Skip to main content
Erschienen in: Neurosurgical Review 1/2012

01.01.2012 | Original Article

Anterior inferior cerebellar artery aneurysms: six cases and a review of the literature

verfasst von: Xin Li, Dong Zhang, Jizong Zhao

Erschienen in: Neurosurgical Review | Ausgabe 1/2012

Einloggen, um Zugang zu erhalten

Abstract

Aneurysms of the anterior inferior cerebellar artery are rare. Six cases of anterior inferior cerebellar artery (AICA) aneurysms treated at one center are presented. The six cases of AICA aneurysms were surgically treated. The clinical features, surgical process, complications, and follow-up are demonstrated. Six patients with six AICA aneurysms were presented including one AVM accompanied aneurysm and one giant aneurysm. Five aneurysms had ruptured, one was unruptured. Five patients presented with subarachnoid hemorrhage (SAH) including two with intraventricular hemorrhaging and one with an intraparenchymal hematoma. One aneurysm was proximal, two were distal, and three were meatal. All cases were treated surgically. Retrosigmoid and far-lateral craniectomy were included. Navigation was accomplished through intraoperative ultrasound and fluorescent angiography. Resection of the aneurysm after clipping was significant. The most common postoperative deficit involved the cranial nerves in four patients. Follow-up was available for all patients for a mean of 68 months. SAH is the most common presentation. The relationship between the aneurysms and the meatus is an important factor for neurological dysfunction. 3D-CTA and MRA may be considered as diagnostic adjuncts. Several special surgical techniques used in our cases are worth noting. Endovascular therapy for AICA aneurysms is in the process of development and should be reserved for special cases.
Literatur
1.
Zurück zum Zitat Duvoisin RC, Yahr MD (1965) Posterior fossa aneurysms. Neurology 15:231–241PubMed Duvoisin RC, Yahr MD (1965) Posterior fossa aneurysms. Neurology 15:231–241PubMed
2.
Zurück zum Zitat Investigators International Study of Unruptured Intracranial Aneurysms (1998) Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 339:1725–1733CrossRef Investigators International Study of Unruptured Intracranial Aneurysms (1998) Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 339:1725–1733CrossRef
3.
Zurück zum Zitat McDonald C, Korb M (1939) Intracranial aneurysms. Arch Neurol Psychiatry 42:298–328 McDonald C, Korb M (1939) Intracranial aneurysms. Arch Neurol Psychiatry 42:298–328
4.
Zurück zum Zitat Weibel J, Fields WS, Campos RJ (1967) Aneurysms of the posterior cervicocranial circulation: clinical and angiographic considerations. J Neurosurg 26:223–234PubMedCrossRef Weibel J, Fields WS, Campos RJ (1967) Aneurysms of the posterior cervicocranial circulation: clinical and angiographic considerations. J Neurosurg 26:223–234PubMedCrossRef
5.
Zurück zum Zitat Kamano S, Kirino T, Mizuno S (1986) Intrameatal aneurysm. Neurochirurgia (Stuttg) 29:28–30 Kamano S, Kirino T, Mizuno S (1986) Intrameatal aneurysm. Neurochirurgia (Stuttg) 29:28–30
6.
Zurück zum Zitat Locksley HB (1966) Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations: based on 6368 cases in the cooperative study. J Neurosurg 25:219–239PubMedCrossRef Locksley HB (1966) Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations: based on 6368 cases in the cooperative study. J Neurosurg 25:219–239PubMedCrossRef
7.
Zurück zum Zitat Locksley HB, Sahs AL, Knowler L (1966) Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section II. General survey of cases in the central registry and characteristics of the sample population. J Neurosurg 24:922–932PubMedCrossRef Locksley HB, Sahs AL, Knowler L (1966) Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section II. General survey of cases in the central registry and characteristics of the sample population. J Neurosurg 24:922–932PubMedCrossRef
8.
Zurück zum Zitat Péter B, Sipos L, Vajda J (1996) Aneurysm of the internal auditory artery: our experience and review of the literature. Acta Neurochir (Wien) 138:1157–1162CrossRef Péter B, Sipos L, Vajda J (1996) Aneurysm of the internal auditory artery: our experience and review of the literature. Acta Neurochir (Wien) 138:1157–1162CrossRef
9.
Zurück zum Zitat Chen ZP (1990) Anterior inferior cerebellar artery aneurysm: report of two cases. Zhonghua Wai Ke Za Zhi 28:490–511 [in Chinese]PubMed Chen ZP (1990) Anterior inferior cerebellar artery aneurysm: report of two cases. Zhonghua Wai Ke Za Zhi 28:490–511 [in Chinese]PubMed
10.
Zurück zum Zitat Crockard HA, Koksel T, Watkin N (1991) Transoral transclival clipping of anterior inferior cerebellar artery aneurysm using new rotating applier: technical note. J Neurosurg 75:483–485PubMedCrossRef Crockard HA, Koksel T, Watkin N (1991) Transoral transclival clipping of anterior inferior cerebellar artery aneurysm using new rotating applier: technical note. J Neurosurg 75:483–485PubMedCrossRef
11.
Zurück zum Zitat Gruber A, Killer M, Bavinzski G, Richling B (1999) Clinical and angiographic results of endosaccular coiling treatment of giant and very large intracranial aneurysms: a 7-year, single-center experience. Neurosurgery 45:793–803PubMedCrossRef Gruber A, Killer M, Bavinzski G, Richling B (1999) Clinical and angiographic results of endosaccular coiling treatment of giant and very large intracranial aneurysms: a 7-year, single-center experience. Neurosurgery 45:793–803PubMedCrossRef
12.
Zurück zum Zitat Ildan F, Gocer AI, Bagdatoglu H, Uzuneyupoglu Z, Tuna M, Cetinalp E (1996) Isolated trigeminal neuralgia secondary to distal anterior inferior cerebellar artery aneurysm. Neurosurg Rev 19:43–46PubMedCrossRef Ildan F, Gocer AI, Bagdatoglu H, Uzuneyupoglu Z, Tuna M, Cetinalp E (1996) Isolated trigeminal neuralgia secondary to distal anterior inferior cerebellar artery aneurysm. Neurosurg Rev 19:43–46PubMedCrossRef
13.
Zurück zum Zitat Kyoshima K, Matsuda M, Handa J (1995) Cerebral aneurysm of the distal anterior inferior cerebellar artery: case report. Nippon Geka Hokan 64:139–145PubMed Kyoshima K, Matsuda M, Handa J (1995) Cerebral aneurysm of the distal anterior inferior cerebellar artery: case report. Nippon Geka Hokan 64:139–145PubMed
14.
Zurück zum Zitat Lawton MT, Daspit CP, Spetzler RF (1997) Technical aspects and recent trends in the management of large and giant midbasilar artery aneurysms. Neurosurgery 41:513–521PubMed Lawton MT, Daspit CP, Spetzler RF (1997) Technical aspects and recent trends in the management of large and giant midbasilar artery aneurysms. Neurosurgery 41:513–521PubMed
15.
Zurück zum Zitat Mizushima H, Kobayashi N, Yoshiharu S et al (1999) Aneurysm of the distal anterior inferior cerebellar artery at the medial branch: a case report and review of the literature. Surg Neurol 52:137–142PubMedCrossRef Mizushima H, Kobayashi N, Yoshiharu S et al (1999) Aneurysm of the distal anterior inferior cerebellar artery at the medial branch: a case report and review of the literature. Surg Neurol 52:137–142PubMedCrossRef
16.
Zurück zum Zitat Nader S, Phiroz T, Albert CL, Michael TL (2008) The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular ear. Neurosurgery 62:1236–1253CrossRef Nader S, Phiroz T, Albert CL, Michael TL (2008) The current role of microsurgery for posterior circulation aneurysms: a selective approach in the endovascular ear. Neurosurgery 62:1236–1253CrossRef
17.
Zurück zum Zitat Nishi S, Taki W, Nakahara I et al (1996) Embolization of cerebral aneurysms with a liquid embolus, EVAL mixture: report of three cases. Acta Neurochir (Wien) 138:294–300CrossRef Nishi S, Taki W, Nakahara I et al (1996) Embolization of cerebral aneurysms with a liquid embolus, EVAL mixture: report of three cases. Acta Neurochir (Wien) 138:294–300CrossRef
18.
Zurück zum Zitat Oana K, Murakami T, Beppu T, Yamaura A, Kanaya H (1991) Aneurysm of the distal anterior inferior cerebellar artery unrelated to the cerebellopontine angle: case report. Neurosurgery 28:899–903PubMedCrossRef Oana K, Murakami T, Beppu T, Yamaura A, Kanaya H (1991) Aneurysm of the distal anterior inferior cerebellar artery unrelated to the cerebellopontine angle: case report. Neurosurgery 28:899–903PubMedCrossRef
19.
Zurück zum Zitat Saito A, Ezura M, Takahashi A, Yoshimoto T (2000) An arterial dissection of the distal anterior inferior cerebellar artery treated by endovascular therapy. No Shinkei Geka 28:269–274 [in Japanese]PubMed Saito A, Ezura M, Takahashi A, Yoshimoto T (2000) An arterial dissection of the distal anterior inferior cerebellar artery treated by endovascular therapy. No Shinkei Geka 28:269–274 [in Japanese]PubMed
20.
Zurück zum Zitat Spallone A, De Santis S, Giuffre R (1995) Peripheral aneurysms of the anterior inferior cerebellar artery: case report and review of the literature. Br J Neurosurg 9:537–541PubMedCrossRef Spallone A, De Santis S, Giuffre R (1995) Peripheral aneurysms of the anterior inferior cerebellar artery: case report and review of the literature. Br J Neurosurg 9:537–541PubMedCrossRef
21.
Zurück zum Zitat Suzuki K, Meguro K, Wadw M, Fujita K, Nose T (1999) Embolization of a ruptured aneurysm of the distal anterior inferior cerebellar artery: case report and review of the literature. Surg Neurol 51:509–512PubMedCrossRef Suzuki K, Meguro K, Wadw M, Fujita K, Nose T (1999) Embolization of a ruptured aneurysm of the distal anterior inferior cerebellar artery: case report and review of the literature. Surg Neurol 51:509–512PubMedCrossRef
22.
Zurück zum Zitat Vincentelli F, Caruso G, Licastro G, Rabehanta P (1998) Association between an aneurysm of the anterior inferior cerebral artery and an arteriovenous malformation fed by the same artery. J Neurosurg Sci 42:41–45PubMed Vincentelli F, Caruso G, Licastro G, Rabehanta P (1998) Association between an aneurysm of the anterior inferior cerebral artery and an arteriovenous malformation fed by the same artery. J Neurosurg Sci 42:41–45PubMed
23.
Zurück zum Zitat Woischneck D, Hussein S (1991) The anterior inferior cerebellar artery (AICA): clinical and radiological significance. Neurosurg Rev 14:293–295PubMedCrossRef Woischneck D, Hussein S (1991) The anterior inferior cerebellar artery (AICA): clinical and radiological significance. Neurosurg Rev 14:293–295PubMedCrossRef
24.
Zurück zum Zitat Drake CG, Peerless SJ, Hernesniemi JA (1995) Surgery of vertebrobasilar aneurysms: London, Ontario experience on 1767 patients. Springer, New York Drake CG, Peerless SJ, Hernesniemi JA (1995) Surgery of vertebrobasilar aneurysms: London, Ontario experience on 1767 patients. Springer, New York
25.
Zurück zum Zitat Gonzalez LF, Alexander MJ, McDougall CG, Spetzler RF (2004) Anteroinferior cerebellar artery aneurysms: surgical approaches and outcomes—a review of 34 cases. Neurosurgery 5:1025–1035CrossRef Gonzalez LF, Alexander MJ, McDougall CG, Spetzler RF (2004) Anteroinferior cerebellar artery aneurysms: surgical approaches and outcomes—a review of 34 cases. Neurosurgery 5:1025–1035CrossRef
26.
Zurück zum Zitat Rhoton AL (2000) The posterior cranial fossa: microsurgical anatomy and surgical approaches. Neurosurgery 47(Suppl):29–68CrossRef Rhoton AL (2000) The posterior cranial fossa: microsurgical anatomy and surgical approaches. Neurosurgery 47(Suppl):29–68CrossRef
27.
Zurück zum Zitat Yamakawa H, Hattori T, Tanigawara T, Sahashi Y, Ohkuma A (2004) Intracanalicular aneurysm at the meatal loop of the distal anterior inferior cerebellar artery: a case report and review of the literature. Surg Neurol 1:82–88, discussion 88CrossRef Yamakawa H, Hattori T, Tanigawara T, Sahashi Y, Ohkuma A (2004) Intracanalicular aneurysm at the meatal loop of the distal anterior inferior cerebellar artery: a case report and review of the literature. Surg Neurol 1:82–88, discussion 88CrossRef
28.
Zurück zum Zitat Cronqvist S, Troupp H (1996) Intracranial arteriovenous malformation and arterial aneurysm on the same patient. Acta Neurol Scand 42:307–316CrossRef Cronqvist S, Troupp H (1996) Intracranial arteriovenous malformation and arterial aneurysm on the same patient. Acta Neurol Scand 42:307–316CrossRef
29.
Zurück zum Zitat Rohde V, Spangenberg P, Mayfrank L, Reinges M, Gilsbach JM, Coenen VA (2005) Advanced neuronavigation in skull base tumors and vascular lesions. Minim Invasive Neurosurg 50:742–749 Rohde V, Spangenberg P, Mayfrank L, Reinges M, Gilsbach JM, Coenen VA (2005) Advanced neuronavigation in skull base tumors and vascular lesions. Minim Invasive Neurosurg 50:742–749
30.
Zurück zum Zitat Akyüz M, Tuncer R (2005) Multiple anterior inferior cerebellar artery aneurysms associated with an arteriovenous malformation: case report. Surg Neurol 64(Suppl 2):S106–S108PubMedCrossRef Akyüz M, Tuncer R (2005) Multiple anterior inferior cerebellar artery aneurysms associated with an arteriovenous malformation: case report. Surg Neurol 64(Suppl 2):S106–S108PubMedCrossRef
31.
Zurück zum Zitat Drake CG, Friedman AH, Peerless SJ (1986) Posterior fossa arteriovenous posterior fossa arteriovenous. J Neurosurg 64:1–10PubMedCrossRef Drake CG, Friedman AH, Peerless SJ (1986) Posterior fossa arteriovenous posterior fossa arteriovenous. J Neurosurg 64:1–10PubMedCrossRef
32.
Zurück zum Zitat Guzman R, Grady MS (1999) An intracranial aneurysm on the feeding artery of a cerebellar hemangioblastoma: case report. J Neurosurg 91:136–138PubMedCrossRef Guzman R, Grady MS (1999) An intracranial aneurysm on the feeding artery of a cerebellar hemangioblastoma: case report. J Neurosurg 91:136–138PubMedCrossRef
33.
Zurück zum Zitat Kikuchi K, Kamisato N, Sasanuma J, Watanabe K, Kowada M (1990) Trigeminal neuralgia associated with posterior fossa arteriovenous malformation and aneurysm fed by the same artery. Case report. Neurol Med Chir (Tokyo) 30:918–921CrossRef Kikuchi K, Kamisato N, Sasanuma J, Watanabe K, Kowada M (1990) Trigeminal neuralgia associated with posterior fossa arteriovenous malformation and aneurysm fed by the same artery. Case report. Neurol Med Chir (Tokyo) 30:918–921CrossRef
34.
Zurück zum Zitat Menovsky T, André GJ, Bartels RH (2002) Aneurysm of the anterior inferior cerebellar artery associated with high-flow lesion: report of two cases and review of literature. J Clin Neurosci 9:207–211PubMedCrossRef Menovsky T, André GJ, Bartels RH (2002) Aneurysm of the anterior inferior cerebellar artery associated with high-flow lesion: report of two cases and review of literature. J Clin Neurosci 9:207–211PubMedCrossRef
35.
Zurück zum Zitat Thompson RC, Steinberg GK, Levy RP, Marks MP (1998) The management of patients with arteriovenous malformation and associated intracranial aneurysms. Neurosurgery 43:202–211PubMedCrossRef Thompson RC, Steinberg GK, Levy RP, Marks MP (1998) The management of patients with arteriovenous malformation and associated intracranial aneurysms. Neurosurgery 43:202–211PubMedCrossRef
36.
Zurück zum Zitat Lee SH, Koh JS, Bang JS, Kim GK (2009) A case of ruptured peripheral aneurysm of the anterior inferior cerebellar artery associated with an arteriovenous malformation a less invasive image guided transcortical approach. J Korean Neurosurg Soc 46:577–580PubMedCrossRef Lee SH, Koh JS, Bang JS, Kim GK (2009) A case of ruptured peripheral aneurysm of the anterior inferior cerebellar artery associated with an arteriovenous malformation a less invasive image guided transcortical approach. J Korean Neurosurg Soc 46:577–580PubMedCrossRef
37.
Zurück zum Zitat Figueiredo EG, Gomes MQ, Brito-Neto RV, Paiva WS, Teixeira MJ (2008) A giant partially thrombosed AICA aneurysm. Arq Neuropsiquiatr 3A:566–568CrossRef Figueiredo EG, Gomes MQ, Brito-Neto RV, Paiva WS, Teixeira MJ (2008) A giant partially thrombosed AICA aneurysm. Arq Neuropsiquiatr 3A:566–568CrossRef
38.
Zurück zum Zitat Pritz MB (1993) Aneurysms of the anterior inferior cerebellar artery. Acta Neurochir (Wien) 120:12–19CrossRef Pritz MB (1993) Aneurysms of the anterior inferior cerebellar artery. Acta Neurochir (Wien) 120:12–19CrossRef
39.
Zurück zum Zitat Dalley RW, Robertson WD, Nugent RA, Durity FA (1986) Computed tomography of anterior inferior cerebellar artery aneurysm mimicking an acoustic neuroma. J Comput Assist Tomogr 10:881–894PubMedCrossRef Dalley RW, Robertson WD, Nugent RA, Durity FA (1986) Computed tomography of anterior inferior cerebellar artery aneurysm mimicking an acoustic neuroma. J Comput Assist Tomogr 10:881–894PubMedCrossRef
40.
Zurück zum Zitat Zager EL, Shaver EG, Hurst RW, Flamm ES (2002) Distal anterior inferior cerebellar artery aneurysms. Report of four cases. J Neurosurg 3:692–696 Zager EL, Shaver EG, Hurst RW, Flamm ES (2002) Distal anterior inferior cerebellar artery aneurysms. Report of four cases. J Neurosurg 3:692–696
41.
Zurück zum Zitat Iwanaga S, Shrier DA, Okawara SH, Numaguchi Y (1999) Value of CT angiography in the evaluation of a peripheral anterior inferior cerebellar artery aneurysm: case report. Clin Imaging 23:77–80PubMedCrossRef Iwanaga S, Shrier DA, Okawara SH, Numaguchi Y (1999) Value of CT angiography in the evaluation of a peripheral anterior inferior cerebellar artery aneurysm: case report. Clin Imaging 23:77–80PubMedCrossRef
42.
Zurück zum Zitat Bambakidis NC, Manjila S, Dashti S, Tarr R, Megerian CA (2009) Management of anterior inferior cerebellar artery aneurysms: an illustrative case and review of literature. Neurosurg Focus 26(E6):1–8 Bambakidis NC, Manjila S, Dashti S, Tarr R, Megerian CA (2009) Management of anterior inferior cerebellar artery aneurysms: an illustrative case and review of literature. Neurosurg Focus 26(E6):1–8
43.
Zurück zum Zitat Nishimoto A, Fujimoto S, Tsuchimoto S et al (1983) Anterior inferior cerebellar artery aneurysm. Report of three cases. J Neurosurg 59:697–702PubMedCrossRef Nishimoto A, Fujimoto S, Tsuchimoto S et al (1983) Anterior inferior cerebellar artery aneurysm. Report of three cases. J Neurosurg 59:697–702PubMedCrossRef
44.
Zurück zum Zitat Andaluz N, Pensak ML, Zuccarello M (2005) Multiple, peripheral aneurysms of the anterior inferior cerebellar artery. Acta Neurochir (Wien) 4:419–422, discussion 422CrossRef Andaluz N, Pensak ML, Zuccarello M (2005) Multiple, peripheral aneurysms of the anterior inferior cerebellar artery. Acta Neurochir (Wien) 4:419–422, discussion 422CrossRef
45.
Zurück zum Zitat Peluso JP, Van Rooij WJ, Sluzewski M, Beute GN (2007) Distal aneurysms of cerebellar arteries: incidence, clinical presentation, and outcome of endovascular parent vessel occlusion. Am J Neuroradiol 28:1573–1578PubMedCrossRef Peluso JP, Van Rooij WJ, Sluzewski M, Beute GN (2007) Distal aneurysms of cerebellar arteries: incidence, clinical presentation, and outcome of endovascular parent vessel occlusion. Am J Neuroradiol 28:1573–1578PubMedCrossRef
46.
Zurück zum Zitat Ishii D, Takechi A, Shinagawa K, Sogabe T (2010) Endovascular treatment for ruptured anterior inferior cerebellar artery aneurysm. Neurol Med Chir 50:396–399CrossRef Ishii D, Takechi A, Shinagawa K, Sogabe T (2010) Endovascular treatment for ruptured anterior inferior cerebellar artery aneurysm. Neurol Med Chir 50:396–399CrossRef
Metadaten
Titel
Anterior inferior cerebellar artery aneurysms: six cases and a review of the literature
verfasst von
Xin Li
Dong Zhang
Jizong Zhao
Publikationsdatum
01.01.2012
Verlag
Springer-Verlag
Erschienen in
Neurosurgical Review / Ausgabe 1/2012
Print ISSN: 0344-5607
Elektronische ISSN: 1437-2320
DOI
https://doi.org/10.1007/s10143-011-0338-1

Weitere Artikel der Ausgabe 1/2012

Neurosurgical Review 1/2012 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.