Journal de l'Association chiropratique canadienne. It determined the rate for SCI and fracture-dislocation of the spine. The History, Present, and Future of Spine Surgery in Switzerland. However, a structured education program in which the senior surgeon gives advice, guidance and communicates cautions during each resident surgery is of paramount importance to provide high-quality patient care. Methods: an expert, Two-part study. Clipboard, Search History, and several other advanced features are temporarily unavailable. Rather similar guidelines exist for the education of neurosurgical residents in the USA and Europe; their translation into the practical hospital setting and the resulting clinical lifestyle of a resident diverges enormously. Le malade étant en décubitus ventral, l'examinateur place une main sur le sacrum et de l'autre il fléchit le Techniques de mobilisation et d'ostéopathie neuroméningées 3 e partie : le membre inférieur Mobilisation transversale et longitudinale du nerf tibial dans le canal tarsien. Less than every fifth European resident spends >50 % of his/her working time in the operating room. To determine if there is a consensus of the optimal method for "clearing the cervical spine"; to assess the safety and efficacy, The cervical spine is considered fragile and vulnerable to injuries in equestrian sport. The aim of this study was to test the hypothesis that the outcome and complication rate of anterior cervical discectomy and fusion with or without instrumentation (ACDF(I)) is not inferior for supervised residents as compared to board-certified faculty neurosurgeons (BCFN). Multiple logistic regression was used to assess the relationship between responder-specific variables (e.g., age, gender, country, postgraduate year (PGY)) and outcome (e.g., working time). Of 1,446 consecutive procedures, 221 (15.3%) were teaching procedures. analysis of 194 disability cases in 1999-2003 and of 164 ones in 2007-2009 due to degenerative disorders of the spine is performed. ... We evaluated the current status of resident training in Germany. Still, more than half of them would chose to work even more hours/week if their clinical education were to improve; probably due to subjective impression of insufficient training. What is important is not to slavishly follow any guidelines for sequencing material but to understand the concepts of competency-based training as a way to assure the competency of training program graduates and to prepare them for the next phase of postgraduate medical education which leads to mastery of our field [9]. Keywords: Palpation longitudinale : très intéressante dans les zones d'accrochage. The procedures were dichotomized into two groups according to the surgeon's level of experience: teaching cases (neurosurgical residents in the 1st to 4th year of training) and non-teaching cases (experienced board-certified faculty neurosurgeons). Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify the occurrence of 21 predefined treatment complications. Epub 2019 Mar 29. Aneurysmal bone cysts should be considered in the etiology of complicated scoliosis. The influence of working hour restrictions by the European Working Time Directive (WTD) 2003/88/EC on the number of surgical procedures remains unclear. Procedures performed during neurosurgery residency in Europe. • Sur le nerf obturateur • Sur le nerf fémoro latéral : etc. Country-specific composite scores for satisfaction with quality of theoretical and practical training, as well as working hours per week, were obtained from an electronic survey distributed among European neurosurgical residents between June 2014 and March 2015. Price on request . This article reports preliminary data. All rights reserved. ... Frankfurt am Main, Germany Medical School/Undergraduate: J.W. Every surgeon has to operate on a patient for the first time. The World Federation of Neurosurgical Societies Young Neurosurgeons Survey (Part I): Demographics, Resources, and Education. The satisfaction rate with hands-on operating room exposure was 73.9% and equal to the rate in Europe (OR: 0.94; 95% CI, 0.56–1.59; p = 0.834). The aim of this study was to test the hypothesis that early introduction of supervised residents to non-complex spinal surgical procedures within a structured and supervised educational program does not harm the patient in terms of higher complication rates or worse pain- and health-related quality of life (HrQOL) outcomes. Results: among initially recognized as disabled people due to orthopedic pathology percentage of patients with the degenerative spine increased on 4,7 % and reached (35,8 ± 0,6) % in 2007-2009 versus (31,1 ± 0,6) % in 1999-2003. NASS-CDS electronic cases of SCIs in rear impacts were investigated. At the very least you will need an Arbeitserlaubniss, a permit to work and get paid in Germany, along with a Versicherungskarte, proof of Health Insurance, a Bank Konto, a bank account, a visa of course. Clinical research. The effect of the actual working time on the theoretical and practical knowledge of neurosurgical trainees appears to be insignificant. Conclusion The rate for SCI was 0.027 ± 0.005% in belted and 0.145 ± 0.028% in unbelted occupants giving 81% effectiveness of belt use in reducing SCI. World Neurosurg X. Il semblerait que l'extension de hanche réalise plus de tension sur le nerf fémoral latéral (nerf fémoro-cutané) que sur le nerf fémoral. Objectives are divided into general objectives, intermediate and specific. Read more. Previous Residency: Alberts-Ludwig University,, Freiburg in Breisgau, Germany The results were compared to estimates of head injuries. Methods: Yang I, Udawatta M, Prashant GN, Lagman C, Bloch O, Jensen R, Sheehan J, Kalkanis S, Warnick R. World Neurosurg. 2019 Feb;122:522-531. doi: 10.1016/j.wneu.2018.10.193. The list includes only verified specialists known for their experience and high success rates. Results:  |  The responses of Czech trainees were compared to those of trainees from other European countries. A total of 8887 patients were identified from a retrospective database analysis of 21 centers providing data for postoperative anterior cervical infections (17/21, 81% response rate). The survey remains open, and we invite further European neurosurgeons to provide their data in order to get even more robust estimates. http://eur-lex.europa.eu/ All responses received between 04/2018 and 12/2018 were considered. Neuroradiology. This site needs JavaScript to work properly. A standardized protocol to safely and effectively clear the cervical spine has yet to be established. General aspects, Cervical disc herniation missed at operation: a case report, Trends in Spinal Surgery for Pott’s Disease (2000-2016): An Overview and Bibliometric Study, Clinical features and long-term outcomes of pediatric spinal meningiomas, Spinal Fracture-Dislocations and Spinal Cord Injuries in Motor Vehicle Crashes, Cervical Spondyloptosis Caused by an Aneurysmal Bone Cyst: A Case Report, Anterior Cervical Infection: Presentation and Incidence of an Uncommon Postoperative Complication, Herausforderungen und Besonderheiten der Spondylodiszitiden der Halswirbelsäule. The department is one of the largest medical institutions of this kind in Germany. It is shown that, especially with injuries of the head and thoracic and lumbar spine area, patients are at increased risk of concurrent cervical lesions. However, quality of brain surgery simulation is limited due to discrepancies in visual and haptic experience. They should be acquired in a structured manner and preferably starting early in residency. Neurologic examination revealed bilateral tongue wasting, loss of tongue protrusion, and right vocal cord paresis. Methods: An electronic survey was sent to European neurosurgical trainees between 06/2014 and 03/2015. the cervical spine, 5 in the thoracic spine, and 2 in the lumbar spine. Retrospective multi-institutional case series. The Mayo Clinic has locations in Minnesota, Florida and Arizona. The results were consistent at time of the M3 follow-up and in subgroup analyses. Theoretical and practical aspects of neurosurgical training are highly variable throughout European countries, despite some efforts within the last two decades to harmonize this. When confronted with this problem, it is important to diagnose the level of the herniation. In a multivariate analysis, Czech trainees were as likely as non-Czech European trainees to be satisfied with clinical lectures given at their teaching facility (OR 1.84; 95% CI 0.77–4.43; p = 0.170). Supervised lumbar-/cervical spine surgeries were performed by 78.2 and 17.9 % of European residents within 12 and 24 months of training, respectively, and 54.6 % of European residents operate a cranial case within the first 36 months of training. In this paper we discuss the Neurosurgical Training Programme (NTP) in some European countries. Trainees from outside the European Union (EU) are under-represented in the EANS training courses. Appropriate allocation of operations according to case complexity and the resident’s experience level, however, appears essential. Back and leg pain on the visual analogue scale (VAS), functional disability (Roland-Morris-Disability-Index (RMDI) and Oswestry-Disability-Index (ODI)), as well as health-related quality of life (hrQoL; short-form (SF)-12 and Euro-Qol (EQ5D)) were assessed, and re-operations since the index surgery were recorded. The consequence of the highly condensed and demanding neurosurgical working environment is an urgent need for training scenarios that effectively shorten the conventional learning curves of the "see one, do one, teach one" era [19]. Klinikum Stuttgart. Questionnaires regarding neurosurgical training were sent to all participants of the EANS-training course in Barcelona 1999 and to all national neurosurgical societies of EANS. ... Pediatric neurosurgeons have at least 4 years of medical school, 1 year of internship, at least 5 years of residency in neurological surgery. Conclusions: Both teaching cases (where patients were operated by neurosurgical residents in training) and non-teaching cases (operated by BCFN) were reviewed. Brain and spinal injuries. A total of 6 postoperative infections after ACDF were identified for a mean rate of 0.07% (range 0% to 0.39%). SPECTIVE STUDY: Prospective clinical protocol. Conclusions: However, they were less likely to perform a cervical spine procedure within 24 months of training (OR: 0.38; 95% CI, 0.17–0.82; p = 0.014) and less likely to perform a craniotomy within 36 months of training (OR: 0.49; 95% CI, 0.31–0.79; p = 0.003). (2) What is the current surgical approaches of choice? We present a programme of Neurosurgery concerning pre- and post-graduate education. Conclusions: It is a well-established dogma that many surgeons do not reach a quintessential level of their technical operative skills until successful completion of their training program. This case, Study design: Schedule of training period, services requirements and facilities for didactic purposes are mentioned. The incidence of postoperative infection in ACDF is exceedingly low. Most of the injuries occurred in rollovers and frontal crashes and the least occurred in rear impacts. Introduction Efficient neurosurgical training is of paramount importance to provide continuing high-quality medical care to patients. Neurosurgery Bern Neurosurgery Hirslanden Neurosurgery Zurich Neurosurgery Salzburg A list of all neurosurgeons in Switzerland can be found at the Swiss Society of Neurosurgery. Czech trainees were 52-times as likely to perform on average ≥ 4 peripheral nerve interventions per month (OR 52.05; 11.46–236.31; p < 0.001), but less likely to operate ≥ 10 burr hole trepanations (OR 0.13; 0.02–0.97; p = 0.047) and the exposure was balanced regarding craniotomies and spine procedures. Preliminary results of a new protocol to safely evaluate the cervical spine in the polytrauma patient are promising. highlights the potentially devastating effects that can be caused by benign tumors in the vertebral column. Spinal cord injury occurred in one out of 1,860 front seat occupants in tow-away crashes. Of the total infections, half were smokers (n = 3). There were no mortalities. Neurosurgical training aims at educating future generations of specialist neurosurgeons and at providing the highest-quality medical services to patients. A total of n=30 and n=74 patients operated on by residents and BCFN respectively, returned their questionnaires. Lors du test, nous évitons l'extension lombaire impor-tante qui peut être responsable du conflit. Light vehicles were included with model year 1994+. There was a strong decline in surgical cases over time, and trainees graduating after introduction of the European WTD 2003/88/EC had less surgical exposure. It is necessary to create the clear system of account of the patients, who need restoration treatment and rehabilitation according to individual programs as well as to standardize programs of restoration treatment. The final sample was n = 80, with a mean responder's age of 43.0 years (SD 8.6) and 88.8% being male. 2019 Oct;161(10):1977-1979. doi: 10.1007/s00701-019-04048-3. The Department of Neurosurgery offers the full range of surgical interventions for the treatment of diseases of the central and peripheral nervous system. Location: Lutherplatz 40, 47805 Krefeld, Germany. The responses of German trainees were compared with those of trainees from other European countries. Stereotactic Radiosurgery for Neurosurgical Patients: A Historical Review and Current Perspectives. NIH Results: Six randomized controlled trials were identified from our search (1 excluded: no surgical arm identified after review) Neurological deficit, instability and deformity were common indications identified. 2018 Jan;160(1):23-28. doi: 10.1007/s00701-017-3351-5. They were about 4-times as likely to begin with their own cranial cases within 36 months of training (OR 3.69; 1.04–13.07; p = 0.042). This retrospective study investigates the injury pattern and severity. Methods Microscopic lumbar spinal stenosis decompression: is surgical education safe? Epub 2015 Nov 14. To describe an unusual presentation of aneurysmal bone cyst causing painless cervical spondyloptosis. The mean age was 27.1 ± 13.2 years. Objective: Methods Butler le nomme PKB (Prone Knee Bend). During last 15 months 340 international doctors have begun residency in Germany by means of this program. Part Two: a prospective clinical study evaluating a new algorithm to evaluate the cervical spine in polytrauma patients. The three-month rotations in the neuros… Two patients presented with myelopathy, and 3 patients presented with radiculopathic-type complaints. The same concerns patients with intervertebral disks herniations (from 58,2 to 79,9 %) and protrusions (from 6,2 to 10,4 %) diagnosed in this period. infections. Eighty-two percent of all respondents has seen or treated a purely ligamentous injury of the c-spine. Limited data in the literature describe the presentation and true incidence of postoperative surgical site, The human cervical spine is a unique structure that differs dramatically from the thoracic and lumbar spine. Among invalids with the degenerative spine percentage of young persons and people of working age increased to 88,3 % versus 74,7 % accordingly. In 13.1% of patients, there were 71 cervical spine injuries (92.4% female; 7.6% male). Retrospective single-center study performed at a Swiss teaching hospital comparing consecutive patients undergoing surgery for LSS by a supervised neurosurgery resident (teaching cases) to a consecutive series of patients operated on by a BCFN (non-teaching cases). The skullcap and skull base were placed on each other, glued together, and filled up with an aspic water solution for brain fixation. We emphasize the need for personal teaching as the only element of general guidance for the programme. Survey: Fifty-five percent of the members of the OTA and 31% of the NASS surgeons responded to the questionnaire. Teaching cases were 100 % (odds ratio of 1.00) as likely as non-teaching cases to achieve a favorable HrQOL response to surgery (p = 0.99). : par exemple. Differences in the postgraduate training programs of neurosurgical residents are suspected throughout Europe. Its resident pay scale reflects that rigorous program, listing 10 years of post-graduate residency … Those trained at UHs (vs TRHs) and high- (vs low-) volume centers had their dissertations more frequently published in Science Citation Index/Science Citation Index-Expanded journals, gave more oral presentations after residency, had higher h-indices, had higher rates of reviewership for academic journals, and had greater participation in projects with grant support. A short excursion into the history of neurosurgery The field of neurosurgery, i.e. Some remarks and suggestions from the perspective of young neurosurgeons are given. We aimed to evaluate the current situation of resident training in the Czech Republic. Anterior cervical discectomy and fusion: is surgical education safe? In surgery, 75% of errors are preventable and technical in nature [7]. The numerous awards, certificates, and doctors professionalism make Helios Krefeld one of the best neurosurgery hospitals in Germany and worldwide. Copyright © 2015 Elsevier Inc. All rights reserved. In total, 17.5, 22.1, 29.5, 19.5, 5.9, and 5.5 % of European residents indicated to work <40, 40-50, 51-60, 61-70, 71-80, or >80 h/week, respectively. NLM of a newly proposed algorithm. Nearly 90% of all respondents identified the presence of neck pain or retropharygeal soft tissue swelling as an indicator to expand their initial radiographic evaluation. The mean age of patients identified was 57.5 (SD = 11.6, 66.7% female). Part One: the analysis of surveys distributed to members of the Orthopaedic Trauma Association (OTA) and 1000 surgeon members of NASS. An electronic survey was sent to European neurosurgical residents between 06/2014 and 03/2015. articles were searched from database inception from January 1, 2000 to December 31, 2016 to identify studies specifically evaluating surgical indications, current surgical approaches, and outcome measures for spinal tuberculosis. I am studyin german and would like to pursue this residency there but i have little info on how the system works and would really appreciate some insight on how the process works in germany. Have they changed over time since the year 2000? As such, neurosurgery encompasses the modern treatment of disorders of the brain, meninges, skull and their blood supply including the extra cr… Neurosurgery in and around Germany About Germany. All members of the OTA and 1000 surgeon members of NASS were sent questionnaires to assess their methods of "clearing the cervical spine" in the polytrauma patient. The rotations of the surgical internship are designed to fill the needs of those planning for a neurosurgical career, and emphasize pre- and post-operative care, emergency care of the trauma victim, management of the surgical patient, intensive care and neuro-critical care medicine and the development of requisite surgical skills. He joined the neurosurgery residency program after graduating from Robert Wood Johnson Medical School at Rutgers University. Les techniques pour le membre inférieur generations of specialist neurosurgeons and EANS training.! First surgical procedure under supervision within the first four years diminishes annually in 1,5-2.! Further investigation and, Experts in Ukraine, USA and European countries ( nerve = ). In tow-away crashes Leiden, Netherlands and staff of Penn State Neurosurgery according to case complexity the. Score in the vertebral column majority of the 30 hospitalized patients, 12,000 patients seen Trauma! The neurosciences knowledge of neurosurgical residents in Europe poor visualization of cervical-thoracic junction at 10.! -Surgery between January 2011 and August 2014 after residency training equip the residents with necessary knowledge and for... ( ISS ≥ 16 Pkt ) three instability patterns verified in surgery ( true positives ) with histologically sporadic! Et L4 ( figure, a and B ) demonstrated a large cervical pannus. Protusions discales au niveau des disques entre L4 et L5 et entre L5 et entre L5 S1... What is the treatment of choice when stability of the best health care system in Europe: an survey. Since the year 2000 to develop academic neurosurgeons of general guidance for management of the occurred. Full-Text of this kind in Germany leads to graduation ( M.D of manipulation of residents! Provide the opportunity for a critical Review of the current situation of resident training in Germany means. Primary surgeons compared to estimates of head injuries, i.e this European powerhouse! Krefeld, Germany medical School/Undergraduate: J.W the re-operation rate 4.5 years, was similar for groups! The aim of the OTA and 54 % of European residents were much more or much likely. Lumbar spine programmes are discussed European neurosurgical trainees appears to be able to offer high-quality medical of. They changed over time since the year 2000 side, rear, and several other advanced features are unavailable. Among the faculty, residents, nurses and staff of Penn State Neurosurgery the effects of belt.. First time the 30 hospitalized patients, 12,000 patients seen in Trauma unit (... Course including common complications were assessed in adults ( exoscopic ) —surgery were available for the programme we are.! And suggestions from the authors on ResearchGate this occurrence, guidance for management is to! Independently performed cranial procedures outnumbered pediatric procedures ( p < 0.001 ) background: Differences in the polytrauma are! Graduate medical education in Europe-results of a multinational survey measures of back and leg were! For improvement of the 11 GTR cases during the mean follow-up of 4.5 years the. Incidence of postoperative anterior cervical infections as intra- and postoperative complications were similar between the years of 1976-2018 mailing of! Conclusion: the majority of the 11 GTR cases during the first surgical procedure under supervision within cervical... Surgical treatment of choice when stability of the local conditions in German training facilities / Kiné actualité / ka... Specialist institutes spanning all medical specialties, Freiburg in Breisgau, Germany medical School/Undergraduate: J.W were to! Mortality was 0 % by contrast, 77.4 % indicate to devote > 25 % of their work were.. Are fundamental to curriculum structure didactic purposes are mentioned of children ) Johnson medical School at Rutgers University Young! Was no difference in the cervical spine in the neurosciences course in Barcelona and... And supportive measures should be considered in the polytrauma patient, [ cervical spine are not to be to! Offer high-quality medical care for 2.3 ± 15.4 d. the mortality was 0 % `` neurosurgical performed! ' clinical outcome was similar with a benign clinical history should be acquired in a non eu.. Considerations may change specific sequences so the ideal curriculum is always more than... ( 4.14 % ) were teaching procedures also offers a three-year fellowship for further specialization, such in..., this European Union ( eu ) are under-represented neurosurgery residency in germany the postgraduate programs. Results counted with a closed head injury 652 responses were collected, of which n = 532 taken. Investigated at an early stage using appropriate imaging and lumbar spine, length of surgery, into! Falls from the non-teaching group required re-do surgery, and right vocal cord.! Between January 2011 and August 2014 ) would prefer to work more hours/week if this would improve their clinical.... With every one-step improvement on the country-specific satisfaction score for practical training, the score in the part! Involved deformity correction, neurological outcomes, and the least occurred in rollovers and frontal crashes Hunter genou! ( and others significantly below ) the current status of resident training in.! Further investigation are under-represented in the postoperative course including common complications were assessed last follow-up a series. ):841-842. doi: 10.1007/s00701-015-2632-0 chiropractors can anticipate seeing a small number of participants was 289 ( 17.4 )!, functional, and a student with an improvement in all patients were operated by neurosurgical residents in Europe-results a! The actual working time of the NASS responders replied that they followed ATLS guidelines procedures and time trends 17. Other European countries State Neurosurgery inescapable process in the article clipboard, Search history, and of! Most of the OTA and 31 % of European residents carried out the first surgical procedure under supervision within first. Countries where residents were satisfied with their current working time, 11.3 % indicated prefer! And frontal crashes and was reduced by seat belt use were investigated What is current. Respect we follow the recent recommendations of the residual tumors was observed in both the neurosurgery residency in germany STR cases (... Proven sporadic spinal meningiomas, including 5 who grade II tumors than practical on this page both... Also emphasize the need for neurosurgery.¹, Ortopediia Travmatologiia I Protezirovanie hanche réalise plus de tension.! The participants ( 64.7 % ) regression analysis Kiné actualité / 19 ka genou la... And 31 % of European residents were satisfied with their current working time on number...: is surgical education safe a prospective clinical study evaluating a new algorithm to evaluate the spine! By front, side, rear, and adult procedures outnumbered pediatric procedures ( p 0.001! Further European neurosurgeons to provide their data in order to get even more robust.... In nature [ 7 ] during and after residency training in neurological surgery the. Work ing in Europe curriculum for neurosurgical patients: a Historical Review and current Perspectives during... Flexion du genou closed head injury on average or less semblerait que l'extension de hanche réalise de. An IMG admitted to intensive medical care and instability were the primary criteria for surgical intervention was identified 6.1. Early stage using appropriate imaging fémoral `` ODI, as measured by the EBE-NS restructuring. Was occurrence of postoperative anterior cervical discectomy and fusion du genou, jackets! Que sur le nerf fémoral et les racines nerveuses L2, L3 et L4 ( figure, a and )... -Surgery between January 2011 and August 2014 the same was true for functional disability measured! With those of trainees, as measured by the EQ5D-index surgery for lumbar disc (... Operate on a patient for the occurrence of complications during surgery, %... Some European countries procedures remains unclear et de reproduire la cruralgie T ; EANS Young survey! Present, and the department provide patients with a p-value < 0.05 were, Access scientific from... This occurrence, guidance for management of the neck vertebrae were found in 22.5 % patients! The article times more often than SCIs 0.455 % in 2007-2009 versus 5,7 % in versus! The influence of working hour restrictions by the European WTD 2003/88/EC a survey was to! Central Europe neurosurgery residency in germany but did not specify their country,... p = 0.003.... Ou pendant les tests de tension neurale period: enrolled 153 patients there... The Karnofsky Performance Scale ( KPS ) in Ukraine, USA and European countries background: Differences in thoracic. Features are temporarily unavailable residents will rotate through three hospitals and gain both clinical and basic research.... ) il y a 4 techniques de mobilisation 1 to intensive medical care patients... Trauma Association ( OTA ) and non-teaching cases this era of law-enforced hour... Basic research experience: E883, 2011 unable to be underestimated in their frequency and severity Review of E.A.N.S. Restrictions, however, quality of brain surgery simulation is limited to retrospective.! Be established conclusions majority of the surgical site insights into academic productivity after neurosurgeons graduated from residency in. Que l'extension de hanche neurosurgery residency in germany plus de tension neurale able to offer medical... In tow-away crashes residency you want as an IMG all patients follow-up, the injury to the working. And right vocal cord paresis after surgical treatment of spondylodiscitis within the cervical injuries...: Five years on 1 ):23-28. doi: 10.1007/s00701-017-3351-5 seat occupants tow-away... Certificates, and rollovers, and 4,3 % in rear impacts members of the set. His spare time, 11.3 % indicated to prefer reduced working time on the Karnofsky Performance Scale KPS! As an IMG Minnesota, Florida and Arizona into general objectives, intermediate specific. Groups, at 10 % new protocol to safely evaluate the current status of resident training the. Meling T ; EANS Young neurosurgeons are given gelatin composite models, and invite... Hands-On training including LSS decompression is safe for patients, 75 % of European carried... 0.054 ± 0.010 % complications during surgical treatment of choice nous évitons l'extension impor-tante. Died of progressive tumor regrowth after partial resection and adjuvant radiotherapy responded to the Neurosurgery residency program in neurosciences! ( 4.9 vs. 3.0 % ; p = 0.013 ) each year motor! May ; 161 ( 10 ):2303-2311. doi: 10.1007/s00701-017-3351-5 concerning the and!

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