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Should lumbar drain be used again to remove recurring CSF fluid in left side of head?

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Practicing since : 2001
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Dear Doctor,

In previous few queries I had asked that my Son went through TBI and had a bulge/Lump of CSF leak fluid accumulated on his left side of the head. Doctor applied "Lumbar Drain" and pressure on bulge and maintained normal pressures around head to control the CSF Flow and heal the Leak. Lumbar drain was stopped for more than 12 hrs and the Fluid started accumulated again the head, though this time with less pressure but its still leaking.

What should be the next step now? Should the doctors continue the Lumbar Drain or some other therapy must be used to stop the Leak. I am relaly worried now, please guide me. I really want to see my son back home.

Posted Sun, 29 Apr 2012 in Brain and Spine
Answered by Dr. Shiva Kumar R 5 hours later

Thanks for the query.

If there is CSF leak the idea of putting a lumbar drain is to reduce the CSF pressure so that the leak closes of automatically without any corrective surgery.

If the CSF leak continues after stopping the drain then it has to be corrected surgically with a graft if possible. We can even try one more time with Lumbar drain.

If it seals off then we avoid major surgery in your son. Discuss this option with the Neurosurgeon and go head with which ever is more beneficial with less risks and complications.

Hope I tried to answer your query. Let me know if you have more queries.

Above answer was peer-reviewed by
Follow-up: Should lumbar drain be used again to remove recurring CSF fluid in left side of head? 4 hours later
Thanks!! for you prompt answer doctor.

Just few more things:

If all the pressures in the skull are normal then shouldn't the leak close by itself.
Also how much time it actually take for dura mater layer to repair on its own. Is there a medicine which can help healing of this layer faster.

What are the success rates of "Dura Mater" healing itself after "Lumbar Drain"

Since my Kid is just 5.5 year old do you think child of this age better tendency to heal the layers itself rather a surgery.

Also Please guide me how should we go about next.

Answered by Dr. Shiva Kumar R 5 hours later
Hello again,

Thanks for getting back.

There are no medicines available to heal the closure of dura mater layer.

The idea is to keep the pressures in the brain in lower range than the normal pressures so that it automatically seals off.

Hence we put lumbar drain to keep pressures lower than normal.

If it does not close by itself, surgery is the only option to close it or else infection may enter from outside and cause meningitis.

If meningitis occurs then it is sometimes difficult to treat.

The chances of spontaneous closure is more than 90% by itself.

Because it is a kid the chance of he getting cured is high. So be positive and try lumbar drain for few more days if possible.

Or else go for the surgery to close it. Your son will be fine. Do not worry.

Hope I have answered your query.

wishing your son a speedy recovery.

Above answer was peer-reviewed by
Follow-up: Should lumbar drain be used again to remove recurring CSF fluid in left side of head? 37 hours later
My Son has been released from ICU today and brought into rehab unit. Where his recovery will be monitored for few days. A bandage has been tied tightly over the area where the lump was , so currently the Lump size is almost 0. Also some more activity has been found in his right side of the body (as brain was hit on left side).

Doctor said they will remove the bandage after sometime to see if lump re fills.

What do you suggest .. are his Leaks gone?
Answered by Dr. Shiva Kumar R 19 minutes later

Thanks for getting back to us.

If the lump is not seen then chances of it getting corrected is high. He is on the recovery path now.

I think he will gradually recover from now on. It looks like his leaks are settling down and probable getting corrected by itself. Also he is getting his function on the right side of the body which is a good sign. So give good rehab for him to recover faster.

Hope my answers have been of help to you.

Wish you and your son good health.

Above answer was peer-reviewed by
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