The bath-plug closure of anterior skull base cerebrospinal fluid leaks

BackgroundThis study presents the technique and results of cerebrospinal fluid (CSF) leak closure by placement of a fat plug on the intracranial surface of the dura. A prospective cohort study of all consecutive patients undergoing endoscopic closure of an anterior skull base CSF leak using the bath-plug technique was performed at a tertiary care center.MethodsThirty-three patients presented with CSF leaks: 6 were traumatic, 7 were spontaneous, 9 were iatrogenic, and 10 were associated with a meningoencephalocele. The average age of the patients was 40 years and the male-to-female ratio was 1.2:1. All patients underwent the bath-plug technique for closure of CSF leaks. The surgical technique was presented.ResultsThirty-one of the 33 patients had a successful primary closure of their CSF leak with 2 patients requiring a repeat procedure. After an average of 28 months follow-up, there were no recurrent leaks in any of the patients. This gives a primary closure success rate of 94% and a secondary closure rate of 100%.ConclusionThe bath-plug technique for closure of anterior skull base CSF leaks was a reliable technique for a large variety of causes

Woodpecker pecking: how woodpeckers avoid brain injury

Woodpeckers are capable of repeated pecking on a tree at remarkably high decelerations (on the order of 10 000 m s−2 or 1000 g). In this paper, I re-examine previous studies of pecking and scaling effects in brain injury. I find that there are three keys to woodpeckers' ability to withstand high decelerations: their small size, which reduces the stress on the brain for a given acceleration; the short duration of the impact, which increases the tolerable acceleration; and the orientation of the brain within the skull, which increases the area of contact between the brain and the skull