Expert Surgical Team Removes Complex Aneurysm Deep in Patient’s Brain
Angela Quashie likes to be thorough. That’s why the Chicago mother of three decided to get a full physical in 2011. The decision may have saved her life.
The University of Chicago Medicine team discovered an aneurysm, or weakened blood vessel, in an area of her brain where she had undergone radiation treatment for another congenital blood vessel anomaly at a different institution 18 years earlier.
“I had thought that the old problem was over,” Quashie said. “But it is so important to listen to your body even if it is just a small whisper. That’s how I would describe the occasional faint, pulsing pain above my left ear.”
The original blood vessel anomaly had disappeared with the irradiation, but some of the vessels in her brain had weakened over time, and a new aneurysm had formed. ”Her previous treatment had worked well,” said Issam A. Awad, MD, director of neurovascular surgery at the University of Chicago Medicine. “But the radiation treatment may have caused progressive weakening of her normal brain arteries over the years.”
A cerebral aneurysm is the ballooning of one of the brain’s arteries. If it bursts, there may be massive, and often fatal, bleeding in the brain.
In Quashie’s case, the aneurysm posed a serious threat. “Any brain aneurysm is serious enough, but hers was deep in the brain. It was difficult to reach and right in the middle of Angela’s speech centers. Any bleeding before, during or after surgery would have devastating consequences,” said Awad. But he was confident, given his extensive experience with such complicated surgeries, that it was her best option.
This recommendation was not made lightly. University of Chicago Medicine physicians take a team approach to medical problem-solving, including weekly neurovascular conferences that gather 20 to 30 practitioners in diverse specialties to review new and complicated cases.
“We have colleagues here who are international leaders in particular aspects of neurovascular conditions, including surgery, catheter techniques, genetics, radiation treatment, imaging and pharmacology,” Awad said. “Getting them together in one room is phenomenally helpful.”
Advanced computed tomography (CT), magnetic resonance imaging (MRI), and selective cerebral angiography techniques with microcatheters are vital in pinpointing neurovascular problems. “We use imaging to confirm diagnoses and then that imaging becomes the road map for everything we do,” Awad said. “Certain problems are quite benign and we can safely reassure patients that nothing needs to be done now. In other cases, imaging will reveal that surgery is needed, perhaps urgently.” But it takes extensive experience to know the difference. Awad has performed hundreds of major neurovascular surgery procedures in his career, including many of the most complex procedures ever performed on the human brain.
In Quashie’s case, a comparison between old and new scans showed that the aneurysm had developed after her previous treatment. “This made the situation much more urgent because it meant the aneurysm was not stable,” Awad said. “It was like driving down the highway on bald tires. A rupture could occur at any time and the consequences would be dire.”
Quashie was shocked. “I was surprised by the diagnosis, because my pain was infrequent and barely noticeable.”
For Quashie, retaining her ability to communicate verbally with the outside world after surgery was paramount. A devout Mahayana Buddhist, she chants daily in prayer. She also loves to express herself through song. A first soprano, she sings in several choral groups at the Nichiren Buddhist community center in the South Loop and at local restaurants and parties.
“My voice is crucial to enjoying life,” Quashie said. “At first, I was hesitant to undergo another surgery, but Dr. Awad was right there with me, already formulating a treatment plan. His confidence instilled confidence in me as well, and I sensed his compassion and genuine concern for my life.”
Awad often spends considerable time making sure patients have all the information they need. “Office visits last 60 to 90 minutes because I must be sure the patient understands the problem and proposed treatment fully,” he said. “I try to give a crash course in that particular problem so the patient and family can make an informed decision.”
From his perspective, Awad finds that a knowledgeable patient makes his work easier. “When patients meet someone who knows a lot about their problem, they feel reassured, no matter how concerning their prognosis is. They want to learn everything they can and they want a team who deals with their type of problem every day, which we do,” he said. “There is absolutely nothing more helpful than a patient and family who understand that we have embarked on a very serious partnership together.”
Quashie’s six-hour surgery was successful. Following a two-month recovery period free of any unexpected major side effects, she returned to her job as a fellowship coordinator at the University of Chicago Medicine in November 2011. She subsequently was readmitted for a minor setback, when another new tiny aneurysm was discovered in the same area of her brain. This was treated successfully using an endovascular catheter technique to repair the aneurysm without open surgery. Access to these different treatment modalities for complex problems is another advantage of the multidisciplinary care provided at the University of Chicago Medicine.
Quashie’s recovery was swift, and she knows the team will be here for her in case of future problems.
“I am 100 percent recovered now,” Quashie said. “It’s as if I never had vascular brain surgery. I am truly grateful to Dr. Awad and his team for saving my life and restoring me to full health.”