#25 Comes and Goes

Last night, Madison had her 25th brain surgery. Here’s what happened.

For about the last three weeks, Madison has been complaining of occasional headaches. This also coincided with the spike in Summer temperatures, so we weren’t sure if she was experiencing a shunt issue or a previously demonstrated vulnerability to dehydration. It had been almost seven months since her last surgery, so we scheduled her for an MRI. It was time to do one anyway.

Last Friday, we took her for an MRI and the results were not favorable. Pressure was clearly increased in a couple of areas in her brain. On the top is a image of her brain from last November. On the bottom is an image from last Friday.

You may recall from an earlier posting that the white spaces are fluid collections that do not exist in someone with normal physiology. The big difference between the two is the fluid collection that has appeared on the top left of the recent image. This indicates the catheter on the right front of her head may not be working. Plus, the grayish stripe that borders the top of the new the fluid collection indicates there is some swelling in her brain. Our doctor was on vacation, but the nurse that walked us through the images felt that, despite Madison’s mild symptoms, a surgery was very much warranted.

Her regular surgeon was back this week and the procedure was scheduled for Wednesday evening. After some mechanical issues with the 3D guidance system, surgery started at around 8pm last night and wrapped up just after 9. Here’s what the surgeon told us.

The catheter in the right front was still working, although at a reduced capacity than intended. In addition, the catheter had become detached from the rest of the shunt system. The catheters are connected to tubing that in turn connects them to the drainage valve. The catheters are attached to the tubing much like you would push the joints of two pipes together and are further secured with a surgical stitch to hold them in place. It’s not uncommon for the pieces to pop apart, despite the stitch, as a patient grows. The doctor thinks this is what happened in this case. The catheter in question had not been touched since 2009 and, other than this most recent issue, had been working fine. He slid a second catheter down the same hole with a slightly different positioning to try to reach more fluid collections. He then pushed fluid in the new catheter and was able to see it flow out the old catheter. This meant that the new catheter was in the same space (or at least a same space) as the new catheter. The old catheter was removed, and that was that. Our surgeon believes that the increased pressure in the right-front was causing the increased pressure in the other areas. So, this should resolve her issues for now.

We’ve pretty much run our course on “minor” surgeries at this point. As you can see from the images above, she does not have one large space but a series of adjoining spaces that all need to be drained. If Madison needs another surgery, she will likely move to a more significant but hopefully more effective procedure. The surgeon thinks there is a high likelihood that the more significant procedure will need to happen, but only time will tell as to when.

In the meantime, Madison is still a little grumpy this morning (who wouldn’t be), but she is eating well and might come home late this afternoon if her day goes well.

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