A team of doctors on Wednesday successfully performed Guyana’s first minimally invasive brain aneurysm surgery.
The surgery was done at the Caribbean Heart Institute (CHI) by a team of doctors led by neurosurgeon Dr Amarnauth Dukhi and supported by an internationally-renowned intervention radiologist Dr Thyrous Yorkis through a joint public/private sector venture.
The surgery, which lasted two and a half hours and cost only a “small percentage” of the US$200,000 typically charged overseas, was performed on 56-year-old Paula Sampson, a Georgetown resident who is scheduled to be discharged today.
At a press conference hosted yesterday at the Georgetown Public Hospital’s Administration Building, New Market Street, Georgetown, Dr Dukhi announced that Guyana is now in line with the two other Caribbean countries that offer the service.
“This is something fantastic for our country, simply because we are now on par with what’s happening around the world with the first world countries. We may be just the third country in the Caribbean who is doing this, other than Trinidad and Jamaica,” Dr Dukhi said.
According to the Johns Hopkins University website, a brain aneurysm, also called a cerebral aneurysm or an intracranial aneurysm, is a ballooning arising from a weakened area in the wall of a blood vessel in the brain. It says if the brain aneurysm expands and the blood vessel wall becomes too thin, the aneurysm will rupture and bleed into the space around the brain. This event is called a subarachnoid hemorrhage and may cause a hemorrhagic (bleeding) stroke. The site notes that a rupturing brain aneurysm and a subarachnoid hemorrhage are life-threatening events.
Dr Dukhi said aneurysms are what neurosurgeons call a “ticking time bomb,” since in the case of a rupture 40% of the patients die, including 15% before they actually get to the hospital. He added that the 60% who survive have various neurological deficits.
According to Dr Dukhi, Sampson had an initial rupture about six weeks ago, which was treated conservatively and resolved. He said after diagnosis, Sampson had a second bleed. “…On a second bleed from brain aneurysm, 78% to 80% of those [patients] die. Fortunately for this particular patient, she made it through the second bleed,” he added, while noting that she couldn’t have been medevacked out of Guyana because of her condition.
Cerebral aneurysms, Dr Dukhi noted, can be treated in two ways. The first method requires a surgical intervention which involves opening and taking out piece of the skull, getting to the bottom of the brain and putting metal clip on the aneurysm, if located.
This procedure, Dr Dukhi said, is extremely risky since it entails the possibility of a rupture during surgery.
“Internationally what is being done currently is something what we call minimally invasive surgery. This simply means treating the aneurysm surgically without actually opening the skull,” he, however, added.
The procedure, he said, entails getting to the aneurysm, localising it and coiling it. “This is simply putting in a structure; a metallic structure that coils into this defect,” he noted, while pointing out that the likelihood of rupture is very high, especially in patients who are aged.
In this instance, the minimally invasive surgery or endovascular treatment involved using the femoral artery to be guided to the brain.
In Sampson’s case, he said, “We found one of the vessels in her brain that was closed down and we had to stent it. So, we actually put a stent in the brain. So we stented one of the vessels in the brain and we were able to sucessfully again coil this aneurysm.”
He said when this is done, a lot of risks are eliminated. “I am happy to say that this patient is going to be discharged tomorrow to go home, talking and everything,” Dr Dukhi said.
In terms of complications, he noted that in most of these cases, the risk of recanalisation of the aneurysm is there. “We are hoping that this case does not happen and this patient will be able to move forward with her normal life and activities,” Dr Dukhi said
