Neurochirurgie最新文献

{"title":"Endoscopic transorbital approach for orbital cavernous hemangioma: A case series","authors":"Cesare Zoia ,&nbsp;Matteo De Simone ,&nbsp;Daniele Bongetta ,&nbsp;Francesco Salomi ,&nbsp;Fabio Pagella ,&nbsp;Giannantonio Spena ,&nbsp;Vittorio Ricciuti","doi":"10.1016/j.neuchi.2025.101716","DOIUrl":"10.1016/j.neuchi.2025.101716","url":null,"abstract":"<div><h3>Background</h3><div>Orbital cavernous hemangiomas (OCH) are the most common benign orbital tumors, often presenting with proptosis. The endoscopic transorbital approach (ETOA) is increasingly being utilized for the treatment of OCH, offering minimal invasiveness and superior cosmetic outcomes. This study aims to evaluate the safety, efficacy, and clinical outcomes of ETOA for OCH.</div></div><div><h3>Methods</h3><div>A retrospective cohort of eight patients who underwent ETOA for OCH between 2020 and 2024 at the Neurosurgical Departments of Fondazione IRCCS Policlinico San Matteo were recorded. Preoperative evaluations included clinical symptoms, radiological assessments, and histology. Data on demographics, clinical presentation, operative time, extent of resection (EOR), complications, and follow-up outcomes were analyzed.</div></div><div><h3>Results</h3><div>The study included eight patients (mean age 55.9 years), with a male-to-female ratio of 1:1.7. All patients presented with proptosis, and 87.5% of lesions were intraconal. Gross Total Resection (GTR) was achieved in 87.5% cases (7/8), with an average operative time of 143.6 min. 37.5% of patients experienced transient postoperative complications, including diplopia (25%) and supraorbital neuralgia (12.5%), but no permanent deficits. The follow-up period ranged from 6 to 32 months, with no cases of recurrence observed.</div></div><div><h3>Conclusions</h3><div>ETOA appears safe and effective technique for the treatment of orbital cavernous hemangiomas, achieving high rates of GTR and low complication rates in the present series. The approach may also offer favorable cosmetic outcomes and short hospitalization times. Nonetheless, further studies with larger cohorts and longer follow-up are needed before drawing definitive conclusions.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101716"},"PeriodicalIF":1.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awake surgery with direct electrical stimulation for safe resection of a deep posterior thalamic cavernous malformation","authors":"Benoit Simonet ,&nbsp;Lydiane Mondot ,&nbsp;Fabien Almairac","doi":"10.1016/j.neuchi.2025.101720","DOIUrl":"10.1016/j.neuchi.2025.101720","url":null,"abstract":"<div><h3>Background</h3><div>Treating symptomatic deep-seated cerebral cavernous malformations (CCMs) is challenging due to surgical risks.</div></div><div><h3>Case description</h3><div>A 37-year-old man underwent awake craniotomy with direct electrical stimulation (DES) for excision of a left posterior thalamic CCM. A transcortical transventricular approach through the superior parietal lobe enabled safe navigation around critical associative and projection white matter tracts.</div></div><div><h3>Results</h3><div>Postoperative MRI confirmed complete resection with preservation of major tracts, and the patient showed significant recovery at three months.</div></div><div><h3>Conclusion</h3><div>This case highlights the potential of awake surgery with DES as a safe and effective method for deep-seated CCMs traditionally deemed inoperable.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101720"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early mechanical failure of posterior lumbar fusion: Literature review based on an illustrative case","authors":"Jean Guyot,&nbsp;Amandine Gavotto,&nbsp;Stéphane Litrico,&nbsp;Antoine Gennari","doi":"10.1016/j.neuchi.2025.101714","DOIUrl":"10.1016/j.neuchi.2025.101714","url":null,"abstract":"<div><h3>Background</h3><div>Posterior lumbar fusion (PLF) has become one of the most common spinal surgery procedures. Early symptomatic loosening of the pedicle screw could be a critical complication, leading to pseudarthrosis. However, revision strategies for pedicle screw loosening are still under debate.</div></div><div><h3>Objective &amp; methods</h3><div>Based on a clinical case, we conducted a literature review of pedicle screw loosening, its risk factors, aetiologies, surgical revision options and outcomes.</div></div><div><h3>Results</h3><div>We describe a clinical case of early mechanical failure of a posterior L4-L5 arthrodesis due to septic cause. Revision surgery consisted of circumferential surgery using ALIF, posterior larger screws and extension of the arthrodesis.</div><div>The review of the literature highlights numerous risk factors for screw loosening and underlines the importance of fitting an interbody device during index surgery in patients at risk.</div><div>In the event of a screw loosening, bacteriological samples should be systematic.</div><div>Symptomatic screw loosening should benefit from revision surgery. There are various options for revision surgery, including anterior revision and the revision of posterior screws.</div></div><div><h3>Conclusion</h3><div>This review highlights the key elements of initial PLF surgery, the importance of septic aetiology in pedicle screw loosening, and suggested surgical strategies in the face of early mechanical failure.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101714"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted MIS transiliac sacroiliac joint fusion: Technical note","authors":"A. Nguyen ,&nbsp;P. Haettel ,&nbsp;B. Ghannam ,&nbsp;R. Assaker ,&nbsp;H.-A. Leroy","doi":"10.1016/j.neuchi.2025.101715","DOIUrl":"10.1016/j.neuchi.2025.101715","url":null,"abstract":"<div><h3>Background</h3><div>Sacroiliac joint dysfunction (SIJD) accounts for 15–25% of chronic low back pain and often follows lumbar fusion. When conservative therapies fail, minimally invasive (MIS) SIJ fusion (SIJF) is indicated. The robot-assisted technique is feasible and safe, enhancing accuracy and reducing radiation exposure.</div></div><div><h3>Case description</h3><div>A 26-year-old woman, eight years after L4-S1 fusion, presented with bilateral SIJD refractory to physiotherapy and intraarticular steroids injection. SIJF was indicated. Here we describe the robot-assisted technique and its advantages.</div></div><div><h3>Conclusion</h3><div>Robot-assisted SIJF is a safe and accurate technique to treat SIJD while reducing radiation exposure. Trajectories planification and consideration of anatomical variations give the robot-assisted technique an advantage over conventional techniques such as fluoroscopy or navigation.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101715"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"5-year follow up after successful craniopagus separation: Review on hydrocephalus and venous system re-arrangement","authors":"Samsul Ashari ,&nbsp;Alvi Aulia ,&nbsp;Affan Priyambodo ,&nbsp;Setyo Widi Nugroho ,&nbsp;Amanda Aldilla","doi":"10.1016/j.neuchi.2025.101717","DOIUrl":"10.1016/j.neuchi.2025.101717","url":null,"abstract":"<div><h3>Introduction</h3><div>Craniopagus is one of the rarest congenital abnormalities. Separation of craniopagus twin is associated with high morbidity and mortality, especially in total type, where the twin had shared dural venous sinuses. One of the complications after separation surgery is hydrocephalus. While detailed cerebral vasculature imaging is needed pre-operatively to ensure most optimal surgical approach, post-operative vasculature imaging is no less important to assess changes in cerebral venous system after separation surgery.</div></div><div><h3>Case presentation</h3><div>Separation surgery was successfully accomplished in a total vertical craniopagus twin with shared dural venous sinuses. One twin experienced hydrocephalus after surgery, while the other twin had CSF leakage from the wound. LP shunt was placed in both twin and they had good recovery. We then compared the cerebral venous structure in both twins, before and after separation surgery using reconstruction of CT venography.</div></div><div><h3>Conclusion</h3><div>Successful separation of total vertical craniopagus twin where both twin developed well without any neurological deficit is a very rare occurrence. Based on follow up CTV, cerebral venous system underwent re-arrangement to accommodate changing hemodynamic needs after separation surgery. This might give us new insight about cerebral venous system that favors good prognosis for craniopagus twin.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101717"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the necessity of systematic ICU after intracranial meningioma surgery: Towards a risk-based approach. Toulouse University Hospital experience","authors":"Remi Raclot ,&nbsp;Jean-Christophe Sol ,&nbsp;Franck-Emmanuel Roux ,&nbsp;Maxime Pommier ,&nbsp;Nicolas Astafieff ,&nbsp;Lubin Klotz ,&nbsp;Amaury De Barros","doi":"10.1016/j.neuchi.2025.101718","DOIUrl":"10.1016/j.neuchi.2025.101718","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial meningiomas are the most common benign central nervous system tumors, often managed with elective surgical resection. While outcomes are generally favorable, postoperative management remains variable, particularly regarding routine Intensive-Care Units (ICU) admission. Given increasing pressure on critical care resources, identifying patients who truly require ICU-level monitoring is essential.</div></div><div><h3>Objective</h3><div>To evaluate early postoperative complications after meningioma surgery and develop a practical risk-based score to guide ICU admission.</div></div><div><h3>Methods</h3><div>We performed a retrospective single-center study of 203 intracranial meningioma resections (2020–2022). Patients were included if they had scheduled surgery and at least one night of postoperative ICU monitoring. A composite endpoint defined ICU-relevant complications within 24 h, including seizures, new deficits, delayed awakening, reintubation, transfusion, intra-veinous (IV) antihypertensives, and urgent imaging or reoperation. Twenty-two clinical, radiological, and surgical factors were analyzed.</div></div><div><h3>Results</h3><div>Postoperative complications requiring ICU-level care occurred in 19.2% of cases, mostly neurological (13.8%). Two-thirds of events occurred upon awakening or in the post-anesthesia care unit (PACU). Univariate analysis identified seven significant predictors: intracranial hypertension, falcine location, motor cortex involvement, operative time ≥3 h, blood loss &gt;500 mL, osmotherapy use, and transfusion. A 10-item risk score demonstrated high sensitivity (92.3%) and negative predictive value (95.9%) using a cut-off of 1 or more points. Using this model, in our population, 36.5% of patients could have safely avoided ICU admission.</div></div><div><h3>Conclusion</h3><div>A risk-based approach to ICU admission after meningioma surgery appears both safe and feasible. Implementation of this score, combined with extended PACU monitoring, could optimize resource use without compromising patient safety. Prospective validation is warranted.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101718"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laser Interstitial Thermal Therapy (LITT) in pediatric neurosurgery: Single center retrospective analysis of 41 consecutive procedures","authors":"Oumaima Aboubakr ,&nbsp;Lelio Guida ,&nbsp;Volodia Dangouloff Ros ,&nbsp;Emma Losito ,&nbsp;Marie Bourgeois ,&nbsp;François Doz ,&nbsp;Jacques Grill ,&nbsp;Gilles Orliaguet ,&nbsp;Estelle Vergnaud ,&nbsp;Stéphane Auvin ,&nbsp;Rima Nabbout ,&nbsp;Kevin Beccaria ,&nbsp;Nathalie Boddaert ,&nbsp;Thomas Blauwblomme","doi":"10.1016/j.neuchi.2025.101719","DOIUrl":"10.1016/j.neuchi.2025.101719","url":null,"abstract":"<div><h3>Introduction</h3><div>Laser Interstitial Thermal Therapy under MRI control has emerged as a safe and efficient alternative to microsurgery in epilepsy and neurooncology procedures. Yet it has been used only recently in seldom European centers. Here, we report our 4 years’ experience with LITT in children (complications, epileptic and oncologic outcomes).</div></div><div><h3>Methods</h3><div>Single center retrospective study of consecutive LITT procedures during the 2021–2024 period. LITT was restricted to pediatrics in the following indications: (i) circumscribed lesion (ii) benign pathology (iii) problematic location for microsurgical resection. After a robotic stereotactic implantation, ablation was performed under MRI guidance with the VISUALASE system. Post operative outpatient clinic and MRI were systematic at 1, 3, 6 and 12 months. Epileptic outcome was defined after ILAE classification, oncological relapse was defined as a volumetric increase after 1 month of follow up.</div></div><div><h3>Results</h3><div>35 children (mean age 11.4yo, M/F ratio = 0.8) were operated in 41 successive procedures. Main indication was focal epilepsy (<em>n</em> = 28 patients; FCD <em>n</em> = 13, LEAT <em>n</em> = 11, HH <em>n</em> = 4) while 7 children were treated for oncological purposes. Lesions were cortical in the insula (<em>n</em> = 8), mediotemporobasal (<em>n</em> = 8) and paracentral (<em>n</em> = 6) regions or subcortical (hypothalamus and basal ganglia <em>n</em> = 6, mesencephalon <em>n</em> = 4). Perioperative transient adverse events occurred in 25.7% and persistent neurological deficit was noted in 2 children. After a mean follow up of 31.2 months, 67.9% of the patients are seizure free and tumoral recurrence was observed in 3/18 cases.</div></div><div><h3>Conclusion</h3><div>In this pediatric cohort of 35 children with challenging brain lesions, LITT ablation was safe and efficient.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101719"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal cord malformations's epidemiology in French children: National cross sectional study based on medico-administrative database.","authors":"C Hervet, C Le Roux, C Gaborit, J Maheut-Lourmiere, C Fremont, H Lardy, L Grammatico-Guillon, T Odent","doi":"10.1016/j.neuchi.2025.101713","DOIUrl":"https://doi.org/10.1016/j.neuchi.2025.101713","url":null,"abstract":"<p><strong>Objective: </strong>Epidemiological data on rare spinal cord malformations in children are lacking in France. Using the national hospital discharge database (PMSI), we studied the care trajectories and estimated the morbidity and mortality burden of these conditions.</p><p><strong>Study design: </strong>We conducted a nationwide historical cohort study from 2010 to 2020, including children diagnosed with rare spinal cord diseases within the scope of the C-MAVEM network. Cases were identified through ICD-10 codes using a semi-automated, multicenter-validated extraction algorithm (positive predictive value >80%). Incidence and in-hospital mortality rates were estimated for the following conditions: Spina Bifida (SB), Arnold Chiari syndrome (ACS), Syringomyelia and Syringobulbia (SM), Diastematomyelia (DM), and Hydromyelia (HM).</p><p><strong>Results: </strong>A total of 10,114 children were identified, corresponding to an estimated prevalence of 67 per 100,000. Incidence rates per 100,000 live births were: 2.6 for SB, 2.2 for ACS, 1.0 for SM, 0.2 for DM, and 0.04 for HM. The mortality was 2.5%, 1.7%, 1.1%, 0.95%, no available for HM, respectively. Most patients were treated in university hospitals with considerable heterogeneity in surgical management depending on etiology and associated malformations.</p><p><strong>Conclusion: </strong>This study provides, for the first time in France, national epidemiological estimates for rare pediatric spinal cord malformations. The use of a validated medico-administrative data extraction approach enables largescale surveillance of these rare conditions, improves understanding of their healthcare burden, and supports planning for specialized care and public health strategies.</p>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":" ","pages":"101713"},"PeriodicalIF":1.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-hemorrhagic external hydrocephalus in adults","authors":"Anaïs Mayras ,&nbsp;Romain Manet ,&nbsp;Baptiste Balança","doi":"10.1016/j.neuchi.2025.101711","DOIUrl":"10.1016/j.neuchi.2025.101711","url":null,"abstract":"","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 6","pages":"Article 101711"},"PeriodicalIF":1.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foix-Alajouanine syndrome: A systematic review and meta-analysis of presentation, management, and outcomes","authors":"Sean O’Leary ,&nbsp;Nathan Fredricks ,&nbsp;Peace Odiase ,&nbsp;Sonia Pulido ,&nbsp;Usama AlDallal ,&nbsp;Ariadna Robledo ,&nbsp;Christopher Thang ,&nbsp;Umaru Barrie ,&nbsp;Salah Aoun","doi":"10.1016/j.neuchi.2025.101710","DOIUrl":"10.1016/j.neuchi.2025.101710","url":null,"abstract":"<div><h3>Objective</h3><div>Foix-Alajouanine syndrome (FAS) is a grouping of rare, progressive spinal arteriovenous malformations causing significant neurological morbidity.</div></div><div><h3>Methods</h3><div>A systematic review of PubMed, Google Scholar, Embase, Science Direct, and Web of Science following PRISMA guidelines identified 30 articles addressing FAS presentation, management, and outcomes.</div></div><div><h3>Results</h3><div>In 27 case reports covering 46 patients (mean age 55.1 years, 71.7% male), common symptoms included lower extremity weakness (84.8%), bladder dysfunction (69.6%), sensory deficits (65.2%), and gait disturbance (65.2%). Imaging (MRI in 82.5%, angiography in 70.0%) frequently revealed dural arteriovenous fistulas and spinal cord hyperintensities, primarily in the thoracolumbar region. Among these patients, 58.7% improved, 13.1% showed no change, 21.7% worsened, and 6.5% died. Surgical clipping (OR 10.67, 95% CI [2.12–68.04], p = 0.002) and resection (OR 5.74, 95% CI [1.18–36.47], p = 0.029) were associated with neurological improvement, whereas lesions in the mid-thoracic region (T6–T9) had reduced likelihood of improvement (OR 0.18, 95% CI [0.04–0.76], p = 0.017). Conservative management correlated with higher mortality (OR 33.89, 95% CI [1.39–826.08], p = 0.023). In three retrospective studies covering 66 patients (mean age 61.5 years, 80.3% male), primary interventions were surgical or endovascular; 63.6% improved, 35.0% worsened, and 1.5% died at follow-up.</div></div><div><h3>Conclusions</h3><div>Early detection by clinical and radiologic signs with quick intervention in the subtypes of FAS are crucial. Surgical clipping and resection demonstrated particularly favorable results, whereas conservative management was associated with increased mortality. Clinicians should maintain a high index of suspicion for subacute myelopathy to facilitate timely diagnosis and improve long-term prognosis.</div></div>","PeriodicalId":51141,"journal":{"name":"Neurochirurgie","volume":"71 5","pages":"Article 101710"},"PeriodicalIF":1.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}