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Background: Posttraumatic spinal cerebrospinal fluid leak (CSFL) without neurological deficit is a rare entity. Historically, the first-line treatment is a nonsurgical approach, which includes Trendelenburg positioning, carbonic anhydrase inhibitor (acetazolamide), and subarachnoid catheter, with a high successful rate of leak correction. However, in some cases, this first-line treatment could fail, being necessary the surgical approach. Case Description: A 23-year-old male with a recent stab wound to his lumbar region, complained of positional headache and fluid outflow through his wound. On physical examination, an active CSFL was detected without evidence of neurologic deficit. Imaging studies showed a CSF collection extending from the right L4 lamina to the subcutaneous tissue. CSF studies revealed bacterial meningitis. The treatment with carbonic anhydrase inhibitors, Trendelenburg position, lumbar subarachnoid catheter, and antibiotics was initiated. Failure of conservative measures prompted a surgical treatment to resolve the CSFL. Intraoperatively, a dura mater defect was identified, and an autologous paravertebral muscle flap was used for water-tight closure of the defect. The patient recovered without further complications and with CSFL resolution. Conclusion: Even though the nonsurgical approach is the first-line of treatment of traumatic CSFL cases, failures can occur. The evidence of a CSF trajectory in imaging studies could be a predictor of treatment failure of the nonsurgical treatment. The surgical treatment as second-line treatment has outstanding results regarding CSFL correction and should be considered when the prediction rate to nonsurgical approach failure is high.

Background Posterior quadrant epilepsy (PCE) is a type of focal epilepsy that originates in the parietal lobe, occipital lobe, and the parietal-occipital border of the temporal lobe, or in any combination of these regions. PCE has a low incidence, but it can cause a great burden in disability-adjusted life years. In this retrospective cohort, patients of all ages with a diagnosis of PCE between 2006 and 2019 were evaluated in a referral center in Bogotá, Colombia. A descriptive analysis of demographic data, clinical history, imaging findings, type of surgery, histopathological diagnosis, outcome, and follow-up was performed using the Engel scale. Methods This study included refractory PCE patients of all ages who were evaluated by the epilepsy surgery group of the Hospital Universitario San Ignacio from 2006 to 2019. Clinical, imaging and surgical variables were obtained from the medical records and analyzed. Results Thirteen patients were included in the study, including 8 males and 5 females.  The mean age of diagnosis was 8.8 years, while the mean age of surgery was 25 years. The most frequent clinical finding was intellectual disability. The most common findings on magnetic resonance imaging were encephalomalacia and gliosis. In 61.5% of the patients, the lateralization of video-EEG matched with brain magnetic resonance imaging alteration. The most frequent types of surgery performed were lobectomies, lesionectomies and cortical resections. Seizure-freedom was achieved in approximately one third of the patients; however, more than half of the patients were free of disabling seizures or had significant improvement after surgery. Conclusions PCE surgery is scarcely performed worldwide, therefore the effectiveness and outcomes are quite variable in the reported literature. In this study, we show that patients with PCE can obtain great benefits in terms of reduction of seizures with a low risk of surgical complications, encouraging the use of this type of procedure in carefully selected patients.