Surgery, giant aneurysm removed from the brain of a 24-year-old

Like a ‘balloon’ ready to burst inside the brain. Thus, the giant aneurysm of 4 centimeters in the brain of a 24-year-old girl, removed with a life-saving surgery at the Niguarda hospital in Milan, presented itself to imaging. The first signs of her presence: a severe headache. Headache. Then the diagnosis. A death sentence that freezes Anna’s life (not her real name). The risk of rupture is indeed very high, doctors say. The girl suddenly finds herself grappling with a time bomb in her head, in a condition of concrete and imminent danger. With an aggravating circumstance: the observation, by the specialists who follow her, of the difficulty of intervening surgically. Cases of carotid aneurysms, such as Anna’s, are frequently treated with endovascular closure of the artery, a procedure possible thanks to the compensation that can be provided by the other cerebral vessels. But this path proves not to be feasible for her, because in the preliminary vascular closure test Anna becomes temporarily paralyzed on the left side of her body. The doctors of the Venetian hospital where she is followed thus turn to the Neurosurgery of the Niguarda and Anna is taken care of by the specialists of the Milanese hospital. “Cerebral aneurysm is an acquired pathology in which the wall of a cerebral artery becomes thin and forms a balloon that is likely to explode. In this case it was a swelling of the internal carotid artery with a diameter of 4 cm (the aneurysms are defined as ‘giants’ above 2.5 cm) “, explains Marco Cenzato, director of Neurosurgery. “Often aneurysms remain silent – says the expert – or are found accidentally during diagnostic tests for other problems. When they occur it is because they are becoming unstable and the risk of rupture is very high, with unfortunately often fatal results”. The life-saving surgery, performed by the Niguarda Neurosurgery team, was very complex: it took 7 hours to temporarily close the carotid artery, exclude the aneurysm and rebuild the correct flow in the cerebral vessels. “The specific difficulty of this case was represented by the need to preserve the flow in the anterior chorionic artery, which arose directly from the aneurysm sac, the interruption of which was responsible for the temporary paralysis suffered by Anna during the trial test”, specifies Cenzato. “To exclude the aneurysm from the circulation – adds Davide Boeris, neurosurgeon of the team, illustrating the technique used for the surgery – we proceeded to the application of some ‘clips’ using the surgical exoscope: a camera connected to a high 4K and 3D resolution that allows a higher definition than the traditional surgical microscope “. This technological instrumentation has been used by the Niguarda Neuro Center for about 2 years: the exoscope allows you to view an operating field of 1 cm on a 55-inch monitor (with a diagonal of 140 cm) without loss of resolution. In this way, neurosurgeons operate standing up looking at the screen in front of them without having to be bent over the binoculars of the microscope. The magnification is also associated with a greater depth of field thanks to the three-dimensional vision obtained through special viewing glasses that allow the images to project off the screen (in ‘3D cinema’ style). The synergy between Neurosurgery, Neuroradiology and Neuroreanimation has made it possible to achieve the result obtained, the experts assure. After only 10 days Anna was discharged, she did not report any kind of consequence from the surgery – they inform from the hospital – and she was able to return with serenity to her daily activities.