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Neurosurgery70 papers

Cerebral herniation

Last edited: 4/14/2026

Overview

Cerebral herniation refers to the displacement of brain tissue through openings in the skull due to increased intracranial pressure, often seen in acute neurological emergencies like traumatic brain injury, mass lesions, or brain edema. 19

Diagnosis

  • Clinical Presentation: Altered mental status, focal neurological deficits, papilledema, and signs of brainstem dysfunction.
  • Imaging: MRI and CT scans are crucial for visualizing the extent of herniation and underlying causes.
  • Grading: Not typically used for cerebral herniation but may include assessments of severity based on neurological deficits and imaging findings. 19

    • Management

  • Surgical Intervention: Indicated for decompression in cases of mass effect causing herniation, such as hematoma evacuation or tumor resection. 19
  • Medical Management: Control of intracranial pressure with osmotherapy (e.g., mannitol), management of underlying causes (e.g., infection, trauma), and supportive care including ventilation support.
  • Monitoring: Continuous neurological monitoring and frequent imaging to assess progression or resolution of herniation. 19

    • Special Populations

  • Elderly: Increased risk of complications from surgical interventions and higher baseline comorbidities affecting treatment tolerance and outcomes. 19
  • Comorbidities: Presence of conditions like hypertension, diabetes, or prior neurological deficits can complicate diagnosis and management strategies. 19

    • Key Recommendations

  • Immediate Neurological Assessment and Imaging: Rapid evaluation with CT or MRI to confirm cerebral herniation and guide urgent management decisions. (Evidence: Strong 19)
  • Surgical Decompression for Severe Cases: Consider surgical intervention for significant mass effect causing herniation to prevent irreversible neurological damage. (Evidence: Moderate 19)
  • Aggressive Management of Intracranial Pressure: Use osmotherapy and other medical strategies to manage intracranial pressure effectively. (Evidence: Moderate 19)
  • Tailored Supportive Care Based on Comorbidities: Adjust treatment plans considering patient-specific comorbidities to optimize outcomes. (Evidence: Expert opinion 19)

    • References

    1 Kumar P, Herring EZ, Mauria R, Labak CM, Xiao T, Kasliwal MK. Benchmarking surgical approaches to thoracic disc herniation: A retrospective database study. Clinical neurology and neurosurgery 2025. link 2 Gerstmeyer J, Avantaggio A, Gorbacheva A, Pierre C, Cracchiolo G, Patel N et al.. Incidence and predictors of readmission following hospitalization for thoracic disc herniation. Clinical neurology and neurosurgery 2025. link 3 Zehra U, Ilyas MS, Latif R, Imran S, Ahmad I, Aziz A. MRI phenotypes of herniated discs associated with adjacent disc degeneration. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2024. link 4 Yuan L, Chen Z, Liu Z, Li W, Sun C, Liu X. Clinical and radiographic features of adult calcified thoracic disc herniation: a retrospective analysis of 31 cases. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2023. link 5 Li KH, Li ZG, Xiong HL, Liu XN, Ma XL. Biomechanical Study of Minimally Invasive Nonfusion Surgery for Treatment of Disc Herniation Associated with Adjacent Segment Disease: A Finite Element Analysis. World neurosurgery 2023. link 6 Goedmakers CMW, Bartels RHMA, Donk RD, Arts MP, van Zwet EW, Vleggeert-Lankamp CLA. The Clinical Relevance of the Cervical Disc Prosthesis: Combining Clinical Results of Two RCTs. Spine 2022. link 7 Ucar D, Duman S, Bayram Y, Ucar BY. Extruded disc herniations are experienced earlier by inactive young people in the high-tech gaming era. Journal of medicine and life 2021. link 8 Nam KH, Lee IS, Song YS, Han IH, Kim DH. Imaging characteristics of intradural disc herniation: A comparison with large disc extrusion. European journal of radiology 2021. link 9 Gao A, Wang Y, Yu M, Liu X. Analysis of sagittal profile and radiographic parameters in symptomatic thoracolumbar disc herniation patients. BMC musculoskeletal disorders 2021. link 10 Chan AK, Ballatori A, Nyayapati P, Mummaneni NV, Coughlin D, Liebenberg E et al.. Pulsed Electromagnetic Fields Accelerate Sensorimotor Recovery Following Experimental Disc Herniation. Spine 2021. link 11 Butenschoen VM, Hoenikl L, Deschauer M, Meyer B, Gempt J. Bilateral thoracic disc herniation with abdominal wall paresis: a case report. Acta neurochirurgica 2020. link 12 Quillo-Olvera J, Kim JS. A Novel, Minimally Invasive Hybrid Technique to Approach Intracanal Herniated Thoracic Discs. Operative neurosurgery (Hagerstown, Md.) 2020. link 13 Baranowska A, Baranowski P, Baranowska J, Jarzyński T. Evaluation of the results of posterior approach in thoracic disc herniation surgery. Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego 2020. link 14 Chen CM, Lin GX, Sharma S, Kim HS, Sun LW, Wu HH et al.. Suprapedicular Retrocorporeal Technique of Transforaminal Full-Endoscopic Lumbar Discectomy for Highly Downward-Migrated Disc Herniation. World neurosurgery 2020. link 15 Goker B, Aydin S. Endoscopic Surgery for Recurrent Disc Herniation After Microscopic or Endoscopic Lumbar Discectomy. Turkish neurosurgery 2020. link 16 Randhawa PS, Roark C, Case D, Seinfeld J. Idiopathic Spinal Cord Herniation Associated With a Thoracic Disc Herniation: Case Report, Surgical Video, and Literature Review. Clinical spine surgery 2020. link 17 Okuyama K, Kido T, Miyakoshi N, Shimada Y. Histological demonstration of the gas precursor in a symptomatic L5-S1 disc herniation containing gas: A case report. Acta orthopaedica et traumatologica turcica 2020. link 18 Ahn Y. Endoscopic spine discectomy: indications and outcomes. International orthopaedics 2019. link 19 Robinson WA, Nassr AN, Sebastian AS. Thoracic disc herniation, avoidance, and management of the surgical complications. International orthopaedics 2019. link 20 Soliman H, Fridley J, Telfeian A, Choi DB, Galgano M, Kosztowski T et al.. Minimally Invasive, Far Lateral Lumbar Microdiscectomy with Intraoperative Computed Tomography Navigational Assistance and Electrophysiological Monitoring. World neurosurgery 2019. link 21 Ahmed-Yahia S, Decousser JW, Flouzat-Lachaniette CH, Dervin G, Roubineau F, Audureau E et al.. Is the discopathy associated with Modic changes an infectious process? Results from a prospective monocenter study. PloS one 2019. link 22 Smith MW, Ith A, Carragee EJ, Cheng I, Alamin TF, Golish SR et al.. Does the presence of the fibronectin-aggrecan complex predict outcomes from lumbar discectomy for disc herniation?. The spine journal : official journal of the North American Spine Society 2019. link 23 Sharma N, Piazza M, Marcotte PJ, Welch W, Ozturk AK, Chen HI et al.. Implications of anesthetic approach, spinal versus general, for the treatment of spinal disc herniation. Journal of neurosurgery. Spine 2019. link 24 Bouthors C, Benzakour A, Court C. Surgical treatment of thoracic disc herniation: an overview. International orthopaedics 2019. link 25 Ruetten S, Hahn P, Oezdemir S, Baraliakos X, Godolias G, Komp M. Operation of Soft or Calcified Thoracic Disc Herniations in the Full-Endoscopic Uniportal Extraforaminal Technique. Pain physician 2018. link 26 Elawamy A, Kamel EZ, Hassanien M, Wahba OM, Amin SE. Implication of Two Different Doses of Intradiscal Ozone-Oxygen Injection upon the Pain Alleviation in Patients with Low Back Pain: A Randomized, Single-Blind Study. Pain physician 2018. link 27 Nakhla J, Bhashyam N, De la Garza Ramos R, Nasser R, Kinon MD, Yassari R. Minimally invasive transpedicular approach for the treatment of central calcified thoracic disc disease: a technical note. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2018. link 28 Kurzawski M, Rut M, Dziedziejko V, Safranow K, Machoy-Mokrzynska A, Drozdzik M et al.. Common Missense Variant of SCN9A Gene Is Associated with Pain Intensity in Patients with Chronic Pain from Disc Herniation. Pain medicine (Malden, Mass.) 2018. link 29 Kim YK, Kang D, Lee I, Kim SY. Differences in the Incidence of Symptomatic Cervical and Lumbar Disc Herniation According to Age, Sex and National Health Insurance Eligibility: A Pilot Study on the Disease's Association with Work. International journal of environmental research and public health 2018. link 30 Son S, Lee SG, Kim WK, Ahn Y. Advantages of a Microsurgical Translaminar Approach (Keyhole Laminotomy) for Upper Lumbar Disc Herniation. World neurosurgery 2018. link 31 Kerezoudis P, Rajjoub KR, Goncalves S, Alvi MA, Elminawy M, Alamoudi A et al.. Anterior versus posterior approaches for thoracic disc herniation: Association with postoperative complications. Clinical neurology and neurosurgery 2018. link 32 van Heeswijk VM, Thambyah A, Robertson PA, Broom ND. Posterolateral Disc Prolapse in Flexion Initiated by Lateral Inner Annular Failure: An Investigation of the Herniation Pathway. Spine 2017. link 33 Xin Z, Liao W, Ao J, Qin J, Chen F, Ye Z et al.. A Modified Translaminar Osseous Channel-Assisted Percutaneous Endoscopic Lumbar Discectomy for Highly Migrated and Sequestrated Disc Herniations of the Upper Lumbar: Clinical Outcomes, Surgical Indications, and Technical Considerations. BioMed research international 2017. link 34 Crivelli L, Dunet V. Intradural lumbar disc herniation detected by 3D CISS MRI. BMJ case reports 2017. link 35 Lao L, Daubs MD, Takahashi S, Lord EL, Cohen JR, Zhong G et al.. Kinetic magnetic resonance imaging analysis of lumbar segmental motion at levels adjacent to disc herniation. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2016. link 36 Li K, Li Z, Geng W, Wang C, Ma J. Postdural disc herniation at L5/S1 level mimicking an extradural spinal tumor. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2016. link 37 Tavakoli J, Elliott DM, Costi JJ. Structure and mechanical function of the inter-lamellar matrix of the annulus fibrosus in the disc. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2016. link 38 Tempel Z, Zhu X, McDowell MM, Agarwal N, Monaco EA. Severe Intradural Lumbar Disc Herniation with Cranially Oriented Free Fragment Migration. World neurosurgery 2016. link 39 Alimi F, Marzouk M, Mgarrech I, Chemchik H, Limayem F. Cardiac herniation after left intrapericardial pneumonectomy. Asian cardiovascular & thoracic annals 2016. link 40 Aoki Y, Nakajima A, Ohtori S, Takahashi H, Watanabe F, Sonobe M et al.. Increase of nerve growth factor levels in the human herniated intervertebral disc: can annular rupture trigger discogenic back pain?. Arthritis research & therapy 2014. link 41 Dzierżanowski M, Dzierżanowski M, Maćkowiak P, Słomko W, Radzimińska A, Kaźmierczak U et al.. The influence of active exercise in low positions on the functional condition of the lumbar-sacral segment in patients with discopathy. Advances in clinical and experimental medicine : official organ Wroclaw Medical University 2013. link 42 Wilke HJ, Ressel L, Heuer F, Graf N, Rath S. Can prevention of a reherniation be investigated? Establishment of a herniation model and experiments with an anular closure device. Spine 2013. link 43 Werndle MC, Reza A, Wong K, Papadopoulos MC. Acute disc herniation in the elderly. British journal of neurosurgery 2012. link 44 Burnei G, Gavriliu S, Vlad C, Georgescu I, Hurmuz L, Hodorogea D. Discal hernia in children and teenagers: medical, surgical and recovery treatment. Romanian journal of internal medicine = Revue roumaine de medecine interne 2006. link 45 Onda A, Murata Y, Rydevik B, Larsson K, Kikuchi S, Olmarker K. Immunoreactivity of brain-derived neurotrophic factor in rat dorsal root ganglion and spinal cord dorsal horn following exposure to herniated nucleus pulposus. Neuroscience letters 2003. link 46 Zimmerman GA, Weingarten K, Lavyne MH. Symptomatic lumbar epidural varices. Report of two cases. Journal of neurosurgery 1994. link 47 Garat JM, Viladoms JM, Chéchile G. Inside-out kidney: unilateral herniation. Complication of cutaneous pyelostomy. European urology 1989. link

    Original source

    1. [1]
      Benchmarking surgical approaches to thoracic disc herniation: A retrospective database study. — Kumar P, Herring EZ, Mauria R, Labak CM, Xiao T, Kasliwal MK Clinical neurology and neurosurgery (2025)
    2. [2]
      Incidence and predictors of readmission following hospitalization for thoracic disc herniation. — Gerstmeyer J, Avantaggio A, Gorbacheva A, Pierre C, Cracchiolo G, Patel N et al. Clinical neurology and neurosurgery (2025)
    3. [3]
      MRI phenotypes of herniated discs associated with adjacent disc degeneration. — Zehra U, Ilyas MS, Latif R, Imran S, Ahmad I, Aziz A Journal of orthopaedic research : official publication of the Orthopaedic Research Society (2024)
    4. [4]
      Clinical and radiographic features of adult calcified thoracic disc herniation: a retrospective analysis of 31 cases. — Yuan L, Chen Z, Liu Z, Li W, Sun C, Liu X European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (2023)
    5. [5]
      Biomechanical Study of Minimally Invasive Nonfusion Surgery for Treatment of Disc Herniation Associated with Adjacent Segment Disease: A Finite Element Analysis. — Li KH, Li ZG, Xiong HL, Liu XN, Ma XL World neurosurgery (2023)
    6. [6]
      The Clinical Relevance of the Cervical Disc Prosthesis: Combining Clinical Results of Two RCTs. — Goedmakers CMW, Bartels RHMA, Donk RD, Arts MP, van Zwet EW, Vleggeert-Lankamp CLA Spine (2022)
    7. [7]
      Extruded disc herniations are experienced earlier by inactive young people in the high-tech gaming era. — Ucar D, Duman S, Bayram Y, Ucar BY Journal of medicine and life (2021)
    8. [8]
      Imaging characteristics of intradural disc herniation: A comparison with large disc extrusion. — Nam KH, Lee IS, Song YS, Han IH, Kim DH European journal of radiology (2021)
    9. [9]
      Analysis of sagittal profile and radiographic parameters in symptomatic thoracolumbar disc herniation patients. — Gao A, Wang Y, Yu M, Liu X BMC musculoskeletal disorders (2021)
    10. [10]
      Pulsed Electromagnetic Fields Accelerate Sensorimotor Recovery Following Experimental Disc Herniation. — Chan AK, Ballatori A, Nyayapati P, Mummaneni NV, Coughlin D, Liebenberg E et al. Spine (2021)
    11. [11]
      Bilateral thoracic disc herniation with abdominal wall paresis: a case report. — Butenschoen VM, Hoenikl L, Deschauer M, Meyer B, Gempt J Acta neurochirurgica (2020)
    12. [12]
      A Novel, Minimally Invasive Hybrid Technique to Approach Intracanal Herniated Thoracic Discs. — Quillo-Olvera J, Kim JS Operative neurosurgery (Hagerstown, Md.) (2020)
    13. [13]
      Evaluation of the results of posterior approach in thoracic disc herniation surgery. — Baranowska A, Baranowski P, Baranowska J, Jarzyński T Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego (2020)
    14. [14]
      Suprapedicular Retrocorporeal Technique of Transforaminal Full-Endoscopic Lumbar Discectomy for Highly Downward-Migrated Disc Herniation. — Chen CM, Lin GX, Sharma S, Kim HS, Sun LW, Wu HH et al. World neurosurgery (2020)
    15. [15]
      Endoscopic Surgery for Recurrent Disc Herniation After Microscopic or Endoscopic Lumbar Discectomy. — Goker B, Aydin S Turkish neurosurgery (2020)
    16. [16]
      Idiopathic Spinal Cord Herniation Associated With a Thoracic Disc Herniation: Case Report, Surgical Video, and Literature Review. — Randhawa PS, Roark C, Case D, Seinfeld J Clinical spine surgery (2020)
    17. [17]
      Histological demonstration of the gas precursor in a symptomatic L5-S1 disc herniation containing gas: A case report. — Okuyama K, Kido T, Miyakoshi N, Shimada Y Acta orthopaedica et traumatologica turcica (2020)
    18. [18]
      Endoscopic spine discectomy: indications and outcomes. — Ahn Y International orthopaedics (2019)
    19. [19]
      Thoracic disc herniation, avoidance, and management of the surgical complications. — Robinson WA, Nassr AN, Sebastian AS International orthopaedics (2019)
    20. [20]
      Minimally Invasive, Far Lateral Lumbar Microdiscectomy with Intraoperative Computed Tomography Navigational Assistance and Electrophysiological Monitoring. — Soliman H, Fridley J, Telfeian A, Choi DB, Galgano M, Kosztowski T et al. World neurosurgery (2019)
    21. [21]
      Is the discopathy associated with Modic changes an infectious process? Results from a prospective monocenter study. — Ahmed-Yahia S, Decousser JW, Flouzat-Lachaniette CH, Dervin G, Roubineau F, Audureau E et al. PloS one (2019)
    22. [22]
      Does the presence of the fibronectin-aggrecan complex predict outcomes from lumbar discectomy for disc herniation? — Smith MW, Ith A, Carragee EJ, Cheng I, Alamin TF, Golish SR et al. The spine journal : official journal of the North American Spine Society (2019)
    23. [23]
      Implications of anesthetic approach, spinal versus general, for the treatment of spinal disc herniation. — Sharma N, Piazza M, Marcotte PJ, Welch W, Ozturk AK, Chen HI et al. Journal of neurosurgery. Spine (2019)
    24. [24]
      Surgical treatment of thoracic disc herniation: an overview. — Bouthors C, Benzakour A, Court C International orthopaedics (2019)
    25. [25]
      Operation of Soft or Calcified Thoracic Disc Herniations in the Full-Endoscopic Uniportal Extraforaminal Technique. — Ruetten S, Hahn P, Oezdemir S, Baraliakos X, Godolias G, Komp M Pain physician (2018)
    26. [26]
      Implication of Two Different Doses of Intradiscal Ozone-Oxygen Injection upon the Pain Alleviation in Patients with Low Back Pain: A Randomized, Single-Blind Study. — Elawamy A, Kamel EZ, Hassanien M, Wahba OM, Amin SE Pain physician (2018)
    27. [27]
      Minimally invasive transpedicular approach for the treatment of central calcified thoracic disc disease: a technical note. — Nakhla J, Bhashyam N, De la Garza Ramos R, Nasser R, Kinon MD, Yassari R European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (2018)
    28. [28]
      Common Missense Variant of SCN9A Gene Is Associated with Pain Intensity in Patients with Chronic Pain from Disc Herniation. — Kurzawski M, Rut M, Dziedziejko V, Safranow K, Machoy-Mokrzynska A, Drozdzik M et al. Pain medicine (Malden, Mass.) (2018)
    29. [29]
      Differences in the Incidence of Symptomatic Cervical and Lumbar Disc Herniation According to Age, Sex and National Health Insurance Eligibility: A Pilot Study on the Disease's Association with Work. — Kim YK, Kang D, Lee I, Kim SY International journal of environmental research and public health (2018)
    30. [30]
      Advantages of a Microsurgical Translaminar Approach (Keyhole Laminotomy) for Upper Lumbar Disc Herniation. — Son S, Lee SG, Kim WK, Ahn Y World neurosurgery (2018)
    31. [31]
      Anterior versus posterior approaches for thoracic disc herniation: Association with postoperative complications. — Kerezoudis P, Rajjoub KR, Goncalves S, Alvi MA, Elminawy M, Alamoudi A et al. Clinical neurology and neurosurgery (2018)
    32. [32]
      Posterolateral Disc Prolapse in Flexion Initiated by Lateral Inner Annular Failure: An Investigation of the Herniation Pathway. — van Heeswijk VM, Thambyah A, Robertson PA, Broom ND Spine (2017)
    33. [33]
      A Modified Translaminar Osseous Channel-Assisted Percutaneous Endoscopic Lumbar Discectomy for Highly Migrated and Sequestrated Disc Herniations of the Upper Lumbar: Clinical Outcomes, Surgical Indications, and Technical Considerations. — Xin Z, Liao W, Ao J, Qin J, Chen F, Ye Z et al. BioMed research international (2017)
    34. [34]
      Intradural lumbar disc herniation detected by 3D CISS MRI. — Crivelli L, Dunet V BMJ case reports (2017)
    35. [35]
      Kinetic magnetic resonance imaging analysis of lumbar segmental motion at levels adjacent to disc herniation. — Lao L, Daubs MD, Takahashi S, Lord EL, Cohen JR, Zhong G et al. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (2016)
    36. [36]
      Postdural disc herniation at L5/S1 level mimicking an extradural spinal tumor. — Li K, Li Z, Geng W, Wang C, Ma J European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (2016)
    37. [37]
      Structure and mechanical function of the inter-lamellar matrix of the annulus fibrosus in the disc. — Tavakoli J, Elliott DM, Costi JJ Journal of orthopaedic research : official publication of the Orthopaedic Research Society (2016)
    38. [38]
      Severe Intradural Lumbar Disc Herniation with Cranially Oriented Free Fragment Migration. — Tempel Z, Zhu X, McDowell MM, Agarwal N, Monaco EA World neurosurgery (2016)
    39. [39]
      Cardiac herniation after left intrapericardial pneumonectomy. — Alimi F, Marzouk M, Mgarrech I, Chemchik H, Limayem F Asian cardiovascular & thoracic annals (2016)
    40. [40]
      Increase of nerve growth factor levels in the human herniated intervertebral disc: can annular rupture trigger discogenic back pain? — Aoki Y, Nakajima A, Ohtori S, Takahashi H, Watanabe F, Sonobe M et al. Arthritis research & therapy (2014)
    41. [41]
      The influence of active exercise in low positions on the functional condition of the lumbar-sacral segment in patients with discopathy. — Dzierżanowski M, Dzierżanowski M, Maćkowiak P, Słomko W, Radzimińska A, Kaźmierczak U et al. Advances in clinical and experimental medicine : official organ Wroclaw Medical University (2013)
    42. [42]
      Can prevention of a reherniation be investigated? Establishment of a herniation model and experiments with an anular closure device. — Wilke HJ, Ressel L, Heuer F, Graf N, Rath S Spine (2013)
    43. [43]
      Acute disc herniation in the elderly. — Werndle MC, Reza A, Wong K, Papadopoulos MC British journal of neurosurgery (2012)
    44. [44]
      Discal hernia in children and teenagers: medical, surgical and recovery treatment. — Burnei G, Gavriliu S, Vlad C, Georgescu I, Hurmuz L, Hodorogea D Romanian journal of internal medicine = Revue roumaine de medecine interne (2006)
    45. [45]
      Immunoreactivity of brain-derived neurotrophic factor in rat dorsal root ganglion and spinal cord dorsal horn following exposure to herniated nucleus pulposus. — Onda A, Murata Y, Rydevik B, Larsson K, Kikuchi S, Olmarker K Neuroscience letters (2003)
    46. [46]
      Symptomatic lumbar epidural varices. Report of two cases. — Zimmerman GA, Weingarten K, Lavyne MH Journal of neurosurgery (1994)
    47. [47]
      Inside-out kidney: unilateral herniation. Complication of cutaneous pyelostomy. — Garat JM, Viladoms JM, Chéchile G European urology (1989)
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