Surgery #5

Well, as usual, things didn't go quite as expected for Mac yesterday! Words you never want to hear out of a pediatric neurosurgeon's mouth are "Well, that was hard." Dr. Gruber replaced the left catheter without any trouble at all, the only reason that one was being monkeyed with was to prevent any infections from brewing. When he opened up on the right hand side, he was planning to go in and open up the cyst that is filling Mac's temporal horn, then place a catheter on the rear right hand side of his head to drain it, and the other areas leading from the front to the back. However, when he opened up where he expected the cyst to be, he wasn't sure if he was even in the right spot. He said he opened it up a few times before he was sure it was the right space, and then found that it is an area with very negative pressure, as has been the rest of Mac's melon. This is why Mac's case has been so difficult to treat. I'm not sure HOW it becomes a negative pressure area, but the analogy that Gruber used to describe what he saw when he got into the cyst was that it was like a water balloon. If you were to poke a hole in a water balloon, you expect the water to flow out. However, what he saw when he opened up the cyst was the equivalent of poking a hole in a water balloon, and seeing all the fluid sucked toward the back of the balloon. The reason that negative pressure is so difficult is because the shunts only engage and drain at a certain pressure level, and so when the pressure is negative, the fluid keeps building and building, without engaging the shunt. Then, when it does finally drain, instead of just being an open hollow space, the negative pressure collapses the cyst around the end of the catheter and clogs the end of it.

So! Instead of placing a catheter in that space, he opted just to leave it alone and only leave the catheter and external drain on the left hand side. The hope is that the pressures will level out now that the cyst has been fenestrated and that the pressure will gradually change from negative to positive pressure. So, hopefully on Tuesday of next week he will be able to put a shunt on the back left of Mac's head, and the right over the temple area on his right hand side. Theoretically, the left sided shunt will drain everything except the temporal horn, and the right side will be dedicated to that area.

Typically Mac is extubated 4-5 hours after surgery, and then is on a nasal cannula to provide positive pressure (which keeps his respirator drive going) for about 12 hours. However, last night they decided just to keep him on the vent until this morning. I am so grateful for good nurses. For one thing, his airway is extremely swollen from being intubated twice in a week. The other reason was so that he could receive all the pain meds that he would like without having to worry about decreasing his respiratory drive. My vote is always that once he is intubated, we might as well take advantage of it and let him be completely comfortable, especially since I would have not been there for extubation in the middle to help him through.

So, its looking like Mac has been granted even more time to up the membership in his fan club in the PICU :) Jeff and I are pretty dissapointed with the extended stay, since it will run into the kid's first week at school, but on the flip side, we are SO incredibly grateful for the skill and patience that Dr. Gruber has exhibited. Every person we talk to who knows that Gruber is Mac's surgeon raves about him. We just can't believe how lucky we are to have him so close to home. There are many parts of the country where people live far enough from a neurosurgeon that they have to take a flight to get to him.

Thanks again for checking up on him!