Kolkata : A 42-year-old farmer from Bihar has made a gradual recovery after undergoing emergency brain surgery at Manipal Hospital, Dhakuria, following a life-threatening brain haemorrhage caused by a ruptured aneurysm. The patient, identified as Ramesh Kumar (name changed), was brought to the hospital with a severe headache, repeated vomiting and drowsiness.
The neurosurgical team, led by Dr. Nirup Dutta, Consultant – Neurosurgery, performed microsurgical clipping to seal the ruptured aneurysm and prevent further bleeding. The case was particularly challenging because of the aneurysm’s complex structure and its location in a delicate region of the brain.
Complex Aneurysm Made Surgery Challenging
Initial CT scans confirmed bleeding around the brain, a condition known as subarachnoid haemorrhage (SAH). Further investigation through Digital Subtraction Angiography (DSA), a specialised imaging technique used to examine blood vessels, revealed an approximately 8.9 × 3 mm aneurysm in the anterior communicating artery (ACOM).
The aneurysm had a wide neck and was accompanied by a hypoplastic left A1 segment, meaning one of the blood vessels supplying the area was smaller than usual. These anatomical features added to the complexity of the procedure and required careful surgical planning.
The patient had no previous diagnosis of a brain aneurysm. Such aneurysms can remain undetected for years because they may not produce noticeable symptoms until they rupture.
Emergency Microsurgery to Prevent Re-bleeding
Considering the severity of the haemorrhage and the risk of another bleed, the medical team opted for urgent surgical intervention.
The doctors performed a left pterional craniotomy, an approach that allows surgeons to access the affected area of the brain through an opening in the skull. They then used microsurgical clipping to seal the aneurysm and prevent blood from entering the weakened section of the blood vessel.
Surgical clipping and endovascular coiling are two established treatment options for brain aneurysms. The choice depends on factors such as the aneurysm’s size, shape and location, as well as the patient’s overall condition. In this case, the team selected microsurgical clipping based on the aneurysm’s characteristics.
ICU Monitoring Helped Patient Recover
Following surgery, the patient was kept under close observation in the Intensive Care Unit (ICU) and High Dependency Unit (HDU). Regular neurological assessments and follow-up imaging were conducted to monitor his condition.
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’s covering. Despite these complications, the patient gradually improved with medical management and close neurological supervision, eventually progressing towards independent mobilisation.
Doctors Warn Against Ignoring Sudden, Severe Headaches
Explaining the seriousness of the case, Dr. Nirup Dutta said that a ruptured brain aneurysm is a medical emergency requiring immediate intervention. He highlighted that the risk of re-bleeding is particularly high during the first 48–96 hours after the initial haemorrhage, and a second bleed can have potentially fatal consequences.
The doctor also emphasised the importance of recognising warning signs, particularly a sudden and extremely severe headache, often described as a “thunderclap headache”. When accompanied by vomiting, loss of consciousness or seizures, such symptoms require immediate medical attention.
A ruptured aneurysm can also lead to complications such as vasospasm, in which blood vessels narrow and reduce the supply of blood to the brain, potentially causing further neurological damage.
The successful treatment highlights the role of timely diagnosis, specialised neurosurgical expertise and comprehensive postoperative care in managing complex neurological emergencies.
