Clival Metastases: Single-Center Retrospective Case Series and Literature Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Case Series
2.2. Literature Review
2.2.1. Search Strategy
2.2.2. Selection Criteria
2.2.3. Data Extraction
3. Results
3.1. Case Series
3.2. Illustrative Case
3.3. Literature Review
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Jozsa, F.; Das, J.M. Metastatic Lesions of the Clivus: A Systematic Review. World Neurosurg. 2022, 158, 190–204. [Google Scholar] [CrossRef] [PubMed]
- Pallini, R.; Sabatino, G.; Doglietto, F.; Lauretti, L.; Fernandez, E.; Maira, G. Clivus Metastases: Report of Seven Patients and Literature Review. Acta Neurochir. 2009, 151, 291–296; discussion 296. [Google Scholar] [CrossRef] [PubMed]
- Sturgis, R.; Mack, A.; Kim, S.; Maier, J.; Heath, E.I. Symptom Outcomes of Cancer Patients with Clival Metastases Treated with Radiotherapy: A Study of 44 Patients. Anticancer Res. 2021, 41, 5001–5006. [Google Scholar] [CrossRef] [PubMed]
- Dekker, S.E.; Wasman, J.; Yoo, K.K.; Alonso, F.; Tarr, R.W.; Bambakidis, N.C.; Rodriguez, K. Clival Metastasis of a Duodenal Adenocarcinoma: A Case Report and Literature Review. World Neurosurg. 2017, 100, 62–68. [Google Scholar] [CrossRef]
- Cathel, A.; Khan, Y.R.; Blais, D.; Mahato, B.; Mahato, D. Metastatic Disease to Clivus: Biopsy or Not? Cureus 2019, 11, e5658. [Google Scholar] [CrossRef] [PubMed]
- Dindo, D.; Demartines, N.; Clavien, P.-A. Classification of Surgical Complications: A New Proposal with Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann. Surg. 2004, 240, 205–213. [Google Scholar] [CrossRef] [PubMed]
- Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. BMJ 2021, 372, n71. [Google Scholar] [CrossRef]
- Amin, M.B.; Greene, F.L.; Edge, S.B.; Compton, C.C.; Gershenwald, J.E.; Brookland, R.K.; Meyer, L.; Gress, D.M.; Byrd, D.R.; Winchester, D.P. The Eighth Edition AJCC Cancer Staging Manual: Continuing to Build a Bridge from a Population-Based to a More “Personalized” Approach to Cancer Staging. CA Cancer J. Clin. 2017, 67, 93–99. [Google Scholar] [CrossRef] [PubMed]
- Ravnik, J.; Hribernik, B.; Lanišnik, B. Endoscopic Endonasal Approaches to the Clival Region. Acta Med. Acad. 2020, 49 (Suppl. S1), 45–53. [Google Scholar] [CrossRef] [PubMed]
- Douglas, J.E.; Lee, J.Y.K.; Rajasekaran, K. Cranial Nerve VI Palsy as Presenting Sign of Previously Undiagnosed Metastatic Prostate Adenocarcinoma to the Clivus. Biomed. Hub. 2020, 5, 210–213. [Google Scholar] [CrossRef] [PubMed]
- Mishima, H.; Ayabe, J.; Watanabe, M.; Togin, S.; Tsuchiya, Y.; Kawasaki, T.; Noda, N.; Maruyama, T.; Tanaka, Y. Clival Metastasis of Hepatocellular Carcinoma with an Initial Histopathological Diagnosis of Atypical Pituitary Adenoma. J. Neurol. Surg. Rep. 2019, 80, e18–e22. [Google Scholar] [CrossRef] [PubMed]
- Zhang, W.-Q.; Bao, Y.; Qiu, B.; Wang, Y.; Li, Z.-P.; Wang, Y.-B. Clival Metastasis of Renal Clear Cell Carcinoma: Case Report and Literature Review. World J. Clin. Cases 2018, 6, 301–307. [Google Scholar] [CrossRef] [PubMed]
- Machío Castelló, M.; Escobar Montatixe, D.; Cenjor Español, C.; Villacampa Aubá, J.M.; Montoya Bordón, J.; Carias Calix, R.; Sáez Pinel, R. Incomplete Cavernous Sinus Syndrome as the Initial Manifestation of a Previously Undetected Metastatic Prostate Adenocarcinoma. Head Neck 2017, 39, E77–E80. [Google Scholar] [CrossRef] [PubMed]
- Ho, K.W.D.; Drew, P.A.; Chuquilin, M. Merkel Cell Carcinoma with Distant Metastasis to the Clivus Causing Symptoms Mimicking Tolosa-Hunt Syndrome: A Case Report and Literature Review. Front. Neurol. 2017, 8, 409. [Google Scholar] [CrossRef] [PubMed]
- Zagzoog, N.; Ra, G.; Koziarz, A.; Provias, J.; Sommer, D.; Almenawer, S.A.; Reddy, K. Metastatic Liposarcoma of the Skull Base: A Case Report and Review of Literature. Neurosurgery 2017, 80, 219–223. [Google Scholar] [CrossRef] [PubMed]
- Yari, N.; Espino Barros Palau, A.; Morgan, M.L.; Levine, N.B.; Lee, A.G. Metastatic Papillary Thyroid Carcinoma Presenting as Abducens Palsy Complicated by Ocular Neuromyotonia. Neuroophthalmology 2016, 40, 97–101. [Google Scholar] [CrossRef] [PubMed]
- Tsunoda, A.; Tanaka, Y.; Sato, T.; Kirimura, S.; Kitamura, K. Vertigo by Breast Cancer Metastasis 33 Years after Treatment. Intern. Med. 2016, 55, 311–313. [Google Scholar] [CrossRef] [PubMed]
- Kapoor, A.; Beniwal, V.; Beniwal, S.; Mathur, H.; Kumar, H.S. Isolated Clival Metastasis as the Cause of Abducens Nerve Palsy in a Patient of Breast Carcinoma: A Rare Case Report. Indian. J. Ophthalmol. 2015, 63, 354–357. [Google Scholar] [CrossRef] [PubMed]
- Lee, A.; Chang, K.-H.; Hong, H.; Kim, H. Sixth Cranial Nerve Palsy Caused by Gastric Adenocarcinoma Metastasis to the Clivus. J. Korean Neurosurg. Soc. 2015, 57, 208–210. [Google Scholar] [CrossRef] [PubMed]
- Mendelson, Z.S.; Patel, A.A.; Eloy, J.A.; Liu, J.K. Endoscopic Palliative Decompression of the Cavernous Sinus in a Rare Case of a Metastatic Renal Cell Carcinoma to the Clivus. Br. J. Neurosurg. 2015, 29, 430–431. [Google Scholar] [CrossRef] [PubMed]
- Zacharia, B.E.; Romero, F.R.; Rapoport, S.K.; Raza, S.M.; Anand, V.K.; Schwartz, T.H. Endoscopic Endonasal Management of Metastatic Lesions of the Anterior Skull Base: Case Series and Literature Review. World Neurosurg. 2015, 84, 1267–1277. [Google Scholar] [CrossRef] [PubMed]
- Kendre, B.; Deopujari, C.; Karmarkar, V.; Ratha, V. A Rare Case of Carcinoma Rectum Metastasing to Clivus. Neurol. India 2014, 62, 85–86. [Google Scholar] [CrossRef] [PubMed]
- Vellutini, E.d.A.S.; Balsalobre, L.; Hermann, D.R.; Stamm, A.C. The Endoscopic Endonasal Approach for Extradural and Intradural Clivus Lesions. World Neurosurg. 2014, 82, S106–S115. [Google Scholar] [CrossRef] [PubMed]
- Deconde, A.S.; Sanaiha, Y.; Suh, J.D.; Bhuta, S.; Bergsneider, M.; Wang, M.B. Metastatic Disease to the Clivus Mimicking Clival Chordomas. J. Neurol. Surg. B Skull Base 2013, 74, 292–299. [Google Scholar] [CrossRef] [PubMed]
- Bohnstedt, B.N.; Tomcik, M.; Eads, T.; Hagen, M.C.; Shah, M. Metastasis of Soft-Tissue Myoepithelial Carcinoma to Clivus. J. Neurosurg. Pediatr. 2012, 9, 161–164. [Google Scholar] [CrossRef] [PubMed]
- Fukushima, M.; Katayama, Y.; Shigemori, Y.; Miyake, H.; Hirayama, T.; Kotani, A. Clivus Metastasis from Gastric Signet Ring Cell Carcinoma after a 10-Year Disease-Free Interval—Case Report. Neurol. Med. Chir. 2012, 52, 751–753. [Google Scholar] [CrossRef] [PubMed]
- Baeg, M.K.; Bae, S.H.; Lee, K.H.; Kim, J.; Park, I.S.; Jin, J.-Y. Diplopia as a Presenting Symptom in a Gastric Gastrointestinal Stromal Tumor. Jpn. J. Clin. Oncol. 2011, 41, 265–268. [Google Scholar] [CrossRef]
- Fraser, J.F.; Nyquist, G.G.; Moore, N.; Anand, V.K.; Schwartz, T.H. Endoscopic Endonasal Minimal Access Approach to the Clivus: Case Series and Technical Nuances. Neurosurgery 2010, 67, ons150–ons158; discussion ons158. [Google Scholar] [CrossRef] [PubMed]
- Kolias, A.G.; Derham, C.; Mankad, K.; Hasegawa, H.; O’Kane, R.; Ismail, A.; Phillips, N.I. Multiple Cranial Neuropathy as the Initial Presentation of Metastatic Prostate Adenocarcinoma: Case Report and Review of Literature. Acta Neurochir. 2010, 152, 1251–1255. [Google Scholar] [CrossRef] [PubMed]
- McGirt, M.J.; Cowan, J.A.; Gala, V.; Garton, H.J.; Muraszko, K.M.; Thompson, B.G. Surgical Reversal of Prolonged Blindness from a Metastatic Neuroblastoma. Childs Nerv. Syst. 2005, 21, 583–586. [Google Scholar] [CrossRef] [PubMed]
- Ulubaş, B.; Ozcan, C.; Acka, G.; Aydn, O.; Saritaş, E. Clivus Metastasis of Squamous Cell Carcinoma: A Rare Location. J. Clin. Neurosci. 2005, 12, 97–98. [Google Scholar] [CrossRef] [PubMed]
- Alessi, G.; Lemmerling, M.; Vereecken, L.; De Waele, L. Benign Metastasizing Leiomyoma to Skull Base and Spine: A Report of Two Cases. Clin. Neurol. Neurosurg. 2003, 105, 170–174. [Google Scholar] [CrossRef] [PubMed]
- DiNatale, A.; Fatatis, A. The Bone Microenvironment in Prostate Cancer Metastasis. Adv. Exp. Med. Biol. 2019, 1210, 171–184. [Google Scholar] [CrossRef] [PubMed]
- Tantivejkul, K.; Kalikin, L.M.; Pienta, K.J. Dynamic Process of Prostate Cancer Metastasis to Bone. J. Cell Biochem. 2004, 91, 706–717. [Google Scholar] [CrossRef] [PubMed]
- Zoli, M.; Milanese, L.; Bonfatti, R.; Faustini-Fustini, M.; Marucci, G.; Tallini, G.; Zenesini, C.; Sturiale, C.; Frank, G.; Pasquini, E.; et al. Clival Chordomas: Considerations after 16 Years of Endoscopic Endonasal Surgery. J. Neurosurg. 2018, 128, 329–338. [Google Scholar] [CrossRef] [PubMed]
- Cavallo, L.M.; Mazzatenta, D.; d’Avella, E.; Catapano, D.; Fontanella, M.M.; Locatelli, D.; Luglietto, D.; Milani, D.; Solari, D.; Vindigni, M.; et al. The Management of Clival Chordomas: An Italian Multicentric Study. J. Neurosurg. 2020, 135, 93–102. [Google Scholar] [CrossRef]
- Passeri, T.; Champagne, P.-O.; Giammattei, L.; Abbritti, R.; Cartailler, J.; Calugaru, V.; Feuvret, L.; Guichard, J.-P.; Polivka, M.; Adle-Biassette, H.; et al. Management Strategies in Clival and Craniovertebral Junction Chordomas: A 29-Year Experience. J. Neurosurg. 2022, 1–13. [Google Scholar] [CrossRef] [PubMed]
- Nyquist, G.G.; Anand, V.K.; Singh, A.; Schwartz, T.H. Janus Flap: Bilateral Nasoseptal Flaps for Anterior Skull Base Reconstruction. Otolaryngol. Head Neck Surg. 2010, 142, 327–331. [Google Scholar] [CrossRef] [PubMed]
- McCoul, E.D.; Anand, V.K.; Singh, A.; Nyquist, G.G.; Schaberg, M.R.; Schwartz, T.H. Long-Term Effectiveness of a Reconstructive Protocol Using the Nasoseptal Flap after Endoscopic Skull Base Surgery. World Neurosurg. 2014, 81, 136–143. [Google Scholar] [CrossRef] [PubMed]
- Champagne, P.-O.; Zenonos, G.A.; Wang, E.W.; Snyderman, C.H.; Gardner, P.A. The Rhinopharyngeal Flap for Reconstruction of Lower Clival and Craniovertebral Junction Defects. J. Neurosurg. 2021, 135, 1319–1327. [Google Scholar] [CrossRef] [PubMed]
- Marchese-Ragona, R.; Maria Ferraro, S.; Marioni, G.; Staffieri, C.; Manara, R.; Restivo, D.A.; Staffieri, A. Abducent Nerve Paralysis: First Clinical Sign of Clivus Metastasis from Tonsillar Carcinoma. Acta Otolaryngol. 2008, 128, 713–716. [Google Scholar] [CrossRef] [PubMed]
- Huq, S.; Shanahan, R.M.; Adida, S.; Bin-Alamer, O.; Abou-Al-Shaar, H.; Niranjan, A.; Hadjipanayis, C.G.; Lunsford, L.D. Gamma Knife Radiosurgery for Clival Metastasis: Case Series and Systematic Review. J. Neurooncol 2024. ahead of print. [Google Scholar] [CrossRef] [PubMed]
# Patient | Age and Sex | Preoperative Symptoms | KPS | Surgical Objective | Volume (cm3) | Clivus Location | Surgical Approach | Skull Base Reconstruction | EOR | Complications | Histology | Adjuvant Therapies | Status at Follow-up | OS (Months) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 81, M | Right VI CN palsy | 70 | Biopsy | 5.9 | Extradural, middle third | EEA | Mucoperiosteum graft | Biopsy | No | LC, previously diagnosed | CT and RT | Deceased | 6 |
2 | 76, M | Left VI CN palsy | 80 | Biopsy | 4.4 | Extradural, middle third | EEA | Mucoperiosteum graft | Biopsy | No | Gastric signet ring cell carcinoma, first diagnosis | CT and RT | Deceased | 5 |
3 | 74, M | Left VI CN palsy | 80 | Resection | 6.3 | Extradural, superior, and middle thirds | EEA | Pedicled flap | Biopsy | No | LC, first diagnosis | CT and RT | Deceased | 7 |
4 | 47, F | Intact | 90 | Biopsy | 0.6 | Extradural, middle third | EEA | Mucoperiosteum graft | PR | No | GEP-NET, previously diagnosed | Resection of breast metastasis | Alive | Alive at 3 months |
Authors | Year | Age and Sex | Primary Neoplasm | Clivus Lesion Volume (cm3) | Symptomatology | Surgical Approach | EOR | Complications | OS |
---|---|---|---|---|---|---|---|---|---|
Present study | 2024 | ||||||||
Patient 1 | 81, M | LC | 5.9 | Right CN VI palsy | EEA | Biopsy | No | 6 | |
Patient 2 | 76, M | Gastric signet ring cell carcinoma | 4.4 | Left CN VI palsy | EEA | Biopsy | No | 5 | |
Patient 3 | 74, M | LC | 6.3 | Left CN VI palsy | EEA | Biopsy | No | 7 | |
Patient 4 | 47, F | GEP-NET | 0.6 | Asymptomatic (PET finding) | EEA | PR | No | Alive at 3 months | |
Ravnik et al. [9] | 2020 | ||||||||
Patient 1 | 67, M | PC | NA | NA | EEA | GTR | No | 12 | |
Patient 2 | 58, F | BC | NA | NA | EEA | GTR | No | 12 | |
Douglas et al. [10] | 2020 | ||||||||
Patient 1 | 81, M | PC | 17.1 | Right CN VI palsy | EEA | Biopsy | No | Alive at 3 months | |
Cathel et al. [5] | 2019 | ||||||||
Patient 1 | 65, M | HCC | NA | Headache, ophthalmoplegia | EEA | Biopsy | No | NA | |
Mishima et al. [11] | 2019 | ||||||||
Patient 1 | 76, F | HCC | NA | Right CN VI palsy | Anterior petrosal approach | STR | Hemorrhage | 6 | |
Zhang et al. [12] | 2018 | ||||||||
Patient 1 | 54, M | RCCC | NA | Right CN III, IV, V2 and VI palsy | EEA | PR | Hemorrhage | Alive at 4 months | |
Machìo-Castellò et al. [13] | 2017 | ||||||||
Patient 1 | 59, M | PC | NA | Left CN III, IV, VI palsy | EEA | Biopsy | No | Alive at 12 months | |
Dekker et al. [4] | 2017 | ||||||||
Patient 1 | 67, M | Duodenal mucinous adenocarcinoma | 15.4 | Bilateral CN VI palsy | EEA | Biopsy | No | Alive at 24 months | |
Ho et al. [14] | 2017 | ||||||||
Patient 1 | 60, M | Merkel cell skin carcinoma | NA | Right ophthalmoplegia, facial hypoesthesia | EEA | Biopsy | No | Alive at 6 months | |
Zagzoog et al. [15] | 2017 | ||||||||
Patient 1 | 43, F | Myxoid liposarcoma | 20.2 | Right CN VI palsy | EEA | STR | No | Alive at 3 months | |
Yari et al. [16] | 2016 | ||||||||
Patient 1 | 45, F | TC | 12.9 | Right CN VI palsy | EEA | STR | No | Alive at 6 months | |
Tsunoda et al. [17] | 2016 | ||||||||
Patient 1 | 76, F | BC | NA | Dizziness | EEA | Biopsy | No | Alive at 48 months | |
Kapoor et al. [18] | 2015 | ||||||||
Patient 1 | 35, F | BC | 13.2 | Left CN VI palsy | EEA | Biopsy | No | Alive at 3 months | |
Lee et al. [19] | 2015 | ||||||||
Patient 1 | 42, F | Gastric carcinoma | NA | Right CN III, VI palsy | EEA | Biopsy | No | 6 | |
Mendelson et al. [20] | 2015 | ||||||||
Patient 1 | 59, F | RCCC | NA | Left CN III, IV, V2 and VI palsy | EEA | STR | No | NA | |
Zacharia et al. [21] | 2015 | ||||||||
Patient 1 | 60, F | TC | NA | Left CN VI CN palsy, headache, tinnitus | EEA | GTR | No | Alive at 12 months | |
Patient 2 | 72, M | LC | NA | Neck pain | EEA | PR | No | 1 | |
Patient 3 | 77, M | PC | NA | Headache | EEA | STR | No | 3 | |
Kendre et al. [22] | 2014 | ||||||||
Patient 1 | 34, M | Rectal signet cell carcinoma | NA | Bilateral CN VI palsy | EEA | GTR | No | NA | |
Vellutini et al. [23] | 2014 | ||||||||
Patient 1 | 54, F | BC | NA | CN XII palsy | EEA | Biopsy | No | NA | |
Patient 2 | 64, F | BC | NA | CN VI palsy | EEA | Biopsy | No | NA | |
Patient 3 | 79, M | PC | NA | CN VI palsy | EEA | Biopsy | No | NA | |
Deconde et al. [24] | 2013 | ||||||||
Patient 1 | 62, F | Leiomyosarcoma | 3.1 | Headache, CN VI palsy | EEA | Biopsy | No | Alive at 7 months | |
Patient 2 | 52, F | BC | 4.6 | Right CN VI palsy | EEA | GTR | No | Alive at 19 months | |
Bohnstedt et al. [25] | 2012 | ||||||||
Patient 1 | 14, F | Myoepithelial sarcoma | NA | Left CN VI palsy | EEA | STR | No | 12 | |
Fukushima et al. [26] | 2012 | ||||||||
Patient 1 | 64, M | Gastric signet ring cell carcinoma | NA | Headache, bilateral CN VI palsy | EEA | PR | No | Alive at 10 months | |
Baeg et al. [27] | 2011 | ||||||||
Patient 1 | 70, M | GI stromal tumor | NA | Right CN VI palsy | EEA | STR | No | Alive at 3 months | |
Fraser et al. [28] | 2010 | ||||||||
Patient 1 | 72, M | Carcinoma (unspecified) | NA | Asymptomatic | EEA | Biopsy | No | NA | |
Kolias et al. [29] | 2010 | ||||||||
Patient 1 | 64, M | PC | NA | Left CN III, IV, V1, V2, VI, VII, IX, X and XII palsy | EEA | Biopsy | No | 17 | |
Pallini et al. [2] | 2009 | ||||||||
Patient 1 | 31, M | Melanoma | NA | Left CN VI palsy | EEA | Biopsy | No | 18 | |
Patient 2 | 67, F | LC | NA | Right CN VI palsy | EEA | Biopsy | No | 12 | |
Patient 3 | 69, M | HCC | NA | Left facial pain, right CN III palsy | EEA | Biopsy | No | Alive at 3 months | |
Patient 4 | 50, M | PC | NA | CN VI palsy | EEA | Biopsy | No | 6 | |
Patient 5 | 57, M | LC | NA | Headache, CN VI palsy | EEA | Biopsy | No | 12 | |
Patient 6 | 76, M | Squamous cell carcinoma | NA | CN VI palsy | EEA | Biopsy | No | 14 | |
Patient 7 | 70, M | PC | NA | CN VI palsy | EEA | Biopsy | No | Alive at 3 months | |
McGirt et al. [30] | 2005 | ||||||||
Patient 1 | 3, M | Adrenal neuroblastoma | 23.3 | Vision loss | Endoscopic ethmoidectomy | Biopsy | No | NA | |
Ulubas et al. [31] | 2005 | ||||||||
Patient 1 | 51, F | LC | 15.8 | Headache, left shoulder and neck pain, weight loss | EEA | Biopsy | No | 1 | |
Alessi et al. [32] | 2003 | ||||||||
Patient 1 | 66, F | Leiomyoma | NA | Right CN VI and XII palsy | High cervical transjugular approach | STR | No | Alive at 12 months |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Carretta, A.; Sollini, G.; Guaraldi, F.; Rustici, A.; Magnani, M.; Asioli, S.; Faustini-Fustini, M.; Pasquini, E.; Zoli, M.; Mazzatenta, D. Clival Metastases: Single-Center Retrospective Case Series and Literature Review. J. Clin. Med. 2024, 13, 2580. https://doi.org/10.3390/jcm13092580
Carretta A, Sollini G, Guaraldi F, Rustici A, Magnani M, Asioli S, Faustini-Fustini M, Pasquini E, Zoli M, Mazzatenta D. Clival Metastases: Single-Center Retrospective Case Series and Literature Review. Journal of Clinical Medicine. 2024; 13(9):2580. https://doi.org/10.3390/jcm13092580
Chicago/Turabian StyleCarretta, Alessandro, Giacomo Sollini, Federica Guaraldi, Arianna Rustici, Marcello Magnani, Sofia Asioli, Marco Faustini-Fustini, Ernesto Pasquini, Matteo Zoli, and Diego Mazzatenta. 2024. "Clival Metastases: Single-Center Retrospective Case Series and Literature Review" Journal of Clinical Medicine 13, no. 9: 2580. https://doi.org/10.3390/jcm13092580