Novel micro-catheter fluorescent dye method to treat aneurysm in deep brain

Nov 27 2013

In March 2013, Eric Wagner told his wife to call 9-1-1 because he was feeling the worst that he had ever felt. He was rushed by EMS to University Hospitals (UH) Ahuja Medical Center, and then airlifted to UH Case Medical Center, where brain scans showed that he had a ruptured aneurysm, a leaking blister on a blood vessel that was letting blood flow into his brain and causing a stroke.

To make matters worse, the aneurysm was located deep in his brain. Fortunately, UH neuroradiologist Jeffrey Sunshine, MD, PhD, closed off the blister with a series of small titanium coils that stemmed the blood flow to that weakened area.

But when Wagner came back for a followup exam in October shortly before his 25th birthday, scans showed that the blister had formed again, which is not unusual for the type of aneurysm that he had, according to Nicholas Bambakidis, MD, Director of Cerebrovascular and Skull Base Surgery in the Department of Neurological Surgery at UH Case Medical Center and Wagner's surgeon.

Dr. Sunshine, who is also Vice Chairman of Radiology at UH Case Medical Center, said of the aneurysm, "It came back with such vigor and growth in such a short amount of time that I've never seen anything like it in 30 years."

"The difficult thing about this case is that his aneurysm is in a part of the brain that controls speech and movement in the right side of his body, so stroke in this location could leave him with the inability to understand speech or talk in any way," said Dr. Bambakidis, who is Director of Cerebrovascular and Skull Base Surgery in the Department of Neurological Surgery at UH Case Medical Center.

Dr. Bambakidis knew that the only definitive way of avoiding a recurrence was to bypass the blood vessel entirely. Otherwise, the aneurysm would return with the same dire consequences.

He decided on a brain bypass, much like a heart bypass. In this case, another vessel would be taken from the patient's scalp and then sewn in to allow blood flow around the weakened area. But finding the exact artery feeding that aneurysm in a myriad of blood vessels deep in the brain was an obstacle the surgeon needed to overcome.

He proposed a rare and relatively new solution, placing a micro-catheter into the aneurysm and shooting a fluorescent dye usually used in eye operations to light up the correct vessel and show them the way.

Said Dr. Sunshine, "When you open up and look at the surface of the brain, there's just a plethora, a number of large arteries. Which one you have to sew into doesn't come with a marker. And so, we were able to use these new technologies to generate our own marker. And that was absolutely key to his success."

He added, "What was really unique about this and a credit to Dr. Bambakidis was to use the technique of putting the catheter in and leaving it and to inject a dye that can be seen through the operative microscope to positively confirm in advance to know where we had to sew one vessel to the other. That was really novel and incredibly important for this patient."

It was the first time for the procedure at UH, one of only a handful of medical centers around the country with the technology and personnel capable of performing the complex procedure.

Once Dr. Sunshine inserted the catheter and injected the dye, the correct vessel lit up brightly while leaving the rest of the brain's blood vessels in the dark.

With that glowing roadmap, Dr. Bambakidis then took the small blood vessel that he had carefully removed from the scalp earlier and sewed it into place. From the operating room, Wagner was taken back to radiology where Dr. Sunshine permanently closed off the aneurysm with another series of coils and could check if the blood flow was working properly and around the blister.

A few days following surgery in November, Wagner was doing well, with no pain and little swelling, and surrounded by his family, including his wife Brittany.

"I look forward to enjoying my life and family and getting back to work. And living the rest of my life without any limitations," said Wagner. "My birthday was on October 29, and that was shortly after I found out I was going to have to have the surgery, and if I'm honest, it was the worst birthday I've ever had. But I'm planning on having the best Thanksgiving I've ever had now. I have lots to be thankful for."

Wagner is originally from Carrollton, Ohio, south of Canton, where his family still lives. Wagner and his wife live in the Lancing, Mich. area.

Source University Hospitals