The Telegraph
Since 1st March, 1999
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Radiology success in major brain surgery

CT or MRI scans, angiographies and other radiological tools are normally used to diagnose medical problems and provide relevant inputs for doctors to decide on the therapy of choice. Interventional radiology, however, notched a significant first in eastern India when it was successfully used to treat a complicated brain disorder by a minimally invasive method at a city hospital.

When 49-year-old Rina Chakraborty first had a bout of severe headache and collapsed on the road, little did she realise that a killer disease was stalking her. She was sent for a CT scan to Apollo Gleneagles Hospitals, which showed a very small thrombus (clotted blood) in a most unusual location, the cisterna magna (a space behind the brain usually filled with a small amount of fluid).

Doctors advised another CT scan with contrast. The imaging revealed a fresh major bleed with a pattern that suggested a very serious pathology — an aneurysm — from one of the arteries supplying an important part of the brain known as PICA (postero-inferior cerebeller artery). Another bleed could have been fatal.

Rina was admitted to Apollo Gleneagles and the cerebral angiography done the same night revealed that the aneurysm was far away in the left-sided PICA, with a cerebral circulation pattern that made a stroke look imminent. After an initial couple of days, blood vessels supplying the brain started narrowing.

Neurosurgeon Siddhartha Ghosh and interventional neuroradiologist Manash Saha decided to go in for minimally invasive treatment, as the patient’s clinical status was too critical for open surgery.

They opted for coiling, a new form of treatment where a thin tube is passed through the groin region, taken up to the aneurysm and packed with coils, without opening the skull. But the aneurysm was situated so far and the artery was so small, that it was not possible to reach near the lesion and coil it.

So they decided to do occlusion of the artery with the aneurysm by injection of glue.

Under special anaesthesia, the artery with aneurysm was occluded by the glue injection.

The entire procedure was completed in one-and-a-half hours and the patient closely observed after that. A month on, she was almost fully recovered and discharged with a minimal problem on the left side. A shunt operation was also done during her stay in hospital.

“It was a case of subarachnoid haemorrhage that presented in a very unusual way. Untreated, this condition has a mortality rate of around 40 per cent in the first few weeks. A cerebral angiography should be done on an emergency basis, since nobody can predict when a second bleed will occur,” observes Saha.

Apollo Gleneagles Hospitals has now started a full-fledged facility of such treatment with a dedicated team of doctors, including a neurologist, neurosurgeon, neuroradiologist and neuroanasthetist.

The super-speciality team decides on patient management together. According to Saha, this is the first time a case was dealt in this way in eastern India. “Till date, only a few cases have been performed using this technique all over India for such a distally-located aneurysm,” he adds.

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