTC) study 22844. Int J Radiat Oncol Biol Phys. 1996;36:549–56.CrossRefGoogle Scholar
  19. 19.
    Leighton C, Fisher B, Bauman G, Depiero S, Stitt L, Macdonald D, et al. Supratentorial low-grade glioma in adults: an analysis of prognostic factors and timing of radiation. J Clin Oncol. 1997;15:1294–301.CrossRefGoogle Scholar
  20. 20.
    North CA, North RB, Epstein JA, Piantadosi S, Wharam MD. Low-grade cerebral astrocytomas. Survival and quality of life after radiation therapy. Cancer. 1990;66:6–14.CrossRefGoogle Scholar
  21. 21.
    Peraud A, Ansari H, Bise K, Reulen HJ. Clinical outcome of supratentorial astrocytoma WHO grade II. Acta Neurochir. 1998;140:1213–22.CrossRefGoogle Scholar
  22. 22.
    Philippon JH, Clemenceau SH, Fauchon FH, Foncin JF. Supratentorial low-grade astrocytomas in adults. Neurosurgery. 1993;32:554–9.CrossRefGoogle Scholar
  23. 23.
    Rajan B, Pickuth D, Ashley S, Traish D, Monro P, Elyan S, et al. The management of histologically unverified presumed cerebral gliomas with radiotherapy. Int J Radiat Oncol Biol Phys. 1994;28:405–13.CrossRefGoogle Scholar
  24. 24.
    Sanai N, Mirzadeh Z, Berger MS. Functional outcome after language mapping for glioma resection. N Engl J Med. 2008;358:18–27.CrossRefGoogle Scholar
  25. 25.
    Shaw E, Arusell R, Scheithauer B, O'Fallon J, O'Neill B, Dinapoli R, et al. Prospective randomized trial of low- versus high-dose radiation therapy in adults with supratentorial low-grade glioma: initial report of a north central cancer treatment group/radiation therapy oncology group/eastern cooperative oncology group study. J Clin Oncol. 2002;20:2267–76.CrossRefGoogle Scholar
  26. 26.
    Shibamoto Y, Kitakabu Y, Takahashi M, Yamashita J, Oda Y, Kikuchi H, et al. Supratentorial low-grade astrocytoma. Correlation of computed tomography findings with effect of radiation therapy and prognostic variables. Cancer. 1993;72:190–5.CrossRefGoogle Scholar
  27. 27.
    van Veelen ML, Avezaat CJ, Kros JM, van Putten W, Vecht C. Supratentorial low grade astrocytoma: prognostic factors, dedifferentiation, and the issue of early versus late surgery. J Neurol Neurosurg Psychiatry. 1998;64:581–7.CrossRefGoogle Scholar
  28. 28.
    Whitton AC, Bloom HJ. Low grade glioma of the cerebral hemispheres in adults: a retrospective analysis of 88 cases. Int J Radiat Oncol Biol Phys. 1990;18:783–6.CrossRefGoogle Scholar
  29. 29.
    Yeh SA, Ho JT, Lui CC, Huang YJ, Hsiung CY, Huang EY. Treatment outcomes and prognostic factors in patients with supratentorial low-grade gliomas. Br J Radiol. 2005;78:230–5.CrossRefGoogle Scholar
  30. 30.
    Barker FG 2nd, Prados MD, Chang SM, Gutin PH, Lamborn KR, Larson DA, et al. Radiation response and survival time in patients with glioblastoma multiforme. J Neurosurg. 1996;84:442–8.CrossRefGoogle Scholar
  31. 31.
    Bloch O, Han SJ, Cha S, Sun MZ, Aghi MK, Mcdermott MW, et al. Impact of extent of resection for recurrent glioblastoma on overall survival: clinical article. J Neurosurg. 2012;117:1032–8.CrossRefGoogle Scholar
  32. 32.
    Brown PD, Ballman KV, Rummans TA, Maurer MJ, Sloan JA, Boeve BF, et al. Prospective study of quality of life in adults with newly diagnosed high-grade gliomas. J Neuro-Oncol. 2006;76:283–91.CrossRefGoogle Scholar
  33. 33.
    Buckner JC, Schomberg PJ, Mcginnis WL, Cascino TL, Scheithauer BW, O'Fallon JR, et al. A phase III study of radiation therapy plus carmustine with or without recombinant interferon-alpha in the treatment of patients with newly diagnosed high-grade glioma. Cancer. 2001;92:420–33.CrossRefGoogle Scholar
  34. 34.
    Curran WJ Jr, Scott CB, Horton J, Nelson JS, Weinstein AS, Nelson DF, et al. Does extent of surgery influence outcome for astrocytoma with atypical or anaplastic foci (AAF)? A report from three radiation therapy oncology group (RTOG) trials. J Neuro-Oncol. 1992;12:219–27.CrossRefGoogle Scholar
  35. 35.
    Dinapoli RP, Brown LD, Arusell RM, Earle JD, O'Fallon JR, Buckner JC, et al. Phase III comparative evaluation of PCNU and carmustine combined with radiation therapy for high-grade glioma. J Clin Oncol. 1993;11:1316–21.CrossRefGoogle Scholar
  36. 36.
    Duncan GG, Goodman GB, Ludgate CM, Rheaume DE. The treatment of adult supratentorial high grade astrocytomas. J Neuro-Oncol. 1992;13:63–72.CrossRefGoogle Scholar
  37. 37.
    Hollerhage HG, Zumkeller M, Becker M, Dietz H. Influence of type and extent of surgery on early results and survival time in glioblastoma multiforme. Acta Neurochir. 1991;113:31–7.CrossRefGoogle Scholar
  38. 38.
    Huber A, Beran H, Becherer A, Prosenc N, Witzmann A. Supratentorial glioma: analysis of clinical and temporal parameters in 163 cases. Neurochirurgia (Stuttg). 1993;36:189–93.Google Scholar
  39. 39.
    Jeremic B, Grujicic D, Antunovic V, Djuric L, Stojanovic M, Shibamoto Y. Influence of extent of surgery and tumor location on treatment outcome of patients with glioblastoma multiforme treated with combined modality approach. J Neuro-Oncol. 1994;21:177–85.CrossRefGoogle Scholar
  40. 40.
    Keles GE, Anderson B, Berger MS. The effect of extent of resection on time to tumor progression and survival in patients with glioblastoma multiforme of the cerebral hemisphere. Surg Neurol. 1999;52:371–9.CrossRefGoogle Scholar
  41. 41.
    Kowalczuk A, Macdonald RL, Amidei C, Dohrmann G 3rd, Erickson RK, Hekmatpanah J, et al. Quantitative imaging study of extent of surgical resection and prognosis of malignant astrocytomas. Neurosurgery. 1997;41:1028–36. discussion, 36–8.CrossRefGoogle Scholar
  42. 42.
    Lamborn KR, Chang SM, Prados MD. Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro-oncol. 2004;6:227–35.CrossRefGoogle Scholar
  43. 43.
    Levin VA, Yung WK, Bruner J, Kyritsis A, Leeds N, Gleason MJ, et al. Phase II study of accelerated fractionation radiation therapy with carboplatin followed by PCV chemotherapy for the treatment of anaplastic gliomas. Int J Radiat Oncol Biol Phys. 2002;53:58–66.CrossRefGoogle Scholar
  44. 44.
    Mcgirt MJ, Chaichana KL, Gathinji M, Attenello FJ, Than K, Olivi A, et al. Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg. 2009;110:156–62.CrossRefGoogle Scholar
  45. 45.
    Nitta T, Sato K. Prognostic implications of the extent of surgical resection in patients with intracranial malignant gliomas. Cancer. 1995;75:2727–31.CrossRefGoogle Scholar
  46. 46.
    Nomiya T, Nemoto K, Kumabe T, Takai Y, Yamada S. Prognostic significance of surgery and radiation therapy in cases of anaplastic astrocytoma: retrospective analysis of 170 cases. J Neurosurg. 2007;106:575–81.CrossRefGoogle Scholar
  47. 47.
    Oppenlander ME, Wolf AB, Snyder LA, Bina R, Wilson JR, Coons SW, et al. An extent of resection threshold for recurrent glioblastoma and its risk for neurological morbidity. J Neurosurg. 2014;120:846–53.CrossRefGoogle Scholar
  48. 48.
    Oszvald A, Guresir E, Setzer M, Vatter H, Senft C, Seifert V, et al. Glioblastoma therapy in the elderly and the importance of the extent of resection regardless of age. J Neurosurg. 2012;116:357–64.CrossRefGoogle Scholar
  49. 49.
    Phillips TL, Levin VA, Ahn DK, Gutin PH, Davis RL, Wilson CB, et al. Evaluation of bromodeoxyuridine in glioblastoma multiforme: a northern California cancer center phase II study. Int J Radiat Oncol Biol Phys. 1991;21:709–14.CrossRefGoogle Scholar
  50. 50.
    Pope WB, Sayre J, Perlina A, Villablanca JP, Mischel PS, Cloughesy TF. MR imaging correlates of survival in patients with high-grade gliomas. Am J Neuroradiol. 2005;26:2466–74.PubMedGoogle Scholar
  51. 51.
    Prados MD, Gutin PH, Phillips TL, Wara WM, Larson DA, Sneed PK, et al. Highly anaplastic astrocytoma: a review of 357 patients treated between 1977 and 1989. Int J Radiat Oncol Biol Phys. 1992;23:3–8.CrossRefGoogle Scholar
  52. 52.
    Puduvalli VK, Hashmi M, Mcallister LD, Levin VA, Hess KR, Prados M, et al. Anaplastic oligodendrogliomas: prognostic factors for tumor recurrence and survival. Oncology. 2003;65:259–66.CrossRefGoogle Scholar
  53. 53.
    Sanai N, Polley MY, Mcdermott MW, Parsa AT, Berger MS. An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg. 2011;115:3–8.CrossRefGoogle Scholar
  54. 54.
    Sandberg-Wollheim M, Malmstrom P, Stromblad LG, Anderson H, Borgstrom S, Brun A, et al. A randomized study of chemotherapy with procarbazine, vincristine, and lomustine with and without radiation therapy for astrocytoma grades 3 and/or 4. Cancer. 1991;68:22–9.CrossRefGoogle Scholar
  55. 55.
    Shibamoto Y, Yamashita J, Takahashi M, Yamasaki T, Kikuchi H, Abe M. Supratentorial malignant glioma: an analysis of radiation therapy in 178 cases. Radiother Oncol. 1990;18:9–17.CrossRefGoogle Scholar
  56. 56.
    Simpson JR, Horton J, Scott C, Curran WJ, Rubin P, Fischbach J, et al. Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive radiation therapy oncology group (RTOG) clinical trials. Int J Radiat Oncol Biol Phys. 1993;26:239–44.CrossRefGoogle Scholar
  57. 57.
    Stark AM, Nabavi A, Mehdorn HM, Blomer U. Glioblastoma multiforme-report of 267 cases treated at a single institution. Surg Neurol. 2005;63:162–9. discussion, 9.CrossRefGoogle Scholar
  58. 58.
    Ushio Y, Kochi M, Hamada J, Kai Y, Nakamura H. Effect of surgical removal on survival and quality of life in patients with supratentorial glioblastoma. Neurol Med Chir (Tokyo). 2005;45:454–60. discussion, 60–1.CrossRefGoogle Scholar
  59. 59.
    Vecht CJ, Avezaat CJ, van Putten WL, Eijkenboom WM, Stefanko SZ. The influence of the extent of surgery on the neurological function and survival in malignant glioma. A retrospective analysis in 243 patients. J Neurol Neurosurg Psychiatry. 1990;53:466–71.CrossRefGoogle Scholar
  60. 60.
    Jakola AS, Myrmel KS, Kloster R, Torp SH, Lindal S, Unsgard G, et al. Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas. JAMA. 2012;308:1881–8.CrossRefGoogle Scholar
  61. 61.
    Pallud J, Fontaine D, Duffau H, Mandonnet E, Sanai N, Taillandier L, et al. Natural history of incidental World Health Organization grade II gliomas. Ann Neurol. 2010;68:727–33.CrossRefGoogle Scholar
  62. 62.
    Potts MB, Smith JS, Molinaro AM, Berger MS. Natural history and surgical management of incidentally discovered low-grade gliomas. J Neurosurg. 2012;116:365–72.CrossRefGoogle Scholar
  63. 63.
    Berger MS. Lesions in functional ("eloquent") cortex and subcortical white matter. Clin Neurosurg. 1994;41:444–63.PubMedGoogle Scholar
  64. 64.
    Hervey-Jumper SL, Li J, Lau D, Molinaro AM, Perry DW, Meng L, et al. Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg. 2015;123:325–39.CrossRefGoogle Scholar
  65. 65.
    Grossman R, Ram Z. Awake craniotomy in glioma surgery. Eur Assoc Neuro-oncol Mag. 2015;4:1–8.Google Scholar
  66. 66.
    Berger MS, Hervey-Jumper S, Wick W. Astrocytic gliomas WHO grades II and III. Handb Clin Neurol. 2016;134:345–60.CrossRefGoogle Scholar
  67. 67.
    Cha S. Perfusion MR imaging: basic principles and clinical applications. Magn Reson Imaging Clin N Am. 2003;11:403–13.CrossRefGoogle Scholar
  68. 68.
    Bogomolny DL, Petrovich NM, Hou BL, Peck KK, Kim MJ, Holodny AI. Functional MRI in the brain tumor patient. Top Magn Reson Imaging. 2004;15:325–35.CrossRefGoogle Scholar
  69. 69.
    Nimsky C, Ganslandt O, Von Keller B, Romstock J, Fahlbusch R. Intraoperative high-field-strength MR imaging: implementation and experience in 200 patients. Radiology. 2004;233:67–78.CrossRefGoogle Scholar
  70. 70.
    Alexander AL, Lee JE, Lazar M, Field AS. Diffusion tensor imaging of the brain. Neurotherapeutics. 2007;4:316–29.CrossRefGoogle Scholar
  71. 71.
    Bello L, Gambini A, Castellano A, Carrabba G, Acerbi F, Fava E, et al. Motor and language DTI Fiber tracking combined with intraoperative subcortical mapping for surgical removal of gliomas. NeuroImage. 2008;39:369–82.CrossRefGoogle Scholar
  72. 72.
    Berman JI, Berger MS, Chung SW, Nagarajan SS, Henry RG. Accuracy of diffusion tensor magnetic resonance imaging tractography assessed using intraoperative subcortical stimulation mapping and magnetic source imaging. J Neurosurg. 2007;107:488–94.CrossRefGoogle Scholar
  73. 73.
    Bizzi A, Blasi V, Falini A, Ferroli P, Cadioli M, Danesi U, et al. Presurgical functional MR imaging of language and motor functions: validation with intraoperative electrocortical mapping. Radiology. 2008;248:579–89.CrossRefGoogle Scholar
  74. 74.
    Duffau H. New concepts in surgery of WHO grade II gliomas: functional brain mapping, connectionism and plasticity--a review. J Neuro-Oncol. 2006;79:77–115.CrossRefGoogle Scholar
  75. 75.
    Thiel A, Herholz K, Koyuncu A, Ghaemi M, Kracht LW, Habedank B, et al. Plasticity of language networks in patients with brain tumors: a positron emission tomography activation study. Ann Neurol. 2001;50:620–9.CrossRefGoogle Scholar
  76. 76.
    Guggisberg AG, Honma SM, Findlay AM, Dalal SS, Kirsch HE, Berger MS, et al. Mapping functional connectivity in patients with brain lesions. Ann Neurol. 2008;63:193–203.CrossRefGoogle Scholar
  77. 77.
    Trinh VT, Fahim DK, Maldaun MV, Shah K, Mccutcheon IE, Rao G, et al. Impact of preoperative functional magnetic resonance imaging during awake craniotomy procedures for intraoperative guidance and complication avoidance. Stereotact Funct Neurosurg. 2014;92:315–22.CrossRefGoogle Scholar
  78. 78.
    Taylor MD, Bernstein M. Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases. J Neurosurg. 1999;90:35–41.CrossRefGoogle Scholar
  79. 79.
    Bekker AY, Kaufman B, Samir H, Doyle W. The use of dexmedetomidine infusion for awake craniotomy. Anesth Analg. 2001;92:1251–3.CrossRefGoogle Scholar
  80. 80.
    Herrick IA, Craen RA, Gelb AW, Miller LA, Kubu CS, Girvin JP, et al. Propofol sedation during awake craniotomy for seizures: patient-controlled administration versus neuroleptic analgesia. Anesth Analg. 1997;84:1285–91.CrossRefGoogle Scholar
  81. 81.
    Olsen KS. The asleep-awake technique using propofol-remifentanil anaesthesia for awake craniotomy for cerebral tumours. Eur J Anaesthesiol. 2008;25:662–9.CrossRefGoogle Scholar
  82. 82.
    Nathan SS, Sinha SR, Gordon B, Lesser RP, Thakor NV. Determination of current density distributions generated by electrical stimulation of the human cerebral cortex. Electroencephalogr Clin Neurophysiol. 1993;86:183–92.CrossRefGoogle Scholar
  83. 83.
    Duffau H, Capelle L, Denvil D, Sichez N, Gatignol P, Lopes M, et al. Functional recovery after surgical resection of low grade gliomas in eloquent brain: hypothesis of brain compensation. J Neurol Neurosurg Psychiatry. 2003;74:901–7.CrossRefGoogle Scholar
  84. 84.
    Duffau H, Moritz-Gasser S, Gatignol P. Functional outcome after language mapping for insular World Health Organization grade II gliomas in the dominant hemisphere: experience with 24 patients. Neurosurg Focus. 2009;27:E7.CrossRefGoogle Scholar
  85. 85.
    Wilson SM, Lam D, Babiak MC, Perry DW, Shih T, Hess CP, et al. Transient aphasias after left hemisphere resective surgery. J Neurosurg. 2015;123:581–93.CrossRefGoogle Scholar
  86. 86.
    Keles GE, Lundin DA, Lamborn KR, Chang EF, Ojemann G, Berger MS. Intraoperative subcortical stimulation mapping for hemispherical perirolandic gliomas located within or adjacent to the descending motor pathways: evaluation of morbidity and assessment of functional outcome in 294 patients. J Neurosurg. 2004;100:369–75.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurological SurgeryUniversity of California San Francisco Medical CenterSan FranciscoUSA

Personalised recommendations