A 42-year-old suffering from ruptured brain aneurysm was saved through a successful endovascular treatment. Brain aneurysm, which is a bulge in a blood vessel able to lead to a subarachnoid hemorrhage, was treated by using a self-expanding contour device that fills the aneurysm, preventing blood flow into the weakened area and reducing the risk of rupture.
A 42-year-old male was presented to the emergency department with a sudden onset of a severe headache and episodes of vomiting in daytime. The intensity of the headache was described as the worst he had ever experienced. Upon arrival, the patient underwent an MRI scan, which revealed bleeding in the frontal lobe of the brain, suggesting a high likelihood of an aneurysmal bleed. An angiogram confirmed the presence of an aneurysm, specifically an outpouching of one of the anteriorly supplying vessels, which had ruptured.A brain aneurysm is a bulge or ballooning in a blood vessel in the brain due to a weakness in the vessel wall. This can lead to a subarachnoid hemorrhage, a type of bleeding in the space surrounding the brain, which is a life-threatening condition. Symptoms include severe headache, vomiting, altered sensorium, and in severe cases, a comatose state. Rapid diagnosis and treatment are critical to prevent re-bleeding and other complications.
The primary goal of treating a brain aneurysm is to prevent re-bleeding. Traditionally, this was done through a surgical procedure known as clipping. During clipping, a neurosurgeon opens the skull and places a metal clip on the neck of the aneurysm to stop blood flow into it. This procedure, while effective, is highly invasive.
However, with advancement in medical technology have led to less invasive treatments for brain aneurysms. One such treatment is coiling, where a catheter is inserted through the groin and navigated to the brain. Tiny platinum coils are then placed inside the aneurysm, promoting blood clotting and effectively sealing it off from the artery.
Considering the broad-neck nature of the aneurysm, traditional coiling was deemed unsuitable, the medical team, led by neurologist Dr. Sheetal Goyal, and interventional neuro-radiologist Dr. Dharav Kheradia of Wockhardt Hospital Mumbai Central, decided to use a contour device, a self-expanding basket-like structure that is inserted into the aneurysm through a catheter.
Once in place, it expands to fill the aneurysm, preventing blood flow into the weakened area and reducing the risk of rupture. This procedure is minimally invasive, involving no major incisions or opening of the skull, which significantly reduces recovery time and the risk of infection.The patient underwent Digital Subtraction Angiography (DSA) to accurately map the aneurysm's size and characteristics. That same night, the contour device was placed and the aneurysm was secured. The patient tolerated the procedure well and showed no neurological deficits post-intervention.
Dr. Goyal said, "The patient's case underscores the importance of immediate medical attention for sudden onset headaches, which can be indicative of severe underlying conditions like aneurysms. The use of advanced endovascular techniques, such as the contour device, offers a minimally invasive option with faster recovery times and reduced risks compared to traditional open surgery."
Dr. Kheradia said, "Brain aneurysms are serious and potentially life-threatening conditions that require immediate medical attention. Advances in medical technology, such as endovascular treatments, have significantly improved outcomes for patients. Procedures like coiling and the use of Contour devices offer less invasive, highly effective alternatives to traditional surgical methods, reducing recovery times and associated risks."
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