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NeuroLogic - Offering a Cure for Cerebral Aneurysms
NeuroLogic Fall 2013
Offering a Cure for Cerebral Aneurysms
Date: November 18, 2013
Alex Coon and Geoffrey Colby are performing a new type of surgery that offers the possibility to remove aneurysms completely.
Doctors have come a long way in treating cerebral aneurysms over the past several decades, says neurosurgeon Alex Coon. While surgeons used to treat these weakened pouches in the brain’s blood vessels with lengthy and often harrowing surgeries that required removing large portions of the skull, aneurysms now are often treated through coiling, threading a long, thin platinum wire from an artery in the groin all the way up to the aneurysm in the brain and packing it into the pouch. If all goes well, the coiled platinum induces a clotting response, which closes off the aneurysm.
Coiling has greatly advanced aneurysm treatment, Coon says. “It’s superior to open surgery in terms of duration of the procedure, not needing to open the skull, and recovery times,” he explains. “But the downside is that there’s a high recurrence rate.”
In about 10 to 30 percent of cases, he says, the clot dissolves and the aneurysm reappears. The risk is even greater for very large aneurysms, which have recurrence rates up to 50 percent.
However, a new procedure offered at Johns Hopkins could prevent recurrence for all sizes of aneurysms. It involves placing a very flexible, thick mesh stent in the blood vessel.
These stents, which resemble miniature Slinky toys, prop open the blood vessel and divert flow away from the pouch. Over time, Coon explains, reduced flow to the aneurysm causes it to clot off and eventually close on its own.
Although the procedure can take weeks or months to work, far longer than the nearly instant results from coiling, the stent offers the possibility of permanently removing the aneurysm. “This device offers a cure, with no recurrence,” Coon says.
Over the short time that this stent, known as the Pipeline Embolization Device, has been offered in the United States, Johns Hopkins has been one of the leaders in performing this surgery, Coon says. He and his colleagues have placed more than 150 of the stents in patients and traveled around the country teaching the technique to other physicians. This extensive experience is drawing patients to Johns Hopkins from across the United States.
“When it comes to your aneurysm,” Coon says, “you want to be in the hands of experts, people who are teaching others.”
To handle increasing demand, Coon was recently joined by a new colleague, Geoffrey Colby, who trained at Johns Hopkins for his neurosurgery residency as well as a fellowship in techniques that allow problems in the brain to be treated through instruments fed through blood vessels elsewhere in the body.
“Having a larger team,” Coon says, “will make this therapy even more accessible for our patients.”