"He survived the accident but could we stop
Mr. Murugan was already a multiple trauma
accident victim. Would he have to undergo
major skull surgery as well?
March 18, 2007. An eventful day for 40-yr
old Mr. Murugan. It was the day he survived
a terrible road traffic accident. He was
rushed to the nearest hospital for
emergency treatment and shifted to
MIOT Hospitals the
Bleeding in the brain
On examination we found Murugan unconscious
with lacerations in various parts of his
body and fractures in his facial bones. A CT
scan of the brain showed air in the
coverings of the brain. He also had a
weakness in the left upper limbs. This was
due to reduced blood supply to the right
half of brain. A CT scan angio done to study
the brain blood vessels showed a laceration
(tear) of the right internal carotid artery
in the brain with pseudo aneurysm formation
(bulging blood vessel).
What needed to be done at once was to plug
the blood leaking from the damaged artery.
By the time the patient was taken for the
procedure the aneurysm had trebled in size.
To prevent it from rupture we decided to
block the blood supply to the aneurysm by
sealing the blood vessels on either side of
A radical new technique
The conventional surgical technique would be
to open the skull and ligate the artery
beyond the aneurysm and open the neck and
ligate the other end. By doing this the
blood flow into aneurysm can be stopped.
Now MIOT can perform the same
procedure through one small pinhole-sized
puncture in the groin. From the right
femoral artery, a catheter was navigated
into the offending brain blood vessel in the
digital cath lab. Here we ran into a
problem. The small branches of the blood
vessel were so convoluted that we could not
get the stent graft through. We were on the
verge of turning this into an open surgery,
when one of MIOT Hospitals Cardiologist
had a brainwave. He suggested that we try
the baby catheter, which is as thin as a
hair, to get past the blood vessel, so that
we could plug the vessel before the aneurysm
and the one beyond it. This worked
brilliantly and the plugs successfully
blocked the blood flow into the aneurysm.
Mr. Murugan recovered very well from the
procedure and resumed normal activity within
A pinhole escape!
Post-traumatic aneurysms are abnormal bulges
that can result in heavy bleeding and lead
to death. This is a dangerous condition and
needs to be treated effectively. The
aneurysm had trebled in size within 2 days.
Timely intervention without any open surgery
led to a faster recovery.
Other areas in brain where such
interventions are performed.
Berry aneurysm of brain- coil embolisation of
aneurysm is done.
Arterio venous malformation of brain –
embolisation – done with liquid agents.
Treatment of carotid cavernous fistula, which
result in pulsatile bulging of the eyes.
Treatment of dural fistulas.
Intracranial balloon angioplasty and stenting - to
Blockade of hypervascular tumors - prior to open
Large aneurysm following trauma blocked by
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