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Unique Surgical Approach Developed to Bypass Patient's Giant Aneurysm

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Neurosurgery

A unique surgical approach developed to bypass a giant aneurysm in the brain of a young woman from Chippewa Falls may help others who need a bypass for a brain tumor or aneurysm.

 

Dr. Mustafa K. Baskaya, a UW Health neurosurgeon, described the method in a recent issue of the journal Neurosurgical Focus. He used a branch of the femoral artery, transplanted from the patient's leg, to bypass the bulging in her brain's carotid artery.

 

"This is the first time this branch of the femoral artery has been used'' in such a brain surgery, Baskaya said, explaining that surgeons generally use arteries from the arms or veins from the legs.

 

The patient, Ashlee Sykora, was 22, and living in La Crosse, when she went to a doctor to find out why she hadn't had a menstrual period for years.

 

"When they checked my hormones, they were so out of whack that they figured I must have a pituitary tumor,'' said Sykora, who had graduated from Chippewa Valley Technical College and was working as a hair stylist.

 

Image of the brain

 

Dr. Mustafa Baskaya, MD, used a femoral artery from the patient's leg to bypass the aneurysm, the first time that blood vessel has been used in such a procedure. View larger image

 

Images courtesy of Betsy True

The pea-sized pituitary gland, located at the base of the brain, secretes hormones that regulate ovulation in women.

But an MRI revealed that she had something more life-threatening than a pituitary tumor - a giant aneurysm in the internal carotid artery that was pressing against the pituitary gland.

 

An aneurysm is a weakening of the blood vessel, which can cause it to balloon, and eventually burst. Sykora's aneurysm was unusually large - 3.5 by two centimeters, or about the size of a matchbook - which made surgery difficult.

 

Sykora came to UW Hospital and Clinics for what would become a series of brain surgeries.

 

First surgeons tried to clip the base of the aneurysm, but that surgery was unsuccessful. Sykora suffered a stroke during surgery and spent about three months in the hospital recovering.

 

Next, they tried endovascular coil embolization, a procedure in which small metal coils are inserted into the aneurysm. When successful, the coils expand, create a blood clot and cut off the blood flow. But this didn't work, either, because the coils compacted, so the aneurysm reoccurred.

 

Dr. Baskaya decided to try a bypass, in which the damaged section of the artery would be bypassed by a blood vessel graft. The normal candidate for a donor artery would be the radial artery in the arm. But in Sykora's case, the artery in one arm had been damaged by lines during her repeated hospitalizations and the artery in her other arm was unsuitable.

 

"She didn't have good arteries in her arms,'' Baskaya says, "and the veins are too big to be used for this kind of a bypass."

 

The superficial temporal artery in her brain was also unusable because it had been affected by earlier surgery.

 

So Dr. Baskaya decided to try something new: First, he teamed up with plastic surgeons who used a vessel which is the branch of the femoral artery. Plastic and heart surgeons used this artery before for different purposes. MR angiography showed that the femoral artery from Sykora's thigh was the right diameter and length to create an appropriate bypass. He used it to create a new route around the aneurysm, connecting it with the carotid artery in her neck, passing it in front of her ear (under the skin) and connecting into the internal carotid artery in the brain, past the site of the aneurysm.

 

The surgery, performed in Madison in July 2007, was a success. On follow-up, repeat angiograms proved the bypass artery is still patent and working nicely.

 

Baskaya said the technique may be useful for other types of vascular bypass brain surgery, such as those involving brain tumors and hard-to-treat vascular brain disease. Patients with atherosclerotic plaque in their brain may also have it in their arm arteries, so finding another substitute to use in bypass surgery is good news for our aging population.

 

"Arteries that are long, have large caliber and are expandable are precious to surgeons who perform a vascular bypass," Baskaya and his co-authors noted in their article. "Unfortunately, only a limited number of vessels fit this description."

 

Sykora said she hasn't seen the journal article, but is glad that her case might help others with serious health problems.

 

"It went really well,'' said Sykora, who calls Baskaya, "a miracle worker."

 
She was able to go home within about a week after her surgery. A year later, she still has some weakness in one hand that prevents her from cutting hair, and is considering going back to school for another career. But compared to how her future looked when she got the diagnosis, she said she's doing well.

 

"I was really freaked out when I found out about the aneurysm,'' she said. "I'm really grateful. Everyone involved in helping me did a good job and I'm thankful to them."