You’ve probably heard the saying that goes “too much of anything is bad”. That applies to a clear liquid called cerebrospinal fluid (CSF). CSF has several roles in the body but its main role is to protect the brain and the spinal cord from damage. However, if it is in excess, it causes a serious problem. When that happens, doctors need to drain the extra fluid to relieve pressure in the brain. In this article, we’re going to explore how this drainage process works, how the procedure is managed, and certain complications that may arise.
Procedure and Management
Firstly, the doctors use a CT scan or MRI to see if CSF drainage is actually needed, and to see where the buildup happened. The area where the catheter will go is then cleaned thoroughly and sterilized to prevent any form of infection.
Depending on the procedure you’ll be getting, you’d either be getting local anesthesia (which numbs the area) or general anesthesia (which puts you to sleep). Inserting the catheter is different for each method of cerebrospinal fluid drainage.
- Lumbar drain: The catheter is inserted in the lower back, just between the bones of the spine.
- Ventriculostomy (EVD): A small hole is made in the skull which allows the catheter to be placed directly into one of the brain’s ventricles (hollow spaces in the brain containing the cerebrospinal fluid).
- Shunt system: The catheter is inserted into the brain’s ventricles, while the other end of the tube is tunneled under the skin, which usually leads to the abdomen.
Once the catheter has been secured in place, the cerebrospinal fluid starts to drain. The drainage could be external, where the fluid goes into a collection bag outside the body. It could also be internal, which is quite different from the external drainage of fluid. In internal drainage, the fluid that is collected from the brain’s ventricles and redirected inside the abdomen, where it can be easily absorbed.
Note: The amount of fluid drained is usually controlled to make sure the drainage isn’t too much or too fast.
How Is The Fluid Monitored During Drainage?
There are a couple of things that doctors have to look out for while draining the cerebrospinal fluid. Remember, the pace at which the fluid is drained is not too much nor too fast.
Firstly, doctors check the brain pressure. The whole point of draining the extra cerebrospinal fluid in the first place is to lower the pressure in the brain. There’s a device called an intracranial pressure (ICP) monitor which doctors use to track the pressure in the brain. The ICP monitor is connected to the catheter used during the ventriculostomy procedure, which then measures the pressure inside the brain, it displays or on the screen. The good thing about this is that it allows doctors to watch the pressure level change in real time.
Secondly, doctors watch how much cerebrospinal fluid is being drained using a drainage system or a graduated cylinder. The catheter removes the cerebrospinal fluid and it is collected in a collection bag designed to measure how much fluid is being drained overtime. However, if the amount of fluid suddenly changes, it could be that there’s a problem like a blockage.
The third thing that is checked is how your brain is functioning by looking at your consciousness, and your reflexes. If these neurological signs aren’t observed during the cerebrospinal fluid drainage procedure, that means some sort of complications has occurred. The doctors also look for signs of infection. It could be a fever or redness around the area where the catheter was inserted.
Lastly, doctors look out for changes in the color of the cerebrospinal fluid. The cerebrospinal fluid is usually clear and colorless. But in some cases, the fluid could look cloudy or even bloody.
Are There Any Complications To Watch Out For?
Definitely! All medical procedures are bound to have some sort of complications. The major complication is infection. The catheter used for drainage can introduce infection into the brain, like meningitis.
Sometimes, inserting the catheter can cause bleeding in the brain or spinal cord. That’s why in some cases, the cerebrospinal fluid which is originally clear and colorless, can become bloody during drainage.
One horrifying complication of cerebrospinal fluid drainage is over-drainage. If too much of CSF is drained too quickly, it can cause the brain to sag. Another complication is blockage of the catheter while draining. If the catheter is blocked or somehow stops working, it can cause the CSF to build up again, causing brain pressure.
Bottom Line
Cerebrospinal fluid (CSF) protects your brain and spinal cord, but having too much of it can be a real problem. CSF drainage is a medical procedure used to relieve pressure in the brain, but it’s not as simple as it sounds. There are things doctors have to be careful about. But even with all that attention, there can still be some complications, like infections, bleeding, or the fluid draining too fast.
