Basilar Tip Aneurysm (4)

Contributor:

Dr. Chris Ekong

Consultants:

Dr. Mike Tymianski
Dr. Christopher Wallace
Dr. John Wong
Dr. Renn Holness
Dr. J Max Findlay
Dr. R Willinsky
Dr. Karel terBrugge
Dr. Gary Steinberg
Dr. Cameron McDougall

Case 32

Age: 49

Sex: Male

History: December 29, 2005. Sudden severe headaches leading to loss of conciousness. Initial assessment showed GCS of 12. Moderate neck stifness. No lateralizing signs. Impression: subarachnoid haemorrhage. CT head done on December 2005.

December 30, 2005 - Dr. Chris Ekong, Neurosurgeon, Regina

Patient was admitted yesterday. He is now fully concious.

To Medi-Fax Neuro-vascular Rounds Group:

I believe he would be better off with coiling rather than open surgery. We can send him to Toronto, Calgary, or Edmonton this long weekend. Do you agree? Can you take him?

Friday, December 30, 2005 - Dr. Mike Tymianski, Neurosurgeon, Toronto

Agree.

Can take.

Let me know how you'd like to proceed.

MT

Friday, December 30, 2005 - Dr. Chris Ekong, Neurosurgeon, Regina

Thanks Mike:

Our SWADD will call your SWADD and arrange transfer.

Chris

Saturday, December 31, 2005 - Dr. Robert Willinsky, Neuroradiologist, Toronto

Chris,

Yes I agree it can be coiled and this would be the preferred treatment.

Bob

Sunday, January 1, 2006 - Dr. Gary Steinberg, Neurosurgeon, Stanford

Chris: I would try coiling as first option. Would be nice to see lateral

angio and 3-D CTA or DSA to get better view of neck. Might need balloon

remodeling or stenting with coiling.

Gary

Monday, January 2, 2006 - Dr. Fred Gentili, Neurosurgeon, Toronto

Hi Chris,

Agree with Gary, definitely would try the coiling option first. Should be doable with or without assisted techniques.

Although there are excellent endovascualr centers closer to you I am on aneurysm call this week-end and would be happy to accept.

Please let me know.

Regards,

Fred

Sunday, January 1, 2006 - Dr. Mike Tymianski, Neurosurgeon, Toronto

Chris:

Happy new year!

A snag with your patient over the last 24h: The Saskatchewan air ambulance people have limited availability over the last 24h, and were unable to do any transfers. Last word was that they can't find a pilot(!). As of now, we are told that the patient won't be transferred until tomorrow.

I'll check into it further. I don't know whether there is anything you can do from your end.

Best

MT

Monday, January 2, 2006 - Dr. Christopher Wallace, Neurosurgeon, Toronto

Agree with Gary and Fred

MRA is often not as helpful as CTA we have found recently in terms of

deciding in advance whether to coil any aneurysm.

We now do CTA and then go to angio/coiling or directly to surgery.

Happy New year Chris

Regards,

Chris

Tuesday, January 3, 2006 - Dr. Mike Tymianski, Neurosurgeon, Toronto

Hi Chris

Attached are the pics for the website posting.

Happy New Year

Mike Tymianski

Friday, January 6, 2006 - Dr. Robert Willinsky, Neuroradiologist, Toronto

Chris,

Your patient is doing well. We were able to occlude the aneurysm using a balloon remodelling technique (see attached images).

A combination of platinum and HydroCoils were used. At this time I feel he is well protected. Therefore we could wait for 6 months to do follow-up imaging. Presently we are using gadolinium enhanced MRA starting 2 months post treatment of ruptured aneurysms. For this patient, a catheter angiogram in Regina at 6 months would be the most practical approach.

I would appreciate

the opportunity to review this follow-up. The long-term follow-up can be discussed at that time.

Thank you for the opportunity to help out in the management.

Bob

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