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<meta name="DC.Title" content="Artificial Intelligence–Assisted Evaluation of the Spatial Relationship between Brain Arteriovenous Malformations and the Corticospinal Tract to Predict Postsurgical Motor Defects" />
<meta name="DC.Identifier" content="10.3174/ajnr.A7735" />
<meta name="DC.Date" content="2022-12-22" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2023 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Preoperative evaluation of brain AVMs is crucial for the selection of surgical candidates. Our goal was to use artificial intelligence to predict postsurgical motor defects in patients with brain AVMs involving motor-related areas.

MATERIALS AND METHODS: Eighty-three patients who underwent microsurgical resection of brain AVMs involving motor-related areas were retrospectively reviewed. Four artificial intelligence–based indicators were calculated with artificial intelligence on TOF-MRA and DTI, including FN5mm/50mm (the proportion of fiber numbers within 5–50mm from the lesion border), FN10mm/50mm (the same but within 10–50mm), FP5mm/50mm (the proportion of fiber voxel points within 5–50mm from the lesion border), and FP10mm/50mm (the same but within 10–50mm). The association between the variables and long-term postsurgical motor defects was analyzed using univariate and multivariate analyses. Least absolute shrinkage and selection operator regression with the Pearson correlation coefficient was used to select the optimal features to develop the machine learning model to predict postsurgical motor defects. The area under the curve was calculated to evaluate the predictive performance.

RESULTS: In patients with and without postsurgical motor defects, the mean FN5mm/50mm, FN10mm/50mm, FP5mm/50mm, and FP10mm/50mm were 0.24 (SD, 0.24) and 0.03 (SD, 0.06), 0.37 (SD, 0.27) and 0.06 (SD, 0.08), 0.06 (SD, 0.10) and 0.01 (SD, 0.02), and 0.10 (SD, 0.12) and 0.02 (SD, 0.05), respectively. Univariate and multivariate logistic analyses identified FN10mm/50mm as an independent risk factor for long-term postsurgical motor defects ( P = .002). FN10mm/50mm achieved a mean area under the curve of 0.86 (SD, 0.08). The mean area under the curve of the machine learning model consisting of FN10mm/50mm, diffuseness, and the Spetzler-Martin score was 0.88 (SD, 0.07).

CONCLUSIONS: The artificial intelligence–based indicator, FN10mm/50mm, can reflect the lesion-fiber spatial relationship and act as a dominant predictor for postsurgical motor defects in patients with brain AVMs involving motor-related areas.

AI
:   artificial intelligence
AUC
:   area under the curve
BAVM
:   brain AVM
CST
:   corticospinal tract
EuDX
:   Euler Delta Crossing
FN
:   fiber number
FP
:   proportion of fiber voxel points
HDVL
:   hemorrhagic presentation, diffuseness, deep venous drainage, and lesion-to-eloquence distance
LASSO
:   least absolute shrinkage and selection operator
LCD
:   lesion-to-corticospinal tract distance
LR
:   logistic regression
M-AVM
:   brain AVM involving motor-related areas
MDs
:   motor defects
ML
:   machine learning
ROC
:   receiver operating characteristic
S-M
:   Spetzler-Martin grading
XGBoost
:   Extreme Gradient Boosting" />
<meta name="DC.Contributor" content="Y. Jiao" />
<meta name="DC.Contributor" content="J. Zhang" />
<meta name="DC.Contributor" content="X. Yang" />
<meta name="DC.Contributor" content="T. Zhan" />
<meta name="DC.Contributor" content="Z. Wu" />
<meta name="DC.Contributor" content="Y. Li" />
<meta name="DC.Contributor" content="S. Zhao" />
<meta name="DC.Contributor" content="H. Li" />
<meta name="DC.Contributor" content="J. Weng" />
<meta name="DC.Contributor" content="R. Huo" />
<meta name="DC.Contributor" content="J. Wang" />
<meta name="DC.Contributor" content="H. Xu" />
<meta name="DC.Contributor" content="Y. Sun" />
<meta name="DC.Contributor" content="S. Wang" />
<meta name="DC.Contributor" content="Y. Cao" />
<meta name="article:published_time" content="2022-12-22" />
<meta name="article:section" content="ADULT BRAIN" />
<meta name="citation_title" content="Artificial Intelligence–Assisted Evaluation of the Spatial Relationship between Brain Arteriovenous Malformations and the Corticospinal Tract to Predict Postsurgical Motor Defects" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Preoperative evaluation of brain AVMs is crucial for the selection of surgical candidates. Our goal was to use artificial intelligence to predict postsurgical motor defects in patients with brain AVMs involving motor-related areas.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Eighty-three patients who underwent microsurgical resection of brain AVMs involving motor-related areas were retrospectively reviewed. Four artificial intelligence–based indicators were calculated with artificial intelligence on TOF-MRA and DTI, including FN&lt;sub&gt;5mm/50mm&lt;/sub&gt; (the proportion of fiber numbers within 5–50mm from the lesion border), FN&lt;sub&gt;10mm/50mm&lt;/sub&gt; (the same but within 10–50mm), FP&lt;sub&gt;5mm/50mm&lt;/sub&gt; (the proportion of fiber voxel points within 5–50mm from the lesion border), and FP&lt;sub&gt;10mm/50mm&lt;/sub&gt; (the same but within 10–50mm). The association between the variables and long-term postsurgical motor defects was analyzed using univariate and multivariate analyses. Least absolute shrinkage and selection operator regression with the Pearson correlation coefficient was used to select the optimal features to develop the machine learning model to predict postsurgical motor defects. The area under the curve was calculated to evaluate the predictive performance.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;In patients with and without postsurgical motor defects, the mean FN&lt;sub&gt;5mm/50mm&lt;/sub&gt;, FN&lt;sub&gt;10mm/50mm&lt;/sub&gt;, FP&lt;sub&gt;5mm/50mm&lt;/sub&gt;, and FP&lt;sub&gt;10mm/50mm&lt;/sub&gt; were 0.24 (SD, 0.24) and 0.03 (SD, 0.06), 0.37 (SD, 0.27) and 0.06 (SD, 0.08), 0.06 (SD, 0.10) and 0.01 (SD, 0.02), and 0.10 (SD, 0.12) and 0.02 (SD, 0.05), respectively. Univariate and multivariate logistic analyses identified FN&lt;sub&gt;10mm/50mm&lt;/sub&gt; as an independent risk factor for long-term postsurgical motor defects (&lt;i&gt;P&lt;/i&gt; = .002). FN&lt;sub&gt;10mm/50mm&lt;/sub&gt; achieved a mean area under the curve of 0.86 (SD, 0.08). The mean area under the curve of the machine learning model consisting of FN&lt;sub&gt;10mm/50mm&lt;/sub&gt;, diffuseness, and the Spetzler-Martin score was 0.88 (SD, 0.07).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;The artificial intelligence–based indicator, FN&lt;sub&gt;10mm/50mm&lt;/sub&gt;, can reflect the lesion-fiber spatial relationship and act as a dominant predictor for postsurgical motor defects in patients with brain AVMs involving motor-related areas.&lt;/p&gt;" />
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<meta name="citation_author_institution" content="bChina National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China" />
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<meta name="citation_author" content="S. Wang" />
<meta name="citation_author_institution" content="aFrom the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China" />
<meta name="citation_author_institution" content="bChina National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China" />
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<meta name="citation_author_institution" content="aFrom the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China" />
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<meta name="twitter:title" content="Artificial Intelligence–Assisted Evaluation of the Spatial Relationship between Brain Arteriovenous Malformations and the Corticospinal Tract to Predict Postsurgical Motor Defects" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Preoperative evaluation of brain AVMs is crucial for the selection of surgical candidates. Our goal was to use artificial intelligence to predict postsurgical motor defects in patients with brain AVMs involving motor-related areas.

MATERIALS AND METHODS: Eighty-three patients who underwent microsurgical resection of brain AVMs involving motor-related areas were retrospectively reviewed. Four artificial intelligence–based indicators were calculated with artificial intelligence on TOF-MRA and DTI, including FN5mm/50mm (the proportion of fiber numbers within 5–50mm from the lesion border), FN10mm/50mm (the same but within 10–50mm), FP5mm/50mm (the proportion of fiber voxel points within 5–50mm from the lesion border), and FP10mm/50mm (the same but within 10–50mm). The association between the variables and long-term postsurgical motor defects was analyzed using univariate and multivariate analyses. Least absolute shrinkage and selection operator regression with the Pearson correlation coefficient was used to select the optimal features to develop the machine learning model to predict postsurgical motor defects. The area under the curve was calculated to evaluate the predictive performance.

RESULTS: In patients with and without postsurgical motor defects, the mean FN5mm/50mm, FN10mm/50mm, FP5mm/50mm, and FP10mm/50mm were 0.24 (SD, 0.24) and 0.03 (SD, 0.06), 0.37 (SD, 0.27) and 0.06 (SD, 0.08), 0.06 (SD, 0.10) and 0.01 (SD, 0.02), and 0.10 (SD, 0.12) and 0.02 (SD, 0.05), respectively. Univariate and multivariate logistic analyses identified FN10mm/50mm as an independent risk factor for long-term postsurgical motor defects ( P = .002). FN10mm/50mm achieved a mean area under the curve of 0.86 (SD, 0.08). The mean area under the curve of the machine learning model consisting of FN10mm/50mm, diffuseness, and the Spetzler-Martin score was 0.88 (SD, 0.07).

CONCLUSIONS: The artificial intelligence–based indicator, FN10mm/50mm, can reflect the lesion-fiber spatial relationship and act as a dominant predictor for postsurgical motor defects in patients with brain AVMs involving motor-related areas.

AI
:   artificial intelligence
AUC
:   area under the curve
BAVM
:   brain AVM
CST
:   corticospinal tract
EuDX
:   Euler Delta Crossing
FN
:   fiber number
FP
:   proportion of fiber voxel points
HDVL
:   hemorrhagic presentation, diffuseness, deep venous drainage, and lesion-to-eloquence distance
LASSO
:   least absolute shrinkage and selection operator
LCD
:   lesion-to-corticospinal tract distance
LR
:   logistic regression
M-AVM
:   brain AVM involving motor-related areas
MDs
:   motor defects
ML
:   machine learning
ROC
:   receiver operating characteristic
S-M
:   Spetzler-Martin grading
XGBoost
:   Extreme Gradient Boosting" />
<meta name="og-title" property="og:title" content="Artificial Intelligence–Assisted Evaluation of the Spatial Relationship between Brain Arteriovenous Malformations and the Corticospinal Tract to Predict Postsurgical Motor Defects" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2022/12/21/ajnr.A7735" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Preoperative evaluation of brain AVMs is crucial for the selection of surgical candidates. Our goal was to use artificial intelligence to predict postsurgical motor defects in patients with brain AVMs involving motor-related areas.

MATERIALS AND METHODS: Eighty-three patients who underwent microsurgical resection of brain AVMs involving motor-related areas were retrospectively reviewed. Four artificial intelligence–based indicators were calculated with artificial intelligence on TOF-MRA and DTI, including FN5mm/50mm (the proportion of fiber numbers within 5–50mm from the lesion border), FN10mm/50mm (the same but within 10–50mm), FP5mm/50mm (the proportion of fiber voxel points within 5–50mm from the lesion border), and FP10mm/50mm (the same but within 10–50mm). The association between the variables and long-term postsurgical motor defects was analyzed using univariate and multivariate analyses. Least absolute shrinkage and selection operator regression with the Pearson correlation coefficient was used to select the optimal features to develop the machine learning model to predict postsurgical motor defects. The area under the curve was calculated to evaluate the predictive performance.

RESULTS: In patients with and without postsurgical motor defects, the mean FN5mm/50mm, FN10mm/50mm, FP5mm/50mm, and FP10mm/50mm were 0.24 (SD, 0.24) and 0.03 (SD, 0.06), 0.37 (SD, 0.27) and 0.06 (SD, 0.08), 0.06 (SD, 0.10) and 0.01 (SD, 0.02), and 0.10 (SD, 0.12) and 0.02 (SD, 0.05), respectively. Univariate and multivariate logistic analyses identified FN10mm/50mm as an independent risk factor for long-term postsurgical motor defects ( P = .002). FN10mm/50mm achieved a mean area under the curve of 0.86 (SD, 0.08). The mean area under the curve of the machine learning model consisting of FN10mm/50mm, diffuseness, and the Spetzler-Martin score was 0.88 (SD, 0.07).

CONCLUSIONS: The artificial intelligence–based indicator, FN10mm/50mm, can reflect the lesion-fiber spatial relationship and act as a dominant predictor for postsurgical motor defects in patients with brain AVMs involving motor-related areas.

AI
:   artificial intelligence
AUC
:   area under the curve
BAVM
:   brain AVM
CST
:   corticospinal tract
EuDX
:   Euler Delta Crossing
FN
:   fiber number
FP
:   proportion of fiber voxel points
HDVL
:   hemorrhagic presentation, diffuseness, deep venous drainage, and lesion-to-eloquence distance
LASSO
:   least absolute shrinkage and selection operator
LCD
:   lesion-to-corticospinal tract distance
LR
:   logistic regression
M-AVM
:   brain AVM involving motor-related areas
MDs
:   motor defects
ML
:   machine learning
ROC
:   receiver operating characteristic
S-M
:   Spetzler-Martin grading
XGBoost
:   Extreme Gradient Boosting" />
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    <title>Artificial Intelligence–Assisted Evaluation of the Spatial Relationship between Brain Arteriovenous Malformations and the Corticospinal Tract to Predict Postsurgical Motor Defects | American Journal of Neuroradiology</title>  
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      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Artificial Intelligence–Assisted Evaluation of the Spatial Relationship between Brain Arteriovenous Malformations and the Corticospinal Tract to Predict Postsurgical Motor Defects</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Y. Jiao</span>, <span class="highwire-citation-author" data-delta="1">J. Zhang</span>, <span class="highwire-citation-author" data-delta="2">X. Yang</span>, <span class="highwire-citation-author" data-delta="3">T. Zhan</span>, <span class="highwire-citation-author" data-delta="4">Z. Wu</span>, <span class="highwire-citation-author" data-delta="5">Y. Li</span>, <span class="highwire-citation-author" data-delta="6">S. Zhao</span>, <span class="highwire-citation-author" data-delta="7">H. Li</span>, <span class="highwire-citation-author" data-delta="8">J. Weng</span>, <span class="highwire-citation-author" data-delta="9">R. Huo</span>, <span class="highwire-citation-author" data-delta="10">J. Wang</span>, <span class="highwire-citation-author" data-delta="11">H. Xu</span>, <span class="highwire-citation-author" data-delta="12">Y. Sun</span>, <span class="highwire-citation-author" data-delta="13">S. Wang</span> and <span class="highwire-citation-author" data-delta="14">Y. Cao</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">December 2022,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A7735 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-100441--61803567744" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Y. Jiao </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.%2BJiao%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jiao%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.%2BJiao%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8351-4602" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Jiao</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">J. Zhang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BZhang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhang%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BZhang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-1764-4959" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Zhang</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">X. Yang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=X.%2BYang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Yang%20X&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AX.%2BYang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-6828-7744" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for X. Yang</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">T. Zhan </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.%2BZhan%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhan%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.%2BZhan%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4587-8557" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T. Zhan</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Z. Wu </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Z.%2BWu%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wu%20Z&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AZ.%2BWu%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9119-4554" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Z. Wu</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Y. Li </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.%2BLi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Li%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.%2BLi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-1330-9827" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Li</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">S. Zhao </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BZhao%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhao%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BZhao%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7527-5226" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Zhao</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">H. Li </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.%2BLi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Li%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AH.%2BLi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-3272-8392" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for H. Li</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">J. Weng </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BWeng%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Weng%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BWeng%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8337-4670" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Weng</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">R. Huo </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BHuo%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Huo%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.%2BHuo%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4708-3133" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. Huo</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">J. Wang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BWang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wang%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BWang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9429-5094" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Wang</a></li></ul></div><div class="author-tooltip-11"><div class="author-tooltip-name">H. Xu </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.%2BXu%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Xu%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AH.%2BXu%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-9294-8349" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for H. Xu</a></li></ul></div><div class="author-tooltip-12"><div class="author-tooltip-name">Y. Sun </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.%2BSun%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sun%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.%2BSun%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-3986-4896" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Sun</a></li></ul></div><div class="author-tooltip-13"><div class="author-tooltip-name">S. Wang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BWang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wang%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BWang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-4919-5390" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Wang</a></li></ul></div><div class="author-tooltip-14"><div class="author-tooltip-name">Y. Cao </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</div><div class='author-affiliation'><span class='nlm-sup'>b</span>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Y.%2BCao%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cao%20Y&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AY.%2BCao%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8289-1120" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Y. Cao</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">Y. Jiao</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-2"><span class="name">J. Zhang</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-2" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-3"><span class="name">X. Yang</span><a id="xref-aff-2-3" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-4"><span class="name">T. Zhan</span><a id="xref-aff-2-4" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-5"><span class="name">Z. Wu</span><a id="xref-aff-2-5" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-6"><span class="name">Y. Li</span><a id="xref-aff-2-6" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-7"><span class="name">S. Zhao</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-7" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-8"><span class="name">H. Li</span><a id="xref-aff-1-4" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-8" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-9"><span class="name">J. Weng</span><a id="xref-aff-1-5" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-9" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-10"><span class="name">R. Huo</span><a id="xref-aff-1-6" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-10" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-11"><span class="name">J. Wang</span><a id="xref-aff-1-7" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-11" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-12"><span class="name">H. Xu</span><a id="xref-aff-1-8" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-12" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-13"><span class="name">Y. Sun</span><a id="xref-aff-1-9" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-13" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-14"><span class="name">S. Wang</span><a id="xref-aff-1-10" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-14" class="xref-aff" href="#aff-2">b</a> and </li><li class="last" id="contrib-15"><span class="name">Y. Cao</span><a id="xref-aff-1-11" class="xref-aff" href="#aff-1">a</a><span class="xref-sep">,</span><a id="xref-aff-2-15" class="xref-aff" href="#aff-2">b</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Yong Cao, MD, <span class="addr-line">Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119 South Fourth Ring Rd West, Fengtai District, Beijing, 100071, China</span>; e-mail: <span class="em-link"><span class="em-addr">caoyong{at}bjtth.org</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/early/2022/12/21/ajnr.A7735.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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