A 70-year-old lady came to us complaining of sudden onset of severe headache, which she described as the worst in her life on August 3, 2017. A CT Scan revealed subarachnoid hemorrhage (leaking of blood into the cerebro spinal fluid at the base of the brain). A cerebral angiography traced the leakage to a ballooning part of brain artery called basilar artery. The location of this ballooning (aneurysm) is so critical that open surgery is extremely difficult and has very high rate of complications. However, with an advanced endovascular intra operative angio-suite and special micro-devices (called catheters and coils) the leaking blood vessel was sealed and the ballooned blood vessel was packed with coils to ensure that it does not bleed again. A major operation was, therefore, avoided. The arrow in Picture A shows ballooning of the artery. The Picture B taken post the endovascular coiling operation shows that it is no longer filling with blood. The operation was difficult as an important artery, which supplies blood to a critical part of the brain was in close association with the neck of the balloon, which had to be preserved in order to prevent devastating neurological deficits. This challenge was successfully met during the two-hour surgery. The patient regained full conscious and had no neurological deficits after the procedure. Her headaches disappeared and she was discharged in 72 hours.
Fig A: Basilar artery of the brain with a balloon like enlargement
Fig B: Complete occlusion with coiling.