Operative Neurosurgery最新文献

{"title":"Interpretation and Strategy to Resolve Neuromonitoring Changes Associated With Brain Sag.","authors":"Mitali Bose, Matthew Toczylowski, Xiaopeng Guo, David D Liu, Thomas Epplin-Zapf, W Bryan Wilent, Wenya Linda Bi","doi":"10.1227/ons.0000000000001430","DOIUrl":"https://doi.org/10.1227/ons.0000000000001430","url":null,"abstract":"<p><strong>Background and objectives: </strong>Intraoperative neuromonitoring (IONM) aides in safe maximal resection of brain tumors in eloquent areas. During the resection of large or deep-seated tumors, shifts in the peri-resectional parenchyma and cortical surface relative to cranial electrodes, or brain sag, can cause false-positive loss of sensorimotor signals. We describe patterns of electrophysiological changes associated with brain sag and a facile technique to rapidly resolve these changes intraoperatively by saline infusion.</p><p><strong>Methods: </strong>We reviewed cases operated on by the senior author and identified cases where brain sag was noted intraoperatively. Preoperative and postoperative imaging, operative details, and IONM electrophysiological traces were analyzed to surmise generalizable patterns.</p><p><strong>Results: </strong>We observe stepwise decreases in somatosensory-evoked potentials and transcranial motor-evoked potentials that occur with removal of a large intraparenchymal mass or after significant loss of cerebrospinal fluid. The pattern of upper extremity or lower extremity signal change depends on the location of the lesion and the positioning of the head, depending on which regions of the motor or somatosensory cortices are most affected by brain sag. Recovery of the somatosensory-evoked potentials and transcranial motor-evoked potentials during saline infusion into the resection cavity or ventricle, which reconstitutes the cortical topography, suggests that the IONM signal change was artifactual, rather than reflecting true physiological injury. We present 6 illustrative cases that highlight distinct patterns of electrophysiological change associated with brain sag and the extent of signal restoration.</p><p><strong>Conclusion: </strong>Brain sag is commonly encountered during the resection of large or deep-seated tumors. Improved understanding of the spatiotemporal electrophysiological signatures of brain sag and application of the saline infusion technique to reverse false-positive drops in neuromonitoring signals improves the utility of IONM and enhances safe resection.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":"28 6","pages":"841-854"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repair of a Delayed, Atypical, Post-Traumatic Ventrolateral Dural Defect of the Cervicothoracic Spine: 2-Dimensional Operative Video.","authors":"Thomas Tyler Patterson, Michael Gaub, Grant W Mallory, Cristian Gragnaniello","doi":"10.1227/ons.0000000000001359","DOIUrl":"10.1227/ons.0000000000001359","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"902-903"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300829","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":"Extended Endoscopic Endonasal Approach for Giant Pediatric Craniopharyngiomas: Technical Note and Case Series.","authors":"YouYuan Bao, LaiSheng Pan, Jun Fu, Xiao Wu, ShenHao Xie, Bin Tang, Tao Hong","doi":"10.1227/ons.0000000000001191","DOIUrl":"10.1227/ons.0000000000001191","url":null,"abstract":"<p><strong>Background and objectives: </strong>Giant pediatric craniopharyngiomas are rare tumors whose clinical and surgical management is extremely challenging. A variety of open transcranial approaches has been used to resect these lesions. Although there has been an increasing acceptance of the endoscopic endonasal approach (EEA) for the resection of pediatric craniopharyngiomas in recent years, many surgeons continue to recommend against the use of the EEA for giant pediatric craniopharyngiomas. This study aimed to evaluate the feasibility of extended EEA for giant craniopharyngiomas in the pediatric population.</p><p><strong>Methods: </strong>All consecutive pediatric patients with giant craniopharyngiomas (diameter >4 cm) who underwent endoscopic endonasal surgery at our institution were retrospectively reviewed. Data on demographic information, preoperative assessment, imaging features, surgical results, complications, and recurrences were recorded and analyzed.</p><p><strong>Results: </strong>A total of 16 pediatric patients with an average age of 12 years were identified. The mean maximum diameter and volume of the tumors were 4.35 cm and 24.1 cm 3 , respectively. Gross total resection was achieved in 13 patients (81.3%) and subtotal resection in 3 patients (18.7%). Postoperatively, partial or complete anterior pituitary insufficiency occurred in 100% of patients, and 62.5% developed new-onset diabetes insipidus. Visual function improved in 9 patients (56.3%) and remained stable in 7 patients (43.7%). Postoperative cerebrospinal fluid leakage occurred in 2 patients and was successfully repaired through the EEA. During a mean follow-up of 44.3 months, 18.8% of patients had a >9% increase in body mass index, and 93.8% of patients successfully returned to school or work. Two patients (12.5%) suffered a recurrence. Disease control was achieved in 16 patients (100%) at final follow-up.</p><p><strong>Conclusion: </strong>The extended EEA allows adequate access to this challenging tumor and enables complete resection and visual improvement with a reasonable approach-related complication rate.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"779-787"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141072232","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":"Trilayered Decompression of the Middle Cranial Fossa for Cavernous Sinus Meningiomas: 2-Dimensional Operative Video.","authors":"Alejandro Bugarini, Rafael Martinez-Perez","doi":"10.1227/ons.0000000000001358","DOIUrl":"10.1227/ons.0000000000001358","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"901"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332318","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":"Letter: Interpretation and Strategy to Resolve Neuromonitoring Changes Associated With Brain Sag.","authors":"Nishanth Sampath, Gomathi Sivakumar, Vishwaraj Ratha, Suresh Bapu","doi":"10.1227/ons.0000000000001565","DOIUrl":"10.1227/ons.0000000000001565","url":null,"abstract":"","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"909-910"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765863","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":"Posterior Reduction and Temporary Fixation Through Intermuscular Approach for Odontoid Fracture.","authors":"Zhenji Xu, Ji Wu, Haibin Wang, Changhong Chen, Bangke Zhang, Xuhua Lu, Bin Ni, Fei Chen, Qunfeng Guo","doi":"10.1227/ons.0000000000001399","DOIUrl":"10.1227/ons.0000000000001399","url":null,"abstract":"<p><strong>Background and objective: </strong>Posterior reduction and temporary fixation (PRTF) through open approach can effectively avoid the loss of C1-C2 motion caused by posterior atlantoaxial fusion in the treatment of odontoid fracture. PRTF through intermuscular approach can preserve the integrity of the paravertebral muscle. However, its contribution to the preservation of C1-C2 rotation remains unassessed in the context of fresh odontoid fractures.</p><p><strong>Methods: </strong>The data of 31 patients with odontoid fractures who underwent PRTF through intermuscular approach were retrospectively reviewed. Operation time, intraoperative blood loss, the time of ambulation and surgery-related complications were recorded. After fracture healing, the instrumentation was removed. The Japanese Orthopedic Association score, Visual Analog Scale score for neck pain, and patient satisfaction were recorded. The range of motion in rotation of C1-C2 was calculated 1 month after removing the instrumentation.</p><p><strong>Results: </strong>Fracture healing was observed in all patients, and the instrumentation was removed. After removing the instrumentation, the range of motion of C1-C2 in rotation was returned to 35.6° ± 4.8°. Patient satisfaction was improved ( P < .05). There was no significant difference in Japanese Orthopedic Association scores and Visual Analog Scale score for neck pain between 2 values before and after removing the instrumentation ( P > .05). No osteoarthritis was observed at the C1-C2 lateral mass joints. There were no perioperative complications.</p><p><strong>Conclusion: </strong>PRTF through intermuscular approach can be used as a salvage treatment of an odontoid fracture with an intact transverse ligament in cases of failure of, or contraindication to, anterior screw fixation. This minimally invasive technique can effectively preserve the rotational function of the atlantoaxial complex.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"772-778"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512927","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":"Comparative Analysis of Efficacy and Safety of Frame-Based, Frameless, and Robot-Assisted Stereotactic Brain Biopsies: A Systematic Review and Meta-Analysis.","authors":"Neslihan Nisa Gecici, N U Farrukh Hameed, Ahmed Habib, Hansen Deng, L Dade Lunsford, Pascal O Zinn","doi":"10.1227/ons.0000000000001408","DOIUrl":"10.1227/ons.0000000000001408","url":null,"abstract":"<p><strong>Background and objectives: </strong>For 50 years, frame-based stereotactic brain biopsy has been the \"gold standard\" for its high diagnostic yield and safety, especially for complex or deep-seated lesions. Over the past decade, frameless and robotic alternatives have emerged. This report evaluates and compares the outcomes, diagnostic yield, and safety of these methods.</p><p><strong>Methods: </strong>Major databases were screened for studies reporting data on diagnostic yield, postoperative hemorrhage, neurological deficits, and mortality after frame-based, robot-assisted or neuronavigation-assisted frameless biopsies. Meta-analysis with random-effect modeling was performed to compare diagnostic yield, operative duration, length of stay, complications, and mortality.</p><p><strong>Results: </strong>A total of 92 studies were included with 9801 patients in the frame-based group, 2665 in the robot-assisted group, and 1862 in the frameless group. Pooled diagnostic yield rates were 97% (96%-98%, I 2 = 49%) in robot-assisted, 95% (94%-96%, I 2 = 74%) in frame-based, and 94% (91%-96%, I 2 = 55%) frameless groups with a statistically significant difference ( P < .01, I 2 = 71%). The mean total operative duration including anesthesia, system setup, patient registration, trajectory planning, and skin incision to closure was significantly shorter in the robot-assisted group (76.6 vs 132.7 vs 97.3 minutes, P < .01). The duration from skin incision to closure was comparable between the groups (robot-assisted: 37.8 mins, frame-based: 42.6 minutes, frameless: 58.2 minutes; P = .23). Pooled rates of symptomatic hemorrhage (0.005% vs 0.009% vs 0.007, P = .71, I 2 = 34%), asymptomatic hemorrhage (4% vs 3% vs 3%, P = .64, I 2 = 93%), transient neurological deficit (3% vs 2% vs 2%, P = .5, I 2 = 72%), permanent neurological deficit (0.001% vs 0.001% vs 0.0002, P = .78, I 2 = 47%), and mortality (0% vs 0.001% vs 0.006%, P < .01, I 2 = 10%) were similar between groups. Deaths were mainly due to postprocedural hemorrhage (robotic: 46%, frame-based: 48%, frameless: 72%).</p><p><strong>Conclusion: </strong>Robot-assisted biopsy is not inferior in diagnostic yield and safety to the gold standard frame-based and neuronavigation-assisted frameless biopsy methods.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"749-761"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588173","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":"Treatment of Acute Iatrogenic Cerebrovascular Injury Using Flow Diverter Stents.","authors":"Eric A Grin, Svetlana Kvint, Eytan Raz, Maksim Shapiro, Vera Sharashidze, Jacob Baranoski, Charlotte Chung, Ayaz Khawaja, Donato Pacione, Chandra Sen, Caleb Rutledge, Howard A Riina, Peter K Nelson, Erez Nossek","doi":"10.1227/ons.0000000000001379","DOIUrl":"10.1227/ons.0000000000001379","url":null,"abstract":"<p><strong>Background and objectives: </strong>Iatrogenic cerebrovascular injury can cause intracranial hemorrhage and pseudoaneurysm formation, putting patients at high risk for postoperative bleeding. No consensus for management exists. This study describes endovascular treatment of these acute injuries with flow diverter stents.</p><p><strong>Methods: </strong>Electronic medical records were retrospectively reviewed for injury type and etiology, timing of diagnosis, and endovascular management, including antiplatelet regimens, embolization results, and clinical outcome.</p><p><strong>Results: </strong>Six patients were included. Three suffered an injury to the internal carotid artery, 1 suffered an injury to the left anterior cerebral artery, 1 suffered an injury to the right posterior cerebral artery, and 1 suffered an injury to the basilar artery. Four of the 6 injuries occurred during attempted tumor resection, 1 occurred during cerebrospinal fluid leak repair, and 1 occurred during an ophthalmic artery aneurysm clipping. All injuries resulted in pseudoaneurysm formation. Four were immediately detected on angiography; 2 were initially negative on imaging. Five were treated with a pipeline embolization device, and 1 was treated with a Silk Vista Baby. Two were treated with 2 pipeline embolization devices telescopically overlapped across the pseudoaneurysm. All devices deployed successfully. No pseudoaneurysm recurrence or rebleeding occurred. No parent artery occlusion or stenosis was observed, and complete pseudoaneurysm occlusion was observed in 4 patients (in 2 patients, follow-up imaging could not be obtained).</p><p><strong>Conclusion: </strong>With proper antiplatelet regimens, flow diverter stents can be used safely to successfully treat complex acute iatrogenic injuries. Early repeat angiogram is needed when immediate postinjury imaging does not discover the point of vessel injury.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"808-816"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300832","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":"Endoscopic Endonasal Internal Carotid Artery Transposition Technique in Tumor With Parasellar Extension: A Single-Center Experience.","authors":"Limin Xiao, Bowen Wu, Han Ding, Yulin He, Xiao Wu, Shenhao Xie, Bin Tang, Tao Hong","doi":"10.1227/ons.0000000000001193","DOIUrl":"10.1227/ons.0000000000001193","url":null,"abstract":"<p><strong>Background and objectives: </strong>Lateralization or mobilization of the internal carotid artery (ICA) during a midline approach is required to expose lesions behind or lateral to the ICA. However, there have been no published data regarding the surgical outcomes of the endoscopic endonasal internal carotid transposition technique (EEITT). This study aimed to analyze the relevant surgical anatomy around the ICA and propose a grading scheme of EEITT.</p><p><strong>Methods: </strong>A retrospective review of patients who underwent EEITT at a single institution was performed. Based on structures that limited the ICA and intraoperative findings, an anatomically surgical grading scheme of EEITT was proposed.</p><p><strong>Results: </strong>Forty-two patients (mean age 45.6 years, 57.1% female patients) were included. Of them, 29 cases (69.0%) were Knosp grade 4 pituitary adenoma, 6 cases (14.3%) were chordoma, 6 cases (14.3%) were meningioma, and a single case (2.4%) was meningeal IgG4-related disease. The EEITT was categorized into Grades 1, 2 and 3, which was used in 24 (57.1%), 12 (28.6%), and 6 (14.3%) cases, respectively. The most common symptom was visual disturbance (45.2%). The gross total resection rate in Grade 1 (79.2%) and Grade 2 (83.3%) was much higher than that in Grade 3 (66.6%). The overall rate of visual function improvement, preoperative cranial nerve (CN) palsy improvement, and postoperative hormonal remission was 89.4%, 85.7%, and 88.9%, respectively. The rate for the following morbidities was cerebrospinal fluid leakage, 2.4%; permanent diabetes insipidus, 4.8%; new transient CN palsy, 9.5%; permanent CN palsy, 4.7%; panhypopituitarism, 7.1%; and ICA injury, 2.4%.</p><p><strong>Conclusion: </strong>The EEITT is technically feasible and could be graded according to the extent of disconnection of limiting structures. For complex tumor with parasellar extensions, the distinction into Grades 1, 2, and 3 will be of benefit to clinicians in predicting risks, avoiding complications, and generating tailored individualized surgical strategies.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"796-807"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089332","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":"Comparative Assessment of Thermal Damage Induced by Bipolar Forceps in a Bovine Liver.","authors":"Neslihan Çavuşoğlu, Abuzer Güngör, Muhammed Emin Aksu, Erhan Emel, Berk Burak Berker, Yücel Doğruel, Uğur Türe","doi":"10.1227/ons.0000000000001385","DOIUrl":"10.1227/ons.0000000000001385","url":null,"abstract":"<p><strong>Background and objectives: </strong>Bipolar electrocautery systems in neurosurgical procedures may induce thermal damage to adjacent tissues, especially neural tissues. Therefore, it is crucial to control thermal spread from the tips of bipolar forceps into adjacent tissues. The goal of this study was to compare the thermal damage induced in unintended adjacent tissues during coagulation with 6 different bipolar forceps.</p><p><strong>Methods: </strong>Fresh ex vivo bovine liver tissues were coagulated with 6 different bipolar forceps: Aesculap® nonstick, Atlas Choice™, ISOCOOL®, SilverGlide®, Spetzler™-Malis®, and VersaTru® (45 trials per bipolar forceps). For all forceps, coagulation was performed with a power setting of 35 Malis units, 1-mm tip spacing, and 3-second activation time. Tissue samples were evaluated for the extent of thermal damage (30 trials per bipolar forceps). Tissue temperatures were measured with thermocouples placed in the tissues (15 trials per bipolar forceps). The area and maximum depth of thermal damage were measured manually with image analysis software.</p><p><strong>Results: </strong>The injury area induced by ISOCOOL® and Atlas Choice™ bipolar forceps was significantly less than that of the Aesculap® nonstick ( P < .001), SilverGlide® ( P < .001), Spetzler™-Malis® ( P < .001), and VersaTru® ( P < .001). The areas of thermal injury caused by the ISOCOOL® and Atlas Choice™ forceps were not statistically significantly different from each other ( P = .08). Lesions from the ISOCOOL® and Atlas Choice™ forceps showed significantly less depth of injury than the Aesculap® nonstick ( P = .001), SilverGlide® ( P < .001), Spetzler™-Malis® ( P < .001), and VersaTru® ( P < .001). There was no statistically significant difference in the depth of thermal injury between the ISOCOOL® and Atlas Choice™ forceps ( P = 1.0).</p><p><strong>Conclusion: </strong>Bipolar forceps that effectively limit excessive thermal dissipation reduce the risk of unintended injury to adjacent or peripheral tissues. In an ex vivo bovine liver model, coagulation tests with ISOCOOL® and Atlas Choice™ bipolar forceps resulted in less depth and lower mean injury areas compared with other forceps.</p>","PeriodicalId":54254,"journal":{"name":"Operative Neurosurgery","volume":" ","pages":"832-840"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523619","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}