Hello.

Thanks for posting your query.

Peritubal (around the tube) fluid collection happens due to many reason. E.g. increased intracranial pressure, shunt block, etc.

Best way to monitor the shunt function is clinically. If the child is improving symptomatically and the hydrocephalus is resolving, that shows shunt is functioning well.

If the shunt is not draining properly, child will not show clinical improvement. You have not mentioned about your child's progress.

Another thing is that there is a chamber in the shunt which looks like fluid collection in MRI or X-ray because the shadow will be opaque. Valve is to prevent the back flow. Your doctor has checked the refilling of shunt chamber by pressing it. If the chamber is refilling well it means shunt is working fine.

In case the fluid is actually collected, revision of shunt is the only answer. But, as per the information you have provided (except your child's clinical findings) I feel the shunt is working nicely, otherwise your doctor would have informed you about it.

I hope, this answers your query. I will be available to answer the follow up queries if any.

Wishing your baby a speedy recovery.

Regards.

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Hello again.

I can understand your anxiety regarding your child's health. But, if your doctor after assessing says that results are fine, then the shunt is working properly.

1. If the collection of fluid is small, it gets absorbed by itself and does not cause serious consequences. But, if the collection is more and intense, patient can worsen and can become drowsy.

2 and 3. Yes, fluid can come out of the shunt under the skin. Fluid leak is peritubal i.e. around the tube.

4. There are holes in the shunt, but it is within the skull and within the cavity of the brain called ventricle and not outside the skull.

5. Yes, the fluid comes out through the hole made for the shunt entry around the tube.

I hope, this answers your query.

Regards.

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Hello.

Burr hole size is usually standard. Tube is plugged with brain tissue and the overlying dura mater as it passes through the brain tissue.

Tubal leak is around the tube. Size of the burr hole does not matter. What matters is puncture site at brain tissue for the leak to occur.

Usually healing takes place over the period if fluid leak is not there or minimal. If the leak is more, shunt revision is the only treatment.

I don't have the opportunity to see the patient, so it is difficult for me to comment exactly. But, I gave you the overview of treatment modality.

I hope, this information helps to relieve your anxiety.

Regards.

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Hello.

Sorry for replying late.

Swelling appears significant. If it is tense and increasing in size, may require revision of shunt.

This can be decided only after clinical examination. If the child is symptomatically better and swelling is not increasing, you can wait and watch. If not, then I would suggest you to see your treating doctor.

I hope, this helps.

Regards.

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