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Quick fix for brain aneurysm – while you’re wide awake

Surgeons can now perform complex operations to repair damaged blood vessels in the brain while patients are awake.

The delicate procedure could be a lifesaver for the 5,000 Britons who suffer a ruptured brain aneurysm every year – where a weakness in the blood vessels inside the skull leads to catastrophic internal bleeding.

It is believed that about two percent of the population have such a weakness, and it usually does not cause any day-to-day problems.

But in half the cases, a rupture, which can occur without warning, means almost instant death. And many of those who survive suffer permanent brain damage.

A graph shows how the delicate procedure, which could be a lifeline for 5,000 Britons a year, will work

If an aneurysm is found on a CT scan before there is a rupture, surgeons typically use a tiny metal implant to support the blood vessels and prevent major bleeding. In the past, the operation had to be performed under general anesthesia, but now they can do it using just local anesthesia and sedation.

Celine Dawes, a 64-year-old housewife from Chingford, northeast London, had the operation last winter and was out of bed an hour after the procedure. She could feel “little tingles” in her head during the operation, but no pain. “I know it saved my life and I’m glad others are getting it now,” she says.

Worryingly, aneurysms usually cause no symptoms until they rupture. They can cause anything from a bad headache and vision problems to a life-threatening stroke.

Despite years of research, scientists still don’t know what causes them, but they’ve been known to run in families. Smoking and high blood pressure also increase the risk.

Ruptures are most commonly seen in adults between the ages of 30 and 60, and they are more common in women than in men. However, it is believed that they can develop at any age. Game Of Thrones star Emilia Clarke, 33, revealed last year that she suffered two in her twenties.

To repair an aneurysm, surgeons insert tiny metal coils into damaged blood vessels, or a ball of mesh known as a brain aneurysm embolization device, or both. They work by blocking blood flow to the aneurysm, sealing it and preventing a rupture. The implants are placed via a catheter, normally inserted into a vein in the thigh or wrist and threaded to the brain.

Celine became the first patient in the UK to have the operation wide awake when surgeons realized her lung condition meant it would not be possible to use general anesthesia.

She first suffered a ruptured aneurysm just before Christmas.

Céline says: “I was standing in my kitchen when all of a sudden I started to feel dizzy. Everything started to spin.

Thinking it was the flu, she was bedridden for two days. But the pain in her head was so intense that she couldn’t sleep and was constantly vomiting.

Surgeons can now perform complex operations to repair damaged blood vessels in the brain while patients are awake

Surgeons can now perform complex operations to repair damaged blood vessels in the brain while patients are awake

When Celine’s daughter returned, she begged her mother to go to the hospital. Brain scans showed Celine had suffered a ruptured aneurysm in the back of her brain. “The doctors took a look at the scan and told me that I was very lucky to still be here,” she adds. She was immediately transferred to the neurosurgery team at the Royal London Hospital, but as she also has a lung condition, using general anesthesia to repair the damage caused by the aneurysm would have been extremely risky.

Neurosurgeon Dr. Paul Bhogal explained to Celine that they were going to try something new – she was going to be awake while they operated on her brain.

During the procedure, which lasted just 35 minutes, her head was placed between two wooden blocks and she was told to lie completely still. Céline followed the instruction to the letter: “I was still tense, I even held my breath in places.

The neurosurgery team injected Celine with a dye that would allow an advanced X-ray to provide a real-time image of the rupture. A local anesthetic was then applied and a catheter inserted into a vein in Celine’s right wrist.

“This is a difficult operation to perform with the patient awake, as one wrong move can spell disaster,” says Bhogal. “Luckily Celine didn’t move a muscle.”

Celine was monitored in hospital for seven days, but Mr Bhogal says it is possible that in future patients will be able to go home the same day.

A year later, Celine no longer had a problem.

Mr Bhogal has since published a study of the procedure and hopes his research will encourage surgeons to perform awake brain aneurysm surgeries on patients at risk of general anesthesia.