Shunt Revision

Dr. Riva-Cambrin's hunch that Nathan's body was unable to absorb all the cerebro-spinal fluid (CSF) being deposited in his abdomen.  So instead of being reabsorbed into his system, the CSF was basically "pooling" in the pocket of his abdomen where the distal end of the shunt was placed.  Once the "pool" was full, no more fluid could fit in the pocket.  Since the shunt couldn't drain anymore, the fluid had no where else to go.  So it stayed in the ventricles, which is what was causing Nathan's head to get bigger.

So we needed to find a new place for the shunt to drain. 

In general, when a venticuloperitoneal (VP) shunt fails, the preferred next best location is a ventriculoatrial (VA) shunt.  So instead of emptying into the abdomen, the shunt empties into the right atrium of the heart.  From there it is carried through the bloodstream and is eliminated and absorbed throughout the body, not just in a single location.

It sounded like a a great plan to us.  However, given Nathan's long history of heart issues, his cardiologist did not think that his heart would be up to the task.  So he said "No" to the VA shunt.  So that meant that we were looking for another location to place the distal end of the shunt.

Upon closer inspection of Nathan's body, Dr. Riva-Cambrin discovered that there was a large open area around Nathan's CDH repair, in the area around his left lung.  This area is known as the pleural cavity.  It is actually a space between the chest wall and the lungs.  It is lined by a membrane along both the chest wall and the lungs.  A fluid called pleural fluid is generally found in the cavity.  The CSF is added to this fluid and is then absorbed into the body. 

 This type of shunt is known as a ventriculopleural (VPL) shunt.  And with Nathan's wacky anatomy, this seemed like the best option available to us.  All of the pieces just seemed to come together.  Nathan's hernia repair was the answer to solving the hydrocephalus problem!  Brilliant!  We felt that this was Divine Intervention smiling down upon us again.

And the surgery went really, really well too.  They had placed Nathan on a ventilator for safety precautions during the procedure.  But he was able to come right off when the surgery was over. 

So Nathan's shunt revision took place 9 weeks and 1 day from the placement of the original shunt.  And considering how much we struggled with the first shunt, we felt a lot better about this one.  We were hoping and praying that this would be it.  Even though we knew that the odds of having another shunt revision were now dramatically higher, we really, really wanted to believe that Heavenly Father would bless Nathan to be able to heal and move forward.