Bronson Neuroscience team takes on giant aneurysm

What started as a trip to buy new eyeglasses led to one of medicine’s scariest diagnoses for Bridgman resident, Laurel Rosebush. Her journey took her to Bronson Methodist Hospital in Kalamazoo, where neuroscience specialists using minimally invasive surgery and new technology saved her life.

When she started making mistakes on the job, Rosebush, 56, thought it was time for a new eyeglass prescription. She had been employed at a casino near her home for years, working the slot machine floor without any problems. But in the space of just a few weeks, she wrote down an incorrect social security number for jackpot winners--twice. "I am not a person to make those kinds of errors," Rosebush says. She was also having more headaches than usual--another problem she thought a new pair of glasses would fix.

Luckily, a vision technician at her optometrist’s office recognized that Rosebush’s right pupil was dilated more than the left one and urged her to see a specialist for a CT scan. Rosebush’s scan results revealed a brain aneurysm arising from the carotid artery, pressing on her right optic nerve.

"No one wants to hear, ‘You have a brain aneurysm,’" Rosebush says. "At first I couldn’t breathe."

Rosebush next saw neurosurgeon Christian Sikorski, MD, with Lakeland Neurosurgery. He ordered a CT scan and other tests. Rosebush learned her aneurysm was very large--classified as "giant"--and it was also the "large-neck" variety, meaning it had a wide opening at its base. Both attributes would make treatment difficult and possibly cause problems to nearby brain structures.

Aneurysms are weak spots in blood vessels that are enlarged and stretched thin.  Left untreated, they can burst. If they burst in an artery that brings blood to the brain, stroke or death is often the result. Every year, 30,000 people in the United States have a ruptured brain aneurysm. This condition is more prevalent in people ages 50 to 60 and three times more prevalent in women.

Aneurysms are most often treated by inserting tiny coils into the aneurysm to divert blood flow. But Rosebush’s aneurysm was so large that inserting many coils would cause problems from additional pressure. The other traditional treatment--clipping, or opening the brain to seal off the base of the aneurysm with a tiny clip--wasn’t an option either. At three centimeters, the size of the aneurysm made major, invasive surgery very risky.

Dr. Sikorski through his professional relationship with Dr. Jeffrey Miller, a neurointerventional surgeon with Bronson Neuroscience Center in Kalamazoo, was aware of a new stent technology called Pipeline. Approved by the FDA two years ago, Pipeline is a flexible mesh tube made of platinum and nickel-cobalt chromium alloy.

It is attached to a catheter and inserted into an artery in the groin, then threaded up into the carotid artery inside the brain. It is expanded against the neck of the aneurysm to divert blood flow away from the aneurysm. The blood remaining inside the aneurysm forms a clot, making the aneurysm less likely to grow or rupture. Aneurysms treated with the Pipeline often shrink or even disappear over time.

Dr.  Miller met with Rosebush and her husband to explain the new procedure. "We totally trusted him," Rosebush says. "We could have gone anywhere--Mayo, or someplace like that--but we had heard so many positive things about Bronson’s neuroscience program that we were at ease before we even got there."

In followup testing after the treatment, Rosebush’s brain scans were clear--her aneurysm was gone. Vision in Rosebush’s right eye is still impaired, but the blur that was once dark now appears lighter and she hopes it will yet improve. She doesn't complain about her sight, however, considering how serious her condition was.

"I’m just lucky to be here," Rosebush says. "If it weren’t for Dr. Miller and this procedure, without a doubt I wouldn’t be here right now."

Bronson has been ranked by HealthGrades as one of America's 100 Best Hospitals for Stroke Care for 2012-2013, and ranked in the top five percent of hospitals in the nation for treatment of stroke for 2012-2013, neurosurgery for 2013 and for neurosciences for 2012-2013.

Source: Candice Elders, Bronson Methodist Hospital
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