Afraid so. But nothing overly dramatic.
The leak of cerebrospinal fluid (CSF) that first occurred a week ago returned at a lower level soon after we went home last Friday, and continued on and off over the weekend. As we’ve learned repeatedly, this whole process is a roller coaster. It was terrific to be home, and as you can see, it gave Neva a chance to be reunited with her best buddy Coco. But the return quickly turned stressful as we watched her leak CSF at a low rate, knowing it could mean a return to the OR. And so it did.
CSF bathes our brain and spinal system. Leaks of this fluid are an unfortunate but not uncommon consequence of any form of brain surgery, including the transphenoidal procedure Neva had 10 days ago. Sometimes these leaks will self-repair without intervention, but CSF is under pressure within the human body, thus it can be difficult for a surgery-induced leak to fix itself against that pressure. When self-repair alone does not work, a lumbar drain is placed in the patient’s spine, from which a small amount of CSF is then allowed to leak into a reservoir. That lowers the pressure in the head, giving the leak a better chance to heal.
Neva had a lumbar drain placed about four hours ago now, followed by an endoscopic examination of her sinus cavity to see if the leak was large and obvious. It was not, which is good news, and is consistent with the low volume of CSF leakage we observed. The fact that the leak is microscopic means the pressure-release of the lumbar drain should resolve the problem. If it does not, surgeons would eventually need to go back in and place another patch over the original surgical wound, but that is unlikely. Lumbar drains resolve CSF leaks in the majority of patients, and Neva’s small leak just helps the odds even more.
A downside? We’ll be in the hospital for Christmas. Lumbar drains are a three day deal at a minimum, so even if things go as quickly as possible, it will be Thursday before we can return home. But we have a truck full of presents, and an unbelievably brave and resilient little girl. She’s not thrilled to be back here of course, but she took it in stride remarkably well. She even thought the “bunny suits” we donned before accompanying her to the OR were worth a good laugh and a family picture. She inspires and humbles us at every turn.