World Neurosurg
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Case Reports
Rapid and progressive venous thrombosis after occlusion of high-flow arteriovenous fistula.
Cerebral venous thrombosis developing after surgical or endovascular obliteration of arteriovenous fistula (AVF) is a rare but devastating complication that has not been adequately reported. ⋯ Rapid occlusion of a high-flow AVF resulting in significant venous stasis can precipitate thrombosis of the venous system distal to the fistulous point. In the presence of large venous pouches and significant venous stasis, strict therapeutic anticoagulation may be required to prevent cerebral venous thrombosis. Therapeutic anticoagulation, though feasible following endovascular treatment, may prove particularly challenging after open surgical interventions given the risk of hemorrhagic complications.
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This report was conceived as a contribution to the national debate regarding U.S. health care (HC) and as a means of explaining the challenges facing U.S. HC to the international readers of WORLD NEUROSURGERY. ⋯ The reversal of the current paradigm of escalating cost of U.S. HC will require extraordinary leadership across the entire spectrum of HC delivery. It is concluded that neither the Affordable Care Act nor the Path to Prosperity will succeed unless the escalating cost of U.S. HC is reversed. It is hoped that this report contributes to that end.
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Recently, somatosensory cortex stimulation has been proposed as a possible treatment for neuropathic deafferentation pain, based on a simple 4-step concept: (1) pain is associated with increased activity in the somatosensory cortex, (2) allodynia-evoked blood-oxygen-level dependence functional magnetic resonance imaging (fMRI) activation depicts the area involved in the pain, (3) if fMRI-guided, neuronavigation-based transcranial magnetic stimulation can transiently suppress the pain, then (4) an extradural electrode can be implanted targeting the same area. ⋯ Combining fMRI and PET scanning can potentially demonstrate continuing map plasticity under progressive somatosensory deafferentation. The functional imaging data can be used as target for pathophysiology-based somatosensory cortex stimulation.
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Gonadotroph pituitary adenomas are common, but the overwhelming majority are classified as nonfunctioning adenomas. Approximately one-third secrete follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH), resulting in an increase in serum levels; however, the sex hormone levels are typically not elevated and the secreted gonadotropin hormones are thought to be biologically inactive. Rarely, gonadotroph adenomas induce an ovarian hyperstimulation syndrome in females. In males, an increase in the testosterone level is even rarer. The authors report the case of a male patient with a gonadotroph pituitary adenoma causing hypersecretion of testosterone and review the medical literature. ⋯ Gonadotroph adenomas are considered a type of nonfunctioning pituitary tumors, because the commonly associated increase in serum FSH and LH does not typically result in elevated sex hormone levels. Herein, we report a rare case of high testosterone level caused by a gonadotroph adenoma successfully treated with transsphenoidal resection. Interestingly, in adult males, the increase in sex hormones does not seem to lead to a recognizable clinical syndrome, and the clinical presentation remains similar to that of nonfunctioning adenomas.