MIOT Hospitals Pinhole Surgery Case Study 2




"He survived the accident but could we stop the bleeding?"

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 next day.

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 it.

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 48 hours.

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 prevent strokes.

  • Blockade of hypervascular tumors - prior to open surgery.

  • Large aneurysm following trauma blocked by vascular plugs.

To know more about MIOT Hospitals, MIOT Hospitals various Departments, MIOT Hospitals Emergency Services, MIOT Accident Rescue Services, MIOT Hospitals Contact Information and other MIOT Hospitals websites, please visit www.miothospitals.com