Fortunately, persistent hydrocephalus is rare. Most patients recover spontaneously, a few require a temporary lumbar drain, and only occasionally is a ventriculoperitoneal shunt needed. When there is postoperative fever with headache or stiffness in the neck, the possibility of either aseptic or bacterial meningitis must be considered. A scan is done to look for an area that might suggest a local infection. A lumbar puncture is then done and administration of broad-spectrum antibiotics is started.
Subsequent treatment is guided by the results of the cerebrospinal fluid examination and cultures.
If the findings suggest aseptic meningitis, steroids are used. When the infection is superficial and the organism is sensitive to antibiotics, it may not be necessary to remove the bone flap. If the infection is extensive, debridement of the wound and removal of the bone flap is necessary. If there is any significant postoperative disability the patient is seen by physical and occupational therapists. Difficulty swallowing due to impaired function in the ninth and tenth nerves should be carefully evaluated with a modified barium swallow and followed by a specialist in swallowing disorders.