Many variables appear to impact the mortality rate within the neurosurgical population. The authors' observations have illuminated some of the reasons why: the data are elusive, documentation is variable, and the modes of statistical analysis are questionable. The first step in addressing this issue is to identify that there is a problem. The authors believe that this study has done so. Presently there is no definitive or reliable source for rating the quality of overall neurosurgical care, nor is there a good and complete source for understanding the quality of neurosurgical care in the US. It is important to view these results as the initial steps to a better understanding of patient outcomes, their measures, and their impact on neurosurgical practice.

SUMMARY Adenosine 3',5'-monophosphate (cyclic AMP), 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA)

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Lumboperitoneal (LP) shunting is considered an effective method of cerebrospinal fluid (CSF) diversion in patients with idiopathic intracranial hypertension (IIH). Confirmation of flow out of the distal portion of the catheter once in its final position can be difficult, especially in obese individuals. A new technique to improve placement of the peritoneal catheter involves laparoscopic catheter insertion. We performed laparoscopic-assisted LP shunt placement for IIH on four patients. Improvement in preoperative IIH symptomatology was noted in all patients. No laparoscopic-procedure-related complications were noted. No problems were noted in shunt functioning and none of the shunts have required revision surgery at last follow-up. LP shunt related complications were noted in two of the four patients. Complications included bilateral lower extremity lumbar radiculopathy in one patient that resolved with a short course of gabapentin, spinal headache in one patient that resolved with bed rest and fluids, and development of a small intracranial subdural hygroma without mass effect in one patient that is asymptomatic and being followed without clinical consequence. Laparoscopic insertion of the abdominal catheter is safe and effective and does not appear to independently cause an increased risk of complications.

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