Re: Shunt Surgery

Posted By Nancee on August 11, 1999 at 12:43:17
I have been diagnosed as having Arnold Chiari Malformation and Syringomelia.  I had decompression surgery, partial laminectomy C-1 and duraplasty in December.  All of my symptoms disapeared.  
Two months ago, my previous symptoms, and new ones reappeared.  I am having problems with balance, excrutiating headaches, disabling hand and feet pain, and breathing difficulties, to name a few.
My neurosurgeon requested that I have a repeat flow study.  On this MRI scar tissue was seen to have restricted the flow at the point of previous surgery in December.  
My neurosurgeon stated that my current problem could be a pressure problem related to the ACM/SM and requested that I undergo two spinal taps.
The results were:  Tap 1--pressure 23 lowered to 13 with abscence of symptoms from Monday-Wednesday.
Tap 2--pressure 19 lowered to 9 abscence of symptoms from Monday-Wednesday.
My questions is regarding shunts.  My nsg is saying that a shunt may be an answer.
Can you give me a 'real' idea of how dangerous it is to have a shunt placed and continue to live with it in place?  I am very scared.  I have been through decompression surgery, and gamma knife surgery for trigeminal neuralgia.  Obviously, I would rather not go through anymore brain surgery.
My breathing difficulties have gotten worse and worse and I now carry an epipen.  I am taking preventative asthma and allergy medication, but I am not responding in the normal fashion to either.
My nsg stated that it could be related to my pressure problem.  I currently take 125 mg of Desapramine, 40 mg of oxycontin TR and IR when needed, Celebrex 200 mg, Diamox 500 mg and Flexeril for pain.  I am not sure if a life with all of these meds is good either as I am only 40.  I would have to assume that this could only progress and not 'fix itself'.
Thank you for your honest opinion.
nancee

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on August 11, 1999 at 16:47:38
Dear Nancee:
Sorry that the surgery has not had the desired effect, at least concerning the hydrocephalus.  Since you have blockage of CSF flow, I think that unless you want to have many spinal taps, your only alternative is a shunt.  Many people have shunts with mostly good outcomes.  Anytime you place a foreign object in the body, you are always at risk for infections.  This is true with shunts.  In addition, there are shunt malfunctions that can occur and either over drain or under drain CSF.  In the hands of a good neurosurgeon most people have good outcomes.  
If I remember your previous postings, your flow study also showed blockage.  So the diamox would have little effect if there is no flow.  
Sorry, but you may have little choice in getting a shunt.  But, I would get a second opinion just in case there might be an opinion difference about the scar tissue and blockage.
Sincerely,
CCF Neuro MD

[Nance__0]

Posted By Nancee on August 12, 1999 at 11:14:02
Could you please tell me if you can what the percentage ratio is for the shunt hardware, itself not having to have revisions or malfunctions?  Also, could you tell me what the percentage ratio is on the individual with a shunt having life threatening complications due to the shunt placement, infections, etc.?  How, also, would you find out if your nsg is good, as you say?  Is there somewhere the average person could call?
Thank you for everything!
Nancee










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