✓ The authors report the details of the successful treatment of 11 of 12 patients with postoperative cerebrospinal fluid fistulas. Continuous lumbar or ventricular fluid drainage was used.

Study design: Retrospective chart review. Objective: To identify and describe factors that influence discharge location -extended care unit (nursing home) or other (private home, group home, or acute care) -following rehabilitation for individuals with a new high lesion spinal cord injury (SCI) (C1-C4) in British Columbia, Canada. Setting: GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada. Methods: Eligible clients were adults admitted to the GF Strong Rehabilitation Centre Spinal Cord Program between 1994 and 2003, with a new C1-4 lesion (traumatic or nontraumatic), and an ASIA score of A-C at time of discharge. Medical charts of 52 individuals were reviewed and data regarding individual characteristics, health-related characteristics, personal context, hospitalization factors, health resources, and other contextual factors were extracted. Results: In total, 40% of clients were discharged to extended care units post rehabilitation. Seven variables were associated at a univariate level: age, employment at the time of injury, preexisting medical conditions, social support, preinjury living situation, and insurance (worker's compensation or motor vehicle) or private funding for equipment. Four variables were associated at the multivariate level: age, preinjury living situation, and insurance or private funding for equipment. Conclusion: A range of individual, health-related, family and social policy variables influence discharge location following rehabilitation for high lesion SCI in British Columbia. The unique combination of variables presented by each individual should be considered by the rehabilitation team in the discharge planning process. Sponsorship: This study was funded by the BC Neurotrauma Fund.

Six patients with myelomeningocele and the Arnold-Chiari malformation developed cricopharyngeal achalasia and lower cranial nerve deficits. Diagnosis is established by cine-esophagram. Distortion of the brain stem or cranial nerves secondary to the Arnold-Chiari malformation may produce the autonomic imbalance necessary for cricopharyngeal achalasia. Treatment is supportive and includes verification of cerebral spinal fluid shunt function. Suboccipital craniectomy may reverse progressive lower cranial nerve deficits and reduce cricopharyngeus spasm. Cricopharyngeal myotomy may be considered when the cranial nerve deficits and cricopharyngeal achalasia are fixed, irreversible, and continue to cause disability.

This study examines cost and outcome in a series of 50 low birthweight infants who suffered severe intraventricular-periventricular hemorrhage and subsequently required ventriculoperitoneal shunting. Although nearly one third of these children might achieve some degree of self-sufficiency, a cost-benefit analysis in this shunted population is not encouraging.

Twenty-six patients have had cranio-peritoneal shunts placed using a new introducer allowing the combination of frameless stereotaxy and neuroendoscopy and placement of a one-piece shunt. Operating times have been acceptable, complication rates have been low, and shunt placement has been accurate in this series.