Aneurysms

Brain aneurysm treatments now have fewer complications, better outcomes

 

icordle@MiamiHerald.com

Mignon Gordon and Marty Israel met through their children, are engaged — and have each survived potentially life-threatening brain aneurysms.

Gordon was working out with her personal trainer in April 2011, when she blacked out with her eyes open. After numerous tests, doctors discovered she had multiple aneurysms, which were treated in the summer of 2011 at Baptist Hospital.

Months later, after she and Israel had begun dating, he felt ill, and she urged him to go to the doctor. He ended up losing consciousness, with an aneurysm that had burst, requiring immediate treatment.

“The doctors are amazing, they really know this procedure inside and out — they saved my life,” said Israel, 63, a mobile massage therapist who lives in Florida City. “I wouldn’t be here.”

“They saved both of us, honey,” added Gordon, 49, who lives in Kendall.

Today, with advances in minimally invasive treatments, more patients are able to survive brain aneurysms, said Dr. Italo Linfante, medical director of interventional neuroradiology and endovascular neurosurgery at Baptist Health Neuroscience Center at Baptist Hospital.

“The good news is we have these techniques that are minimally invasive, they can be applied to all kinds of aneurysms, even those previously considered untreatable and in particular, a ruptured aneurysm,” said Linfante, who treated Israel.

A brain aneurysm is a bulge or ballooning in a blood vessel in the brain. It often looks like a berry hanging on a stem, according to the Mayo Clinic.

The danger is that a brain aneurysm can leak or rupture, causing bleeding into the brain, called a hemorrhagic stroke.

Most often a ruptured brain aneurysm occurs in the space between the brain and the thin tissues covering it, causing a subarachnoid hemorrhage.

A ruptured aneurysm quickly becomes life-threatening, and requires immediate medical treatment.

“It’s like a bomb in the brain,” Linfante said.

Doctors say patients describe a ruptured aneurysm as the worst headache they ever had. Other symptoms before it bursts can include visual problems, facial droop or eyelid drop. But often with an unruptured aneurysm, there are no symptoms at all.

In fact, most brain aneurysms don’t rupture or create health problems, and are detected during tests for other conditions. But in some cases, treatment for an unruptured brain aneurysm may be appropriate, and may prevent a rupture in the future, doctors say.

Because Gordon had a family history of ruptured aneurysms — her mother died in 2000 of a rupture — she was at greater risk and treatment was recommended, said Dr. Guilherme Dabus, director of the fellowship program in interventional neuroradiology at Baptist Health Neuroscience Center, who treated three of Gordon’s aneurysms, using minimally invasive stent-assisted coil embolization.

While surgery involving opening the cranium was once the standard treatment for brain aneurysms, great strides have been made in endovascular techniques using coil embolization, in which a doctor places a catheter in the artery in the groin and navigates through the blood vessels to reach the blood vessel in the brain, Dabus said.

There, a micro-catheter is inserted and small coils are put in to block the aneurysm, so the blood flow to the brain is not stopped. When the neck of the aneurysm is wide, a stent is used to support the coils, he said.

Though previously published statistics have shown that 40 percent of patients die from ruptured aneurysms, Linfante said he believes the updated, but yet unpublished figure, is now between 10 percent and 20 percent at high volume centers nationwide such as Baptist, which performs more than 100 such minimally invasive treatments a year.

“In the last 10 years there has been a gradual shift in how we treat aneurysms, and now it has become almost routine,” he said.

“The endovascular approach is much better, with less complications and better outcomes in both ruptured and unruptured aneurysms.”

Most aneurysms are diagnosed between the ages of 30 and 60. Risk factors for brain aneurysms include smoking, high blood pressure and heavy drinking, Dabus said.

“If you have a brain aneurysm, you should seek treatment from people who have experience and do a fair number of these treatments,” he said.

Florence Black has a family history of aneurysms — a sister and two nieces have died from ruptures — and she knew she also had aneurysms, which were being monitored.

In December, she felt discomfort when she pressed on her eyeball, so she went to Mount Sinai Medical Center in Miami Beach, where she was told they were “seeping” and about to burst, and needed treatment.

“I am very fortunate, because a lot of people have passed away,” said Black, 69, a registered nurse who lives in North Miami.

Dr. John Chaloupka, a neuro-endovascular surgeon at Mount Sinai’s department of neurosurgery and radiology, who is also director of neuro-interventional service, treated Black with stent-assisted coil embolization.

Chaloupka was a fellow in training at the UCLA Medical Center in the early 1990s where the coiling treatment was invented. He said he was one of the first doctors in the world to do coil embolization, and has since treated more than 1,600 aneurysms.

He has also treated aneurysms with balloon assisted coiling and “Y stenting,” which uses two stents.

“Here at Mount Sinai we are treating a lot of complex types of aneurysms that are very difficult to treat with conventional endovascular procedures,” he said. “So we are doing more complex and complicated procedures.”

For aneurysm survivors like Black, as well as Gordon and Israel, these latest treatments have proved to be lifesaving.

“I’m fine. I ride my bike three miles and walk three miles every day,” Black said. “I really feel lucky.”

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