Our calm was disrupted this week. Five months ago, Henry's head circumference was measuring in the 5th percentile for his age group. This measurement has been steadily climbing since that time and is now in the 90th percentile. Increase in head circumference is driven by two factors: brain development or the pressure from trapped cerebral spinal fluid (a condition known as hydrocephalus). Given the nature of Henry's brain injury, the latter is more likely. However, Henry's head is not misshapen, his fontanelle is still soft, and his eye examination showed no abnormal pressure behind his eyes. Each of these factors is evidence against hydrocephalus.
To find out what is actually going on inside of Hank's head, our neurologist ordered an MRI. The MRI was performed at Evanston Hospital, where we spent most of the day waiting for Henry to wake up from sedation. By the time he awoke, the results had been read, and we were sent directly to Children's Memorial Hospital in Chicago for a consult with a pediatric neurosurgeon. The new MRI shows that Henry's ventricles are now much, much larger than they were back in December, the time of his second MRI. Ventricle size increase can be caused by either brain atrophy or fluid retention. Due to the dramatic increase in size, our neurosurgeon suspects that both factors are present.
A shunt is the usual apparatus for dealing with excess fluid. Because of the extremely swollen ventricles and brain matter of unknown integrity, we need to take extra precaution that Henry's brain does not collapse due to draining the fluid too quickly. To reduce the risk to Henry's brain, they are going to install an adjustable, high-pressure shunt. Once installed, the pressure point of the valve on the shunt can be adjusted by using a special magnet. (We won't be doing this at home.) Our goal will be to drain enough fluid from the brain so that the brain tissue has optimal space in which to operate but not so much that his brain collapses. He will be closely monitored by the surgeon at Children's Memorial Hospital. Children's has a special MRI for monitoring ventricle size that requires only about five minutes to capture the image and does not necessitate sedation.
We do not have a specific date yet, but we have been informed that Henry's surgery will take place late next week. Although this surgery is a big deal for us, it appears to be the simplest, most routine surgery that a pediatric neurosurgeon performs. Hank's surgeon assures us that he will be back to normal within a couple of days.
If Henry's brain is currently under stress from being compressed, we may observe an increase in his functional development once the pressure inside his head is normalized. Meade and I are resisting the urge to hope or speculate at this time. We want to get him safely through this surgery, then we'll see what unfolds.
OK, enough of the medical discussion. Henry continues to grow bigger and cuter...
Here he is trying to wake up from being sedated for the MRI:
Here is our Big Guy practicing his sitting in the corner of the couch:
Here is some serious bed head:
Hank loves hanging out with his family.