Fall 2016
Treating Unruptured Aneurysms Can Be An Overnight Success
Patients Return Home The Next Day And Avoid Craniotomy With Pipeline Embolization Device

The Pipeline embolization device spans the aneurysm opening to prevent blood from flowing into the aneurysm. Without blood pressing against its walls, the aneurysm will deflate over time like a balloon, as shown in the illustration below.
It’s not often that dental implants lead to discovery of an aneurysm, but that’s exactly what happened to Beth Quinn. After implant surgery in 2010, Beth experienced excruciating pain in her jaw. Over the next two years she tried pain medication and even underwent root canals to find relief. In 2012, a head CT uncovered something unexpected - an unruptured aneurysm.

Beth’s primary care provider referred her to Carolina Neurosurgery & Spine Associates for care. The aneurysm was very large and compressing nearby nerves that control eye movement. Immediate action was needed to treat the aneurysm before it did permanent damage to the nerves or ruptured, leading to severe disability or death.

“In a way that made it easier,” Beth remarked. “The only option was to move forward.”

Historically, patients in Beth’s situation would undergo a craniotomy to clip the aneurysm. This traditional, open surgery normally requires weeks of recovery, but Carolina Neurosurgery & Spine Associates neurosurgeon Joe Bernard, MD, determined that Beth was a candidate for a less invasive endovascular procedure. Dr. Bernard used a Pipeline embolization device to collapse her aneurysm without open brain surgery.

Beth Quinn

The Pipeline embolization device is a mesh tube put in place by threading a catheter in the leg. The device spans the aneurysm opening and diverts the flow of blood away from the aneurysm, which eventually causes it to collapse. Unlike those undergoing traditional aneurysm surgery, Pipeline patients typically go home from the hospital one day after their procedure and return to normal activities within just a few days. Dr. Bernard was the first in North Carolina to implant a Pipeline device in 2011. He now teaches the procedure to other surgeons across the country.

After having the Pipeline procedure, Beth returned home the next day with only a slight headache. Now, four years later, she’s still doing great.

“My story has a very happy ending,” said Beth. “An ending made possible by Dr. Bernard and this practice.”

“Pipeline is an incredible breakthrough that makes it possible to offer a less invasive option for treating patients with large or giant aneurysms,” said Dr. Bernard.

Treating Unruptured Aneurysms Of All Sizes
Dr. Bernard cautions that the Pipeline embolization device is not the right solution for every aneurysm. Other endovascular techniques or traditional open surgery may be a better option for success depending on the specifics of the aneurysm.

The neurosurgeons of Carolina Neurosurgery & Spine Associates have the expertise and experience to help patients select the best treatment based on the size, shape and location of an aneurysm with the least risk possible.

Coil embolization
Aneurysm clipping

Endovascular Approaches To Aneurysms
Like the Pipeline embolization device, most other endovascular procedures are catheter-based and address diseased vessels from the inside, without the need for a craniotomy. Some aneurysms are effectively treated by using coils to fill the aneurysm space to lower the chance of rupture. Other advanced devices, such as the Neuroform stent system, combine the use of coils and a small mesh tube stent. This stent is placed across the neck of an aneurysm with a wide opening to prevent the coils from coming out into the normal blood vessel.

Aneurysm Clipping
Some aneurysms cannot be treated using endovascular techniques. These aneurysms usually require clipping, a procedure in which a small metal clip is placed at the base of the aneurysm. This process cuts off blood supply to the aneurysm, lowers pressure inside the aneurysm walls and reduces the chance of rupture. Aneurysm clipping usually requires the removal of part of the skull in order to reach the aneurysm. When the procedure is over, the “skull flap” is put back in place and anchored with plates and screws.

Eyebrow Craniotomy
If aneurysm clipping is required, a less invasive option is available for some patients. The eyebrow craniotomy is a minimally invasive approach to access the brain using a much smaller incision than traditional brain surgery. During this procedure, an incision is made along the edge of the eyebrow and a keyhole opening is then created in the skull. The neurosurgeons of Carolina Neurosurgery & Spine Associates are one of the few groups in the Carolinas using this innovative technique to clip aneurysms, remove brain tumors and treat other brain disorders. Eyebrow craniotomy reduces the risk of brain damage during surgery because brain retractors are not required. This less invasive approach has proven to enhance patient recovery time without sacrificing outcomes.

Intraoperative Angiography
In some cases, we are able to perform intraoperative angiography during surgery to ensure that blood is flowing properly through the operative area, instead of waiting until after surgery to do an angiogram. This makes it possible to adjust an aneurysm clip or stent, if needed, to make sure the aneurysm has been addressed and there is optimal blood flow through the vessels.

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