Scary diagnosis inspires a medical innovation
Hopkins doctor uses device in a new way to treat a brain aneurysm
Brianna Atkins was supposed to be playing in the opening game for her California high school’s soccer team in January 2015 when she was overcome by a massive headache.
She was rushed to the hospital, where emergency room staff told her it was probably just the flu. But her mother, whose brother died in his teens of brain cancer after suffering similar headaches, badgered the doctors to look further.
A CAT scan revealed a mass in Atkins’ brain. Doctors later told her it was a very large aneurysm — a bulging, weak area in the wall of an artery that supplies blood to the brain. If it ruptured, it likely would kill or disable her. Surgery to fix it came with enormous risks.
“The doctors were really straight with me. They said, ‘If you do survive, you’re probably going to be paralyzed or have a mental problem,’ ” Atkins, now 20, said of the surgery. “When you get news like that, you kind of find peace in it. I didn’t freak out.”
A month later, Atkins was in Baltimore for an experimental operation at Johns Hopkins Hospital. Neurosurgeon Alexander Coon performed an innovative, minimally invasive surgery deep inside Atkins brain using a combination of treatments, including use of a device meant for treating aneuryms in the large arteries of the neck.
“It’s a very daring treatment,” said Coon, a specialist in the cerbrovascular field in Hopkins’ department of neurosurgery. “We spared her months of recovery, and not only was this aneurysm cured but she’s gone on to live a very normal life and will live a normal life because of it.”
He has since performed three or four similar procedures, he said. A paper he submitted on Atkins’ case to the Journal of Neurointerventional Surgery is being peerreviewed for publication. He also has given presentations on it to doctors from around the world.
“I don’t want to say it’s controversial, but it’s highly discussed because it’s a tricky thing to do,” he said.
What made the surgery unique is where he used the device. The California neurologist Atkins’ parents first consulted told her the size and location of the aneurysm was very problematic. It was deep, near a part of the brain that controls the body’s ability to breathe and stay awake. The neurologist urged the family to go to Hopkins, where she had studied with Coon.
Typically, aneurysms are closed off with coils that promote clotting or they are clipped off to block blood flow to the aneurysm. But the location meant the clipping procedure would likely damage her brain and leave her with disabilities, and the coils were likely to fall out because of the aneurysm’s size.
Coon recommended using a combination of the coils and what’s known as a pipeline embolization device. Approved by the U.S. Food and Drug Administration in 2011 for treating large aneurysms in the carotid artery, the device is a stent made of platinum and nickel-cobalt designed to cut off the blood flow to the aneurysm,