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Objective The diversion of cerebrospinal fluid (CSF) has been widely used in the prevention and treatment of CSF fistulae. A common method is the use of a lumbar drainage system. Although it is effective, several serious complications can develop, which can be avoided by regulating the flow of CSF with a standard intravenous infusion pump. Technique We present a simple, inexpensive, and accurate method of flow-controlled lumbar subarachnoid drainage that minimizes patient discomfort and the unpredictability of a gravity-dependent system. This system uses a standard lumbar drain connected to an intravenous infusion pump to provide drainage of CSF in a constant and predictable manner. Results A total of 42 patients from two institutions were treated with this method. CSF fistulae occurred secondary to trauma in 9 patients, after spinal surgery in 11 patients, after transsphenoidal surgery in 10 patients, and after cranial base surgery in 12 patients. Resolution of the fistula was attained in 36 of 42 patients. There were no deaths, no cases of deep venous thrombosis, and no incidence of meningitis. One patient developed tension pneumocephalus, and two patients developed headache with nausea and vomiting. All patients were ambulatory, and only three patients required narcotic analgesia for headaches. Conclusion Pump-regulated lumbar subarachnoid drainage is safe and effective in the treatment of CSF fistulae, as reported elsewhere in the literature. The advantage of this method is that the drainage of CSF can be carefully controlled and titrated in a predictable fashion. Because the system is independent of gravity to produce drainage of CSF, patients are not confined to bed and serious complications of overdrainage can be avoided.

HIPPOCRATIC WORKS LEND themselves still today to the modern physician for further analysis of his approach to the diagnosis and treatment of various pathological conditions. We present an attempt to systematize his methodology regarding the management of head trauma and present it in the format of a modern-era algorithm.

Objective To describe the technique of temporal lobotomy and demonstrate that it may produce results equivalent to anterior temporal lobectomy in the control of drug-resistant complex partial seizures of anterior temporal lobe origin. Methods Patient selection and evaluation was similar to that for other patients undergoing anterior temporal lobectomy, with the exception that the 10 selected patients all demonstrated extensive lobar or hemispheral atrophy on magnetic resonance imaging or computed tomographic scans. The lobotomy technique involved posterior and superior disconnection, each of which was broken down into lateral and mesial components. Results At last follow-up, seven patients were seizure-free, one had rare seizures, and two had a less than 90% decrease in seizures. These outcomes are similar to those in our overall temporal lobectomy series. One patient who underwent left-sided temporal lobotomy had a speech fluency deficit postoperatively. Conclusion Temporal lobotomy seems to be an effective disconnective procedure in the treatment of drug-resistant temporal lobe epilepsy. Larger series will be needed to better define its role in the management of this condition.