Madrid
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Not every time a brain aneurysm you have to intervene. In cases where it is, where it is likely to break or it is already broken, there are basically two types of procedures, endovascular treatment and open surgery (the latter reserved for selected cases), in the case of endovascular treatment using a catheterization, the arteries of the brain are navigated reaching the aneurysm that must be treated (embolization). It is precisely in this last field that great progress has been made, with Spain as one of the protagonists.
Thus, pioneeringly,
Interventional Neuroradiology Unit of the Jiménez Díaz Foundation (Madrid) has successfully operated on an aneurysm in the wrist of a patient, who was conscious at all times, and who was also discharged on the same day.
The doctor Claudio Rodriguez Fernandez is the head of the Interventional Neuroradiology Unit of this Madrid hospital, belonging to the group
Quironsaludand responsible for this milestone in contemporary medicinewhich have been applied in cases of unruptured aneurysms and that meet the selection criteria for this protocol.
In order to understand it, explain that brain aneurysms are weaker or thinner points that bulge or swell in an artery in the brain, filling with blood. “On many occasions they are detected because the patient is being tested for another reason. Among the main dangers of aneurysms is that they can burst or rupture, causing serious health problems in patients, such as the dreaded subarachnoid hemorrhage that can ultimately lead to serious neurological sequelae or even death. They are more frequent in women, and between 30 and 60 years old, although they can occur at any age and person, ”points out the expert.
Specifically, Dr. Rodríguez Fernández points out that the Fundación Jiménez Díaz has various protocols for this type of pathology, including one of high resolution and minimal invasion applicable to a subgroup of patients, and in which various aspects are taken into account such as age, patient comorbidities, characteristics and location of the aneurysm to be treated, as well as the type of device required to seal the aneurysm.
In this case they treated Waita patient who already has two operations for a brain aneurysm behind her, the first in the groin and the second that has been performed from the wrist with this new protocol.
«The first time, although everything had gone well, by protocol, I had to spend the first night in the ICU; while in this second intervention, following a few hours on the floor, I went home the same day, and that night I was using the mobile phone with the hand where I had been operated on to talk to my doctors and family. The recovery was better and faster, with less pain and discomfort from the scar », he recalls.
This procedure, in the opinion of the head of the Interventional Neuroradiology Unit of the Jiménez Díaz Foundationrepresents a “pioneering technique in Europe and in much of the world», which is characterized by minimal invasion to the patient, as well as greater comfort for him, and with clinical results similar to the standard technique, apart of course from an «optimal psychological process».
It is “safe, effective, and efficient”, and in different bibliographic series fewer complications have been shown than the standard treatment, according to the interventional neuroradiologist. “At the Fundación Jiménez Díaz we are pioneers in this technique and in treating aneurysms in this way,” the doctor remarks.
Local anesthesia and patient collaboration
The operation consisted of an outpatient intervention (with local anesthesia) of a cerebral aneurysm by radial approach (through the wrist) with the patient awake, and who was discharged on the same day, only six hours following the intervention.
Specifically, it was the second picture of this type that had to be operated on in the same patient, since a little more than two years before, Dayana’s constant blood pressure surges, 45 years old, led her to carry out various tests that gave with the final diagnosis of two cerebral aneurysms.
The first, located in the left side of the brain, was then operated on using the usual procedure: with a femoral approach (through the groin), general anesthesia and between 48 hours and four days of admission. It was a success in medical terms and in terms of the patient’s recovery, but Dayana had a very bad time from a psychological point of viewaccording to Dr. Rodríguez Fernández.
To treat this second aneurysm that continued to grow, this time located on the contralateral side of the brain, his team proposed the new high-resolution protocol that they have been carrying out in selected patients: operating through the wrist with local anesthesia, which facilitates communication and monitoring of the patient during treatment, as well as early discharge in the first six hours following the intervention.
There are currently other hospitals that operate on cerebral aneurysms by radial approach, which do so with local anesthesia with the patient slightly sedated or even, in some pioneering centers in the US, on an outpatient basis; but doing it by uniting these conditions, as well as optimizing the processes that may invade the patient such as (probes, central lines, etc.) in the same intervention, all this associated with a monitoring program during the hours following discharge, is something pioneer that the Fundación Jiménez Díaz has been implementing for more than a year in selected patients.
Dayana’s neurovascular intervention might be performed according to this pioneering protocolon the one hand, because the patient met the inclusion criteria in terms of characteristics of the aneurysm to be treated, age, comorbidity and absence of other risk factors, added to her preferences and compliance with the therapeutic proposal and, on the other hand, because the technical endowment and experience of the team of the Interventional Neuroradiology Unit of the Fundación Jiménez Díaz.
“Recovery was better and faster, with less pain and discomfort,” recalls Dayana just six days following the intervention, acknowledging that, although the logical fear passed at the time of hearing the diagnosis, knowing that there were good treatment alternatives and the help, information and accompaniment of the hospital professionals, in his opinion, made the difference.
