Lenox Hill Hospital is First Reported Center in US to Use New Intracranial Bypass
“Mr. David came to us with a very large, three-centimeter brain aneurysm, which is a weakened area in the wall of an artery in the brain,” said David J. Langer, MD, LHH’s Director, Division of Neurosurgery. “The aneurysm, located near the left middle cerebral artery, had tripled in size over a four year period.”
Dr. Langer explains that traditionally, there are two ways to treat an aneurysm safely and effectively: clipping and coiling. Clipping is a surgical procedure performed on both ruptured and unruptured aneurysms. In this procedure, the neurosurgeon performs a craniotomy through a small opening in the skull. Once the aneurysm is located with the operating microscope, the neurosurgeon places a clip across the base of aneurysm, cutting off the blood flow to the aneurysm while allowing flow to remain normal through the adjacent branch vessels, “de-fusing the aneurysm.”
Coiling is a minimally invasive endovascular procedure that requires the insertion of a catheter into the femoral artery in the leg. The catheter is then navigated through the blood vessels into the brain to the aneurysm. Soft platinum coils are inserted through the catheter and deployed in the aneurysm. The coils conform to the shape of the aneurysm, fill the sac and block blood flow to prevent the aneurysm from rupturing.
“In Mr. David’s case, due to its size and location, our team determined that the best way to treat the brain aneurysm would be to combine the procedures of an intracranial bypass surgery and neuro-endovascular coiling.”
Intracranial bypass is a surgical procedure used to reroute blood around a blocked blood vessel in the brain to restore blood flow. A small hole in the skull is made to expose the area of the brain that needs to be treated. The neurosurgeon then takes a healthy blood vessel from an area outside the brain and connects it to a blood vessel inside the brain. This reroutes blood around the aneurysm, restoring blood flow. In some cases, an intracranial bypass can involve taking a vein or artery from the arm or leg and use it to direct blood around a blockage.
“Traditionally, intracranial bypasses were done by accessing the donor blood vessel through the neck in order to complete the bypass,” said Peter Costantino, MD, FACS, North Shore-LIJ’s Senior Vice President, Head and Neck Service Line. “However, Dr. Langer and I have developed a new surgical approach so that the vessel graft is completely intracranial, avoiding the need to make a neck incision. This new approach improves the safety and efficacy of the bypass.”
The combined interventional surgical approach of intracranial bypass surgery and coiling was performed by LHH’s neuro-vascular team of Dr. Langer, Dr. Costantino and Rafael Alexander Ortiz, MD, Director of Neuro-Endovascular Surgery at Lenox Hill Hospital.
“The combined approach offers a safer option for definitive treatment of the aneurysm,” said Dr. Ortiz. “A vein from the patient's leg was grafted and used to connect the donor artery in the face to the recipient artery in the brain. After the bypass, I performed neuro-endovascular coiling, in which tiny wires are routed through remote blood vessels to the aneurysm, where these soft, thin platinum wires are coiled into a mesh-like ball. Coiling closes off the blood supply to the aneurysm and prevents it from rupturing and causing a hemorrhagic stroke or bleeding in the brain. At the end of the combined procedures, all monitoring was normal and baseline.”
Mr. David, a Kew Gardens Hills resident, is now enjoying life with his wife, Avigayil and their three children. He volunteers at the Brain Injury and Stroke Assistance organization in Brooklyn, NY, to help traumatic brain injury and stroke survivors.