Cranioplasty Tomorrow AM! - April 8th - Day 52

Brian's cranioplasty is scheduled for tomorrow (Fri 4/9) at 10am CST.

I'll do my best to explain what I learned from the surgeon tonight:

• After reviewing Brian's CT scans since the time of the injury until now, it appears that the ventricles in Brian's brain have enlarged slightly, implying that his cerebral spinal fluid *may* not be draining on his own properly, which would then require a shunt. 
• After the surgeon examined Brian in person, however, he saw that the area on his head where the cranium was removed has sunken significantly & is soft -- meaning that if there was indeed pressure build up, he would expect for that area to be swollen and/or hardened. Since that is not the case, he is assuming Brian won't need a shunt.
• Fun fact: He told me that sometimes for patients that have had a craniectomy, their brains get 'used' to the cranium not being there and can 'expand' - aka he brain gets comfy because it doesn't have the skull to contain it - hence could explain why the ventricles appear expanded on the scan (for all doctrors reading this, please bear with my interpretations but I think I'm tracking). In most cases, he said that once the skull cap is replaced, the brain remarkably 'remembers' where and what it should do and things return to normal, from a draining perspective. The surgeon anticipates that will be the case for Brian. 
• Since they want to be certain and not install one unnecessarily, they are going to perform the cranioplasty & then place an EVD (external ventricular drain) again to monitor over the next 3-5 days (same like they did when he was in the ICU in the beginning when we were watching his ICPs). They'll challenge his drain in the days ahead and that will tell them whether or not he's draining the fluids on his own. If he is, they remove the drain & we're good to go! If he isn't, then they will do a second operation to remove the EVD & 'install' the shunt.
• I appreciate his approach to give Brian a chance to prove what he's able to do before doing an operation that he may not need. So let's keep praying for the best case scenario of Brian's brain doing what it needs to do all by itself, no shunt needed!
• Operation start to finish should take 1.5 - 2hrs max! 

Updates from today in general:

• Brian had his eyes open for a majority of the day! The longest I've seen in the past month is one full hour straight. Today he had his eyes open for most of the morning, with a few 30 min breaks, and then wide open from 2:30p - 6p!
• He spontaneously 'shook' / 'kicked' his left leg 3x this morning (it shocked me)! And I was able to get him to repeat that movement by tickling his feet and again this evening when I attempted to move his leg myself.
• Vitals are stable stable stable!! 

"And the God of all grace, 

who has called you to his eternal glory in Christ, 

after you have suffered a little while,

will himself restore you and make you strong, firm & steadfast"

-1 Peter 5:10

^ This is a verse I read to Brian all the time. 

It brings me great comfort, but I love that this verse feels so specifically suited for Brian.

I pray, God, that after Brian has suffered a little while, you (the God of all grace) will restore Brian and make him strong, firm & steadfast!

Bless the surgeons & medical team tomorrow morning. May their minds be fresh & awake and their hands be steady & gentle. Thank you for their care & for the angel nurses that tend to Brian's needs! Thank you for the confidence and peace you've given our family in this stage! Thank you for answered prayers! We trust you!

Please be so close to Brian tonight as he rests and tomorrow during his surgery. Continue to keep him stable & healing. Thank you for showing us improvement daily! Hold him and send your angels concerning him. 

I even pray that you might wake him up, in the days ahead, after his operation & anesthesia wears off. What a miracle that would be! Nothing is impossible with you, so I boldly ask, in Jesus' name, for his consciousness to return to him sooner than we could expect. You are able! 

Give us rest tonight and strength tomorrow, Amen!