Cerebrospinal fluid leaks following trans-sphenoidal surgery occurred in 6.0% of cases. Nonadenomatous disease and presence of an intraoperative leak were independent predictors of a postoperative leak. Endoscopic re-exploration combined with packing was an effective technique in managing uncomplicated postoperative leaks. In the setting of meningitis and postinfectious hydrocephalus, more invasive techniques such as ventriculoperitoneal shunt may be necessary.

Dura-splitting CCJ decompression in pediatric patients with Chiari I malformation and without syringomyelia is safe, provides good early clinical results, and significantly reduces resource use. A randomized controlled trial of dura-splitting decompression in a uniform population of patients with Chiari I malformation is indicated.

A classification scheme for facial pain syndromes describing seven categories has previously been proposed. Based on this classification scheme and a binomial (yes/no) facial pain questionnaire, we have designed and trained an artificial neural network (ANN) and as an initial feasibility assessment of such an ANN system examined its ability to recognize and correctly diagnose patients with different facial pain syndromes. One hundred patients with facial pain were asked to respond to a facial pain questionnaire at the time of their initial visit. After interview, an independent diagnosis was assigned to each patient. The patients’ responses to the questionnaire and their diagnoses were input to an ANN. The ANN was able to retrospectively predict the correct diagnosis for 95 of 100 patients (95%), and prospectively determine a correct diagnosis of trigeminal neuralgia Type 1 with 84% sensitivity and 83% specificity in 43 new patients. The ability of the ANN to accurately predict a correct diagnosis for the remaining types of facial pain was limited by our clinic sample size and hence less exposure to those categories. This is the first demonstration of the utilization of an ANN to diagnose facial pain syndromes.

Object: This study was performed to evaluate the reliability and utility of using monopolar impedance monitoring for estimation of the location of the thermocouple electrode during a pallidotomy procedure. Methods: In 26 patients, impedance profiles were measured at 2-mm intervals and anatomical boundaries were marked on postoperative MRI studies in 19 patients. The pattern of change in impedance as the electrode was towards the target coordinates in the globus pallidus was studied empirically in relation to MRI-defined anatomy and by electrical stimulations. The pattern of impedance change was of greater reliability than absolute impedance values. A drop in impedance was noted in 10 cases where the electrode entered the putamen or globus pallidus upon exiting the internal capsule, and in 9 of these this drop was measured before or at the distal boundary of the internal capsule. A variable pattern in the region of the base of the globus pallidus was observed, with 10 of 19 cases demonstrating a decrease and 8 cases an increase, consistent with the proximity of a CSF cistern in the former and the ansa lenticularis and optic tract in the latter. Simulations showed that the monopolar electrode was more sensitive to the approach of a boundary than the bipolar electrode. Conclusion: Our measurements and simulations suggest that a monopolar electrode could predict a nearby region of high or low impedance before penetrating it and a trend of decreasing impedance as the distal edge of the globus pallidus is approached.