Neurointerventional surgery saves woman from ruptured brain aneurysm

When Jane Waltz went to the emergency room at Christiana Hospital, she felt silly saying she was there for a headache. But her decision to go helped save her life.

A CT scan showed that she was experiencing a subarachnoid hemorrhage caused by a ruptured brain aneurysm. That meant blood was leaking into the space around her brain because a tiny section of an artery had bulged like a blister and then bled.

“Suddenly, I had this incredible pain in my head,” Ms. Waltz remembers. “My head literally felt like it was going to explode. It was a different headache from any headache I’ve ever had, and my neck was stiff, too.”

Her condition was critical. Without immediate treatment to stop the bleeding, she risked suffering a hemorrhagic stroke, brain damage and possibly even death. So a combined neurovascular team led by neurosurgeon Paul T. Boulos, M.D., and neurointerventionalist Sudhakar R. Satti, M.D., immediately went to work to treat Ms. Waltz.

Her treatment began with an external ventricular drain to reduce the pressure that the blood was placing on the brain. During this procedure, Dr. Boulos surgically placed a plastic tube through the skull and into a fluid-filled cavity within the brain to drain excess fluid. Then Dr. Satti performed five hours of neurointerventional surgery to treat the ruptured aneurysm.

Ms. Waltz’s case was especially complicated. She experienced a rare blister aneurysm, which is a smaller protrusion of the blood vessel and more prone to rupture than the typical saccular, or berry, aneurysm.

Dr. Satti says a blister aneurysm typically cannot be repaired with open surgery. Instead, he and his team successfully treated Ms. Waltz with a stent-supported coil embolization, which is a less invasive style of treatment performed under general anesthesia.

The procedure involved cutting a small incision near the groin and inserting thin plastic tubes and wires in the femoral artery. These tubes were used to navigate through the blood vessels to the site of the rupture. To stop the bleeding, Dr. Satti placed a metal cylinder – a stent – across the base of the aneurysm and then filled the expanded artery with a coil of platinum threads. Highly advanced X-ray equipment was used during the procedure to allow the surgeon to see his work.

The small size of the blister aneurysm – which was about as tiny as the tip of a No.  2 pencil – added to the challenge of repairing the rupture. The traditional microsurgical clip to close the aneurysm with open surgery would be difficult or impossible given the size, shape and location of the aneurysm. Using the coil embolization technique alone wouldn’t work either because the aneurysm was not deep enough to hold in the metal coils. Adding the stent to the process, however, provided enough support to keep the coils in place.

Ms. Waltz is thankful that the minimally invasive surgery is available at Christiana Care. Until she underwent the endovascular procedure, she had no idea it existed.

“The level of care I received at Christiana Care was excellent, from beginning to end.” she says. “I’m so thankful to live near a big hospital that was able to provide the team of doctors I needed.”

Statistically, Ms. Waltz is lucky. Dr. Satti said typically only about 30 percent of people who experience a ruptured aneurysm will survive to one year without a major disability.

Ms. Waltz had her emergency surgery in December 2010. Today, the 41-year-old from Bear, Del., is back at her job as a reporting analyst in the technology sector.

“Everything looks great,” she says. “I’m so lucky to be alive, and without any brain damage.”