Cerebrospinal fluid leak from shunt incision

[billrobynn]

My son had a shunt due to a subarachnoid cyst.  On Nov 9th he had surgery for shunt failure and on Nov. 14th he had CSF fluid leaking from incision.  It was discovered that he had another failure, had revision and is now having fluid leaking again.  His neuro. did not tap his shunt or do CT scan this time, said she thinks it is residual fluid coming from the burr hole.  He is now 1 week 3 days post op.  Is it reasonable to expect a leak still?  I can not find any information on this anywhere.  Also isnt infection a major worry?
Thank you
Robynn

[Joyce K Lee, MD]

Dear billrobynn,

Thank you for submitting your question.
I will answer your concerns to the best of my abilities, but please be informed that I am unable to offer a diagnosis based on your history and list of symptoms.
I am limited in not having the opportunity to perform a full neurologic examination on your son, nor am I able to review the pertinent imaging.
This is solely for educational purposes and should in no way be a substitute for a formal evaluation by a certified physician.

To begin, I feel obligated to inform you that this is more of a neurosurgical question.
I am a neurologist by training.
I have however corresponded with my neurosurgery colleagues regarding your comments and this is the consensus.

To answer your question, yes -- the fact that your son continues to have a leak from the incision site is very concerning.
This is not considered "normal" and should not be written off as such.

I think that an investigation to rule out infection (e.g. an abscess or meningitis) is definitely warranted.
Here at the Cleveland clinic, our neurosurgeons would tap the shunt and run a shunt series to assess the shunt's level of functioning.  At minimum, a CT is required.

Please do not sit on this -- seek medical attention from a neurosurgeon as soon as possible.
If you do not feel comfortable with his current neurosurgeon, seek an opinion from an alternate surgeon.
If you are unable to make an appointment soon, go to the closest ER.

I don't want to alarm you, but I would feel worse sugar-coating the situation.

Thank you,
Hope this helps,
JKL, MD

[Joyce K Lee, MD]

Dear billrobynn,

Thank you for submitting your question.
I will answer your concerns to the best of my abilities, but please be informed that I am unable to offer a diagnosis based on your history and list of symptoms.
I am limited in not having the opportunity to perform a full neurologic examination on your son, nor am I able to review the pertinent imaging.
This is solely for educational purposes and should in no way be a substitute for a formal evaluation by a certified physician.

To begin, I feel obligated to inform you that this is more of a neurosurgical question.
I am a neurologist by training.
I have however corresponded with my neurosurgery colleagues regarding your comments and this is the consensus.

To answer your question, yes -- the fact that your son continues to have a leak from the incision site is very concerning.
This is not considered "normal" and should not be written off as such.

I think that an investigation to rule out infection (e.g. an abscess or meningitis) is definitely warranted.
Here at the Cleveland clinic, our neurosurgeons would tap the shunt and run a shunt series to assess the shunt's level of functioning.  At minimum, a CT is required.

Please do not sit on this -- seek medical attention from a neurosurgeon as soon as possible.
If you do not feel comfortable with his current neurosurgeon, seek an opinion from an alternate surgeon.
If you are unable to make an appointment soon, go to the closest ER.

I don't want to alarm you, but I would feel worse sugar-coating the situation.

Thank you,
Hope this helps,
JKL, MD