Case Study: Transfusion-Free Brain Surgery

Nadine A. Beltran of Whittier, California, had a bomb ticking in her brain-a cerebral aneurysm-and she didn’t even know it. Aneurysms are weak spots in the walls of arteries in the brain that balloon out over the years; as the walls get thinner and weaker, the risk that they may rupture increases.

Brain Surgery Blood ManagementIn May 1999, that is exactly what happened to Beltran, a 33-year old Jehovah’s Witness. The ruptured vessel resulted in severe bleeding in and around the brain, causing her tremendous headaches, nausea, vomiting and sleepiness. She went misdiagnosed for weeks, however, as aneurysms are rare.

Once a correct diagnosis was made, Beltran’s local hospital wanted to perform a craniotomy–opening her skull to get to the bleeding–but could not guarantee it would be a bloodless procedure.

That’s when her brother found the USC program; Beltran was transferred to USC University Hospital on May 29, and immediately underwent surgery.

As part of USC’s neurointerventional team, George P. Teitelbaum, M.D., and Donald W. Larsen, M.D., both associate professors of neurological surgery, specialize in using less-invasive techniques for treating aneurysms–techniques that do not involve cutting the skull open to expose the brain. They are both experts in embolization–the introduction of some substance into a blood vessel in order to block it–for vascular malformations and tumors of the brain, neck and spine. The technique will either cure these lesions, or make them more amenable to surgery and/or radiation therapy.

To treat Beltran, Teitelbaum and Larsen threaded soft platinum coils through a microcatheter into the area of the artery with the aneurysm. They continued the process until the aneurysm was completely filled with coils. These coils caused the blood in the aneurysm to clot, thereby reducing the chances of another rupture.

“Not only was the procedure bloodless,” notes Larsen, “but Nadine did not have to undergo the traditional craniotomy.” In addition, Beltran has shown no signs of neurological deficits. “She made a complete recovery,” says Larsen.

Beltran doesn’t recall much about the experience, but her mother, Juanita, certainly does. “Everyone was so nice and informative,” she says. “They respected our beliefs, and answered all of our questions. And they saved our daughter’s life.”

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