Q: What are the criteria for cerebrospinal fluid tests to be met for a second surgery after a post-operative infection and a second bypass surgery? Answer: As far as I know, many of our patients who have been referred from outside hospitals have described the experience of having more than two surgeries based on the reference of cerebrospinal fluid tests in the literature or textbooks and still failing, which means that the cerebrospinal fluid test criteria are still not reliable. I have answered this question several times: the closer the cerebrospinal fluid is to normal and the longer the duration or days of normalcy, the higher the success of subsequent shunts, and there is no absolute reference. Recently we received a case of recurrent intracranial infections after craniotomy of a craniopharyngioma after removal of the pterygoid plateau. After several times of normal cerebrospinal fluid for more than a month, the shunt failed and was finally found to be caused by the resetting of the cranial flap into dead bone with abscess formation around it and intracranial filling with bone wax and biogel. Q: In a friend’s case, a patient with cryptococcal meningitis was given domestic liposomal amphotericin B. However, after administration, the patient developed hematuria, so the dose was not increased, but the disease has progressed and is considered poorly controlled. What should I do in this case? Should we combine fluconazole or flucytosine or continue to increase the dose to treat the cryptococcal infection first? Also can intrathecal AMB be, and can intrathecal AMB liposomes be? Answer: We have been puzzling for a while, if it is indeed a drug-induced complication, you can consider changing the drug, if the drug sensitivity shows only amphotericin B, you can start with smaller small doses and gradually increase the dosage, we have had cases of this. Never be too hasty, always start with a very low dose and always increase slowly as directed, otherwise it will cause more and more difficult problems to deal with. In addition, please refer to some experience: in most cases, simple fungal intracranial infections do not cause significant temperature increase. There are many reports from abroad on the reduction of intrathecal administration, but my experience states that intrathecal injection of antifungal drugs is ineffective (my personal experience only). Q: After performing a lateral ventricular puncture with drainage only, the chance of complicating infection is significantly greater in the soft access group than in the hard access group. I would like to ask you what you think about the chances of complications of infection in these two types of channels and what are the reasons? Answer: Based on the experience of our patients, and the principle of treatment, I can say that the difference between the two methods will not be significant, and if it is just a statistical difference, I think it is also not clinically meaningful in practice, because the two methods are actually one method. We receive many patients every year with hose drainage and shunt infections, and also patients with hard tube drainage. I can only say that both methods are not good methods, and it is meaningless to compare them, because such a difference would give a false impression or create a misconception, which is equivalent to saying “soft channel drainage does not cause intracranial infection”.