Kolkata: The neurosurgery
team at Manipal Hospital, Dhakuria has successfully treated a 42-year-old
farmer, Mr. Ramesh Kumar (name changed), from Bihar, who arrived at the
hospital with a life-threatening brain haemorrhage caused by a ruptured anterior
communicating artery (ACOM) aneurysm. ACOM is a weak, balloon-like bulge in
a blood vessel connecting the two main arteries supplying the front part of the
brain. The patient was initially presented with severe headache, repeated
vomiting and drowsiness. Imaging tests subsequently confirmed, bleeding around
the brain caused by a ruptured aneurysm, medically known as aneurysmal
subarachnoid haemorrhage (SAH). Given the seriousness of the condition and the
risk of re-bleeding, the team led by Dr. Nirup Dutta, Consultant -
Neurosurgery, Manipal Hospital, Dhakuria, decided that urgent surgical
intervention was necessary to secure the aneurysm.
Mr. Ramesh had no
previous diagnosis of a brain aneurysm, which can remain undetected for years
without causing any noticeable symptoms. A CT scan confirmed bleeding around
the brain, while a further specialized test called Digital Subtraction
Angiography (DSA), which provides detailed images of the blood vessels in the
brain, revealed a complex, wide-neck aneurysm measuring approximately 8.9 × 3
mm in the anterior communicating artery. The aneurysm also had a hypoplastic
left A1 segment, meaning one of the blood vessels supplying the area was
smaller than usual, making the procedure more challenging and requiring careful
surgical planning.
A brain aneurysm is
a weak, balloon-like bulge in the wall of a blood vessel that can remain silent
until it ruptures. Once it bursts, it can cause bleeding around the brain and
become life-threatening. Following the first bleed, the risk of bleeding again
is particularly high during the first 48-96 hours. A second bleed can be much
more dangerous and may lead to severe brain damage or even death. According to
the treating doctor, around 50-70% of patients may not survive a second bleed,
making it extremely important to treat a ruptured aneurysm as quickly as
possible. A ruptured aneurysm can also lead to complications such as vasospasm,
a narrowing of the blood vessels that can reduce blood flow to the brain and
potentially cause another stroke.
The doctors
performed a specialized procedure known as microsurgical clipping to secure the
ruptured aneurysm and prevent it from bleeding again. The patient underwent a
left pterional craniotomy, a surgical approach that involves opening a small
part of the skull to reach the affected area of the brain. The aneurysm was
then carefully identified and clipped to stop blood from entering the weakened
portion of the blood vessel. While both surgical clipping and endovascular
coiling are established treatments for brain aneurysms, the choice depends on
the patient's condition and the size, location and shape of the aneurysm. In
this case, the team selected surgical clipping based on the characteristics of
the aneurysm and the patient's condition.
The surgery
demanded exceptional precision because the aneurysm was in a delicate region of
the brain and had a wide neck with complex vascular anatomy. Following the
procedure, the patient required close monitoring in the ICU/HDU, serial
neurological assessments and repeated imaging. Postoperative scans showed some
bleeding and swelling in the brain, along with a small area of stroke and a
collection of blood beneath the brain covering. However, with comprehensive
medical management and close neurological monitoring, the patient gradually
improved and progressed towards independent mobilization.
Speaking about the
case, Dr. Nirup Dutta, Consultant - Neurosurgery, Manipal Hospital, Dhakuria,
said, “A ruptured brain aneurysm is a life-threatening emergency where timely
intervention is critical. The risk of re-bleeding is particularly high during
the first 48-96 hours, and a second bleed can have serious and potentially
fatal consequences. In this case, the aneurysm had a complex anatomy, with a
wide neck and a hypoplastic A1 segment, making the surgery technically
challenging. Our priority was to secure the aneurysm at the earliest possible
opportunity and prevent further bleeding. With careful microsurgical clipping,
close postoperative monitoring and comprehensive medical care, the patient has
made a favorable recovery despite the severity of his condition. It is also
important to recognize the warning signs of a ruptured aneurysm. A sudden,
extremely severe headache, often described as a ‘thunderclap headache’,
particularly when accompanied by vomiting, loss of consciousness or seizures,
should never be ignored and require immediate medical attention. Thus, early
diagnosis and timely treatment can play a crucial role in preventing
re-bleeding and serious neurological complications.”
Mr. Ramesh's
successful recovery represents an important outcome in the management of a
complex ruptured brain aneurysm and underscores the importance of early
diagnosis, timely surgical intervention, specialized neurosurgical expertise
and comprehensive postoperative care in treating life-threatening neurological
emergencies.