GALVESTON, Texas – Surgeons at the University of Texas Medical Branch’s Clear Lake Hospital recently combined two different neuroscience procedures to treat a patient’s rare condition. The innovative and life-saving procedure was a first for UTMB.
The patient was suffering from a rare condition known as a dural arteriovenous fistula, which is formed when arteries and veins in the lining of the brain create an abnormal connection. When the patient’s fistula ruptured, it caused significant bleeding and became a medical emergency. She had a small stroke from the untreated fistula. If left untreated, she would continue to have a 10% annual risk of stroke, which the doctors considered unacceptably high.
The combined treatment included neurosurgery followed by a neuroendovascular treatment.
Dr. Peter Kan, chairman of UTMB’s Department of Neurosurgery, and Dr. Patrick Karas, a neurosurgeon at UTMB, performed the procedures on the patient in the Clear Lake hospital’s hybrid operating room where the medical staff can see X-ray images of a patient’s blood vessels during surgery.
“This type of procedure can only be performed safely in specialized hybrid operating rooms like this one, so we know if we are being successful in real time,” Kan said. “Only certain more sophisticated hospitals have them.”
The neurosurgery part of the combined treatment involved surgery through the nasal cavity to gain access to fistula. It was not possible to access it from the blood vessels, Kan said. The second part of the combined case was the less-invasive neuroendovascular portion that included placing thin tubes in blood vessels to embolize—or block—the abnormal blood vessels.
“Our case went great,” Kan said. “This is the first of its kind at UTMB, and only the second reported case with such an approach.”
“This is the second in the world, as far as we know,” Karas said. Kan and Karas reported the first case in the September 2021 issue of the Journal of Neurosurgery.
Following the procedure, the patient did very well.
“She went home and her fistula is cured,” Kan said. “It is not at risk of brain bleeding anymore.”
Since UTMB opened the Clear Lake hospital in 2019, the neurosurgery department has grown to provide emergency neurosurgery coverage 24 hours a day, seven days a week. UTMB began its Department of Neurosurgery in 2020 and named Kan its inaugural chair. In December 2021, Kan operated on the hospital’s first ruptured aneurysm.