Surgery Explanation

For reference, I thought I would jump into the types of surgeries I underwent. This procedure was performed February 5th, thirteen days after my admission to ICU.


First surgery: Along my artery wall behind my left eye, the aneurysm was spotted bulging and the source of my bleeding.


Information on the procedure has been copied directly from https://my.clevelandclinic.org/


Clipping. One treatment for securing a brain aneurysm is through microsurgical clipping. This surgery requires a craniotomy. A craniotomy is performed by making an incision on the head and temporarily removing a small portion of skull. After the brain is exposed, the surgical team uses an intraoperative microscope to dissect through the brain to access the aneurysm. Once the aneurysm is visualized, a small clip is placed around the base, or neck, of the aneurysm. The skull portion is replaced and fastened with plates and screws, and the incision is closed.













Complications from SAH can include brain swelling and hydrocephalus. Bleeding from a subarachnoid hemorrhage can cause swelling of the brain, which can be life threatening. Monitoring of the brain’s pressure is important for any patient with symptoms of significant brain swelling. Medications can be used to treat brain swelling.

Bleeding can also cause hydrocephalus, an excess of the cerebrospinal fluid (CSF) in the brain. Our brains float in a bath of CSF. This fluid is made primarily in spaces in the center areas of our brain called ventricles. The bleeding that occurs in SAH can cause an obstruction in the ventricles that blocks the fluid from passing through and these spaces get larger.

This bleeding can also interfere with the brain’s ability to reabsorb the fluid normally. Hydrocephalus can be potentially dangerous if untreated. The treatment for hydrocephalus is to drain the excess fluid

My friends, I unfortunately came across the complication weeks after my discharge from the hospital on February 16th.

On March 2nd, I went in for a scan, which confirmed my neurosurgeons fear that I would have hydrocephalus, more accurately Adult on-set hydrocephalus. The following symptoms are noted from https://www.aans.org/


I’m referencing them because I had all the symptoms except seizures

· Headaches

· Nausea

· Difficulty focusing the eyes

· Unsteady walk or gait

· Leg weakness

· Sudden falls

· Irritability

· Drowsiness

· Change in personality and behavior

· Seizures


-Here is additional information from the same website to explain hydrocephalus:

Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles (fluid-containing cavities) of the brain and may increase pressure within the head. Although hydrocephalus often is described as "water on the brain," the "water" is actually CSF — a clear fluid surrounding the brain and spinal cord. CSF has three crucial functions:

1. It acts as a "shock absorber" for the brain and spinal cord;

2. It acts as a vehicle for delivering nutrients to the brain and removing waste; and

3. It flows between the cranium and spine to regulate changes in pressure within the brain.


The average adult produces about one pint of CSF daily. When an injury or illness alters the circulation of CSF, one or more of the ventricles becomes enlarged as CSF accumulates. In an adult, the skull is rigid and cannot expand, so the pressure in the brain may increase profoundly.

Because of the severity of the hydrocephalus my physician decided on a ventriculoperitoneal (VP) shunt. As I have explained in previous posts, this was the worst surgery for me, and it’s not considered invasive.


Description of the VP shunt:


About the VP shunt from https://www.mskcc.org/


To help drain the extra CSF from your brain, a VP shunt will be placed into your head. The VP shunt works by taking the fluid out of your brain and moving it into your abdomen (belly), where it’s absorbed by your body. This lowers the pressure and swelling in your brain. The valve controls the flow of CSF fluid. It’s attached on one end to the short catheter so it can drain the fluid away from your brain. The short catheter can be placed in the front, back, or side of your head.

The reservoir collects a small amount of CSF which your doctor can use to sample your CSF for tests if needed.

The long catheter is attached to the other end of the valve. The long catheter is placed under your skin, behind your ear, down your neck, and into your abdomen.

As the VP shunt drains extra CSF and lessens the pressure in your brain, it may ease some of your symptoms. Some symptoms will stop right after the VP shunt is inserted. Others will go away more slowly, sometimes over a few weeks.

The amount of fluid that’s drained by your VP shunt depends on the settings on the shunt. If you have nonprogrammable VP shunt, your doctor will program the settings in advance and they can’t be changed. If you have a programmable VP shunt, the settings can be changed by your doctor if needed.


Second Surgery: VP shunt:


This procedure is done in the operating room under general anesthesia. It takes about 1 1/2 hours. A tube (catheter) is passed from the cavities of the head to the abdomen to get rid of the excess cerebrospinal fluid (CSF). A pressure valve and an anti-syphon device ensure that just the right amount of fluid is drained. Copied directly from https://www.mskcc.org/


The procedure is done as follows from


https://medlineplus.gov/ency/article/003019.htm:


An area of hair on the head is shaved. This may be behind the ear or on the top or back of the head.

The surgeon makes a skin incision behind the ear. Another small surgical cut is made in the belly.

A small hole is drilled in the skull. One end of the catheter is passed into a ventricle of the brain. This can be done with or without a computer as a guide. It can also be done with an endoscope that allows the surgeon to see inside the ventricle.

A second catheter is placed under the skin behind the ear. It is sent down the neck and chest, and usually into the belly area. Sometimes, it stops at the chest area. In the belly, the catheter is often placed using an endoscope. The doctor may also make a few more small cuts, for instance in the neck or near the collarbone, to help pass the catheter under the skin.

A valve is placed underneath the skin, usually behind the ear. The valve is connected to both catheters. When extra pressure builds up around the brain, the valve opens, and excess fluid drains through the catheter into the belly or chest area. This helps lower intracranial pressure. A reservoir on the valve allows for priming (pumping) of the valve and for collecting the CSF if needed.

For my procedure, my neurosurgeon opted for the catheter to drain fluid into my abdomen.

The risks and complications scare me the most, nonetheless it’s a part of me and something I have to live but with awareness in the back of my head. The following complications are copied directly from Johns Hopkins Medicine

https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/cerebral-fluid/procedures/shunts.html








Shunt Complications and Risks

Potential complications of shunt surgery include those related to the actual operation as well as those that may occur days to years later.

Each person’s situation is different, so it is important for individuals and their families to consider these potential complications carefully. You should discuss all your concerns with the doctor to ensure that the potential benefit of getting a shunt outweighs the risks.

Risks and complications may include:

Blockage (obstruction) is one of the most common problems. Blockages can often be fixed (sometimes with further surgery) and rarely result in serious harm.

Shunt malfunction may include over- or under-drainage. A shunt system that is not functioning properly requires immediate medical attention.

· Over-drainage: When the shunt allows cerebral fluid to drain from the brain’s ventricles more quickly than it is produced, the ventricles can collapse, tearing blood vessels and causing bleeding in the brain or blood clot, marked by severe headache, nausea, vomiting, seizure and other symptoms. This risk occurs in approximately 5 to 10 percent of people with shunts.

· Under-drainage occurs when CSF is not removed quickly enough. Pressure builds and the symptoms of hydrocephalus recur.

Infection at the site of the surgical wound, the shunt or in the cerebrospinal fluid itself (meningitis). Symptoms may include a low-grade fever, soreness of the neck or shoulder muscles, and redness or tenderness along the path of the shunt. Hydrocephalus symptoms may reappear as well. If you suspect an infection, call 911 and go to the nearest emergency room immediately.

It is difficult to predict how long shunts will last, but some practitioners note that about half of all shunts need to be revised or replaced after 6 years.

-The VP shunt is no joke, my friends. My head, neck and abdomen went through extreme tenderness. Since I’m small framed I can trace the catheter all the way down until it hits my abdomen. It freaks me out when my hand accidentally grazes the tube. The shunt on the back of my head is large and took several days before I could lay down comfortably. The shunt is best described as a golf ball from the outside. In time, my hair will cover it up, but I’m slowly getting use to it being exposed. This shunt is a part of me for the rest of my life and I will need surgery every 8 years. It’s a psychological battle, knowing there is a permanent device in my body. I must counter those intrusive thoughts with- I’m alive!

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