TREATING BRAIN ANEURYSMS
Brain aneurysms affect up to 15 million Americans. Until recently, patients with some types of aneurysms were sent home to die. But now some doctors are using technology to treat the condition.
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At age 54, Ursula Spear was not only in pain, she was losing the use of her arms and legs.
Ursula Spear
Had an aneurysm
"Cleaning the ceiling, something like that, oh my God, I just couldn't do it."
Finally, an MRI revealed the problem.
Ursula Spear
"Oh, you have an aneurysm, and it's inoperable."
A dolichoectatic aneurysm was pressing on Ursula's brain stem. Her prognosis was bleak.
Michael Lawton, MD
Neurosurgeon
University of California, San Francisco
San Francisco, California
"They go from being normal, healthy patients to being wheelchair-bound to having aspiration pneumonia, to being institutionalized and ultimately dying."
But Ursula refused to give up. She found a surgeon at the University of California who was using computer modeling to operate on "inoperable" brain aneurysms.
Michael Lawton, MD
"It's going to revolutionize the way we look at aneurysms."
To treat Ursula's aneurysm, doctors would have to close one or both arteries leading to it, perform a bypass by grafting a vein from one end to the other or do both.
Michael Lawton, MD
"Frankly, there's a lot of guess work, and the risks of intervening are high."
Doctors cannot predict how this type of aneurysm will react to the various strategies. But computers can.
Michael Lawton, MD
"The computer can look at each one and say, 'Alright, this is the best intervention to try to reduce that.'"
Based on computer modeling, Doctor Lawton shut one artery and did a bypass. The results are dramatic. Ursula's aneurysm has shrunk from this to a safe size.
Ursula's head and neck aches are gone. And she's even happy to be able to do mundane tasks that were once impossible.
The technique is only being used at UCSF, and Doctor Lawton says they are conducting a study to determine its accuracy. Right now, it's only being used on certain types of aneurysms, but he says it could be used on all types in the near future.
BRAIN ANEURYSMS: A brain aneurysm is a ballooning-out of the wall of an artery in the brain. Often this wall is weakened by disease, injury or an abnormality present at birth. Aneurysms are often caused or made worse by high blood pressure. They are not always life-threatening, but serious consequences, such as a stroke, can result if one bursts in the brain. This is called a hemorrhagic (or bleeding) stroke. When a blood vessel on the brain's surface ruptures and bleeds into the space between the brain and the skull -- but not into the brain itself -- it is called a subarachnoid hemorrhage. When an artery in the brain bursts, flooding the surrounding tissue with blood, it's called a cerebral hemorrhage.
DETECTING ANEURYSMS: Several imaging techniques, such as X-ray angiography, magnetic resonance imaging (MRI) or computed tomography (CT), are used to detect aneurysms. An aneurysm may be small and not cause symptoms. A doctor will want to check it regularly to see if it's enlarging. Symptoms of an aneurysm depend on where it's located. Aneurysms in the brain can cause impaired vision and headaches. The larger an aneurysm becomes, the more likely it is to burst.
STANDARD TREATMENT: Brain aneurysms are generally treated surgically. In surgical treatment for a brain aneurysm, tiny metal clips are typically used to separate the aneurysm from the normal vessel. The clips keep blood from entering the aneurysm, and as a result, future bleeding is prevented, and nearby brain tissue is protected. For more aneurysms that are in difficult areas or contain clots inside of them, the blades of the clip are unable to squeeze the aneurysm or make the separation from the normal vessel.
NEW HOPE: New computer technology now offers patients with particularly dangerous aneurysms new hope. The program produces 3-D images of the blood pounding through brain arteries almost like engineers visualize wind currents around airplanes. Guided by those models, surgeons cut into the brain and rerouted part of the blood flowing through the critical artery, easing stress on aneurysms until it essentially healed over. "There are a lot of people probably being told, 'My God, this is a horrible aneurysm. We have nothing to offer you. You'll probably be dead in two to five years,"' Michael Lawton, M.D., a neurosurgeon at the University of California, San Francisco, says. "We think we have something to offer that may stop this downward spiral." About 20 patients have had the imaging since the project began in 2002, and Dr. Lawton believes many patients' lives will be saved by this new technique.
Carol Hyman
University of California, San Francisco
San Francisco Medical Center
3333 California St. Ste 103
San Francisco, CA
94143-0462
(415) 476-2557
chyman@pubaff.ucsf.edu
pub.ucsf.edu
Copyright © 2006 Ivanhoe Broadcast News, Inc.
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