World Neurosurg
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Troubleshooting of deep brain stimulators (DBSs, Activa SC/PC/RC Medtronic PLC, Minneapolis, Minnesota, USA) sometimes results in a decision to replace a tunneled stretch-coil extension cable. We present a simple technique to accomplish this atraumatically without a tunneling tool. ⋯ A less expensive and faster technique for passing pulse generator extension cables may be the use of a sternal wire. Using the described technique, pulse generators may be quickly and safely adjusted from side to side and site to site as the clinical situation dictates.
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Indocyanine green videoangiography (ICG-VA) after clipping can be misleading in evaluating aneurysm exclusion when the dye is injected before clipping. This is due to indocyanine green (ICG) entrapment by the clip blades in the aneurysm dome. ⋯ The "ICG entrapment sign" can be used intraoperatively as an indirect sign of excluded aneurysm and can be helpful in the decision-making process for aneurysm treatment when ICG-VA is performed before clipping.
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Primary lactotroph disinhibition, or stalk effect, occurs when mechanical compression of the pituitary stalk disrupts the tonic inhibition by dopamine released by the hypothalamus. The resolution of pituitary stalk effect-related hyperprolactinemia postoperatively has not been studied in a large cohort of patients. We performed a retrospective review to investigate the time course of recovery of lactotroph disinhibition after transsphenoidal surgery. ⋯ Transsphenoidal surgery can provide durable normalization of serum prolactin levels and related symptoms caused by pituitary stalk compression-related lactotroph disinhibition.
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Traumatic brain injury (TBI) is a critical public health problem worldwide with a significant socioeconomic burden. Although improved safety regulations in high-income countries have resulted in a decline in traffic-related TBI, the incidence of TBI in low-income countries is on the rise. We illustrate the trends and factors involved in TBI in a large Cambodian governmental hospital in Phnom Penh. In addition, suggestions for improvement of the country's road traffic safety are discussed. ⋯ Our study suggests prevention and management of TBIs can have a measurable public health impact in Cambodia. Initiative examples include helmet safety awareness campaigns, stricter penalties, improvement of prehospital care, and more efficient triage. A high proportion of unhelmeted motorcycle accidents correlates with an increase in epidural hematomas.