After last week’s canceled surgery, it took about two days to get updates from all three doctors and get in touch with the scheduler to figure out the next steps. The plan (for now) is that I will be admitted to Hopkins Bayview on Monday or Tuesday and then a nurse anesthetist will administer the blood patch into my lower back. I’ll then lay flat for 24–48 hours before going in for an MRI to see if the Chiari is still wedging down and blocking the CSF flow to my back or if the additional CSF flow raises it back up.
The only catch is that there are a limited number of beds and we won’t know bed availability until I call the charge nurse on Monday morning. They cannot hold beds for elective admissions in the event that there is a stroke or seizure patient that also needs to be admitted (understandably). If there are no beds on Monday, then we’ll try again on Tuesday. Either way, I should be able to get the blood batch sometime next week.
For those who want to know more about the procedure itself, here is a fuller description. Blood patches are usually administered if a patient develops a CSF leak after an epidural or lumbar puncture from the needle placement. It’s not too uncommon and is a relatively simple fix. In my case, they’re using it just a bit differently. The doctor explained it as a “shotgun” approach. He said they’ll inject 10–20 cc’s of my own blood into my back with the hopes that the blood will travel up my spine and clot to prevent any CSF from leaking below my skull base. I’ll then have to lay flat for 24–48 hours so that as CSF regenerates, it doesn’t drain out from the existing leak in my skull base. Their hope is that over the course of the day, I’ll develop enough CSF to resume to normal levels and it will raise the Chiari back to a normal position. Since I have such a significant leak in my skull base, as soon as I stand, the CSF will run into my neck (as it has been doing for the last month or two) and cause the Chiari to drop/kink again. This procedure isn’t intended to fix anything, but rather prove which came first, t̶h̶e̶ c̶h̶i̶c̶k̶e̶n̶ ̶o̶r̶ ̶t̶h̶e̶ ̶e̶g̶g̶ the Chiari or the leak.
The doctors should know the results as soon as the MRI is complete. They said they’ll reconvene shortly thereafter to see which surgery I need. That being said, they all reminded me that this could take another 2–3 weeks to coordinate. While it’s hard to sit and wait, I’d also rather know that they’re thinking through all of the options and coming up with the best possible solution for a long term fix. I’ll try to post an update after we get home next week. xo, Susan