A 40-year old farmer from Andhra Pradesh had episodes of blurred vision, slurred speech and tingling sensations in his left hand and leg, lasting throughout the day, that interfered with his ability to go about his daily living activities. After having no relief with his initial treatments, he sought further clinical evaluation in Bangalore. A CT scan MRI and an MR Angiogram of the brain done at an outside hospital revealed a critically located Giant aneurysm on the right middle cerebral artery (MCA) of his brain. He sought further treatment at Manipal Hospitals, Airport Road for his complex condition.  

“This gentleman came to us with partial seizures and a headache from a Giant Aneurysm on the Right Middle cerebral artery (MCA), which is a major source of blood supply to the movement related zones of the brain. Interference with this blood supply often causes the patient to become paralyzed. Giant aneurysms present symptoms like brain tumors or strokes, and are often fatal if not treated early. Innovative and individualized treatment are needed to cure these patients without serious lasting complications.” elaborated the operating surgeon Dr. Bopanna KM, HOD & Consultant-Neurosurgeon, Manipal Hospitals, Old Airport Road, Bangalore.

The large size, deep location and the essential blood vessels that arise from this aneurysm require complex neurosurgical reconstruction to seal off the aneurysm and simultaneously maintain blood supply to the normal brain. Manipal Hospitals, Old Airport Road, Bangalore is known to regularly carry out such complex brain surgeries.

The treatment of Giant aneurysms are associated with much higher complication rates, because of their complex anatomy. Surgical strategy and experience play a crucial role in treatment outcome and these procedures are best done at a tertiary care center under an experienced Neurosurgeon along with a good neuro-rehabilitation team.

Based on his preoperative tests, the patient underwent a two stage procedure. An initial microsurgical bypass (called Superficial Temporal Artery STA to Middle Cerebral Artery MCA bypass) to re-route blood flow to the brain using a donor scalp artery was done. Following an intraoperative angiogram to confirm adequate blood flow through the by-pass, blood flow into the aneurysm was occluded and it was further decompressed resulting in an effective cure.

Post-operatively, he had temporary left sided weakness.  Dr. Dheeraj A, HOD & Consultant-Physical Medicine & Rehabilitation, Manipal Hospitals, Old Airport Road assessed the patient, and he was started on neuro-rehabilitation intervention and received physiotherapy, occupational therapy and Speech / language therapy.

“He responded favorably to comprehensive rehabilitation and was discharged with a home based neuro-rehabilitation program. His family formed an integral part of the rehabilitation team by continuing these rehabilitation measures at home. He has recovered almost completely. He is ambulant, independent with activities of daily living and continues with home-based rehabilitation” added Dr. Dheeraj A.

Highlighting the need to seek early treatment in such cases, Dr. Bopanna KM said, “The mortality goes up significantly, as high as 50%, if these giant aneurysms rupture. The necessity for patients to seek early treatment is paramount. Unfortunately, most patients only present after the aneurysm has ruptured.”

At his last follow up, a month later, the patient was free from headaches and seizures and had returned to his daily activities, now cured from an otherwise fatal disease.