A Danish patient suffered a cerebral hemorrhage with symptoms of severe headache and constant vomiting. Fortunately, he was taken to FV Hospital, where the medical team promptly diagnosed and treated him with a cerebrovascular intervention, without surgery.
The journey to save life
Doctors from the Emergency Department of FV Hospital quickly performed tests on the patient. The MRI scan results showed that the patient had a hemorrhage in the brain stem. With a cerebral hemorrhage not caused by trauma or impact, the CT scan recorded that the patient had a very rare disease, which is a dural arteriovenous fistula, accompanied by a very large, 25mm, ruptured venous aneurysm. If the hospital failed to intervene now, he could be gone at any moment.
Without hesitation, the interdisciplinary team of doctors including the Accident & Emergency Department, Anaesthesiology & ICU, the Department of Diagnostic Imaging and Interventional Radiology held an emergency consultation. Dr Huynh Huu Danh – an expert in Diagnostic Imaging and Interventional Radiology at FV Hospital – determined that this was a rare case, with a dural arteriovenous fistula and a large ruptured cerebral venous aneurysm, with a risk of continued bleeding, threatening the patient’s life.
Instead of traditional open skull surgery, the doctors decided to apply endovascular intervention. This is an advanced, minimally invasive, highly effective treatment method but requires the doctor’s skill. The patient was immediately taken to the Cathlab. Dr. Huynh Huu Danh directly performed the endovascular intervention with the support of a DSA digital subtraction angiography machine.
Dr. Danh said that because the aneurysm was located in a difficult-to-reach location, the doctor had to insert the catheter through the vein instead of the artery. “If intervention through the artery is like driving on a flat asphalt road, intervention through the vein is like going through rugged, bumpy, winding terrain, with a higher risk of complications,” Dr. Danh compared.
From a small incision in the thigh, Dr. Danh skillfully inserted the catheter and a microscopic guide wire from the vein, moving to the aneurysm area in the brain, placing a total of 12 coils (spiral-shaped metal coils) inside the aneurysm to “patch” the damaged area, blocking the blood flow through the ruptured aneurysm.
After only a few hours, the patient was stable, no longer nauseous, and had less headache. In the following days, the MRI scan showed that the cerebral hemorrhage did not increase and began to gradually decrease. Mr. F. was discharged from the hospital after 2 weeks of monitoring.
Rare disease but a silent killer
Dural arteriovenous fistula is a very rare disease, which can be formed due to infection, trauma or congenital. Dural arteriovenous fistula with a venous aneurysm is even rarer, and the risk of cerebral hemorrhage when accompanied by a venous aneurysm is very high. Patients with the disease often do not have any symptoms, until the fistula or aneurysm ruptures, causing a hemorrhagic stroke, affecting their lives.
To detect early cerebrovascular diseases that can cause stroke, the best way is to conduct MRI screening for the brain. At FV Hospital, there is a stroke screening program where patients are examined directly by interventional neurologists and cardiologists, have their organs function checked, and undergo magnetic resonance angiography (MRA) and carotid angiography.
Treatment of dural arteriovenous fistula or cerebral aneurysm by endovascular intervention has the advantage of being minimally invasive and having a high success rate. However, this method needs to be performed in a modern Cathlab, by doctors specializing in endovascular intervention and neurointervention. FV Hospital has a modern Cathlab, a DSA angiography machine that produces clear vascular images, helping to perform more precise operations and shortening intervention time. Dr. Huynh Huu Danh is one of the experienced endovascular intervention specialists, who can perform the procedure on both children and adults.
FV Hospital officially applies Health Insurance for Neurointervention and Endovascular Intervention procedures with a support level of up to VND50 million. These procedures include: Transarterial chemoembolization for liver cancer treatment (TACE); Uterine fibroid embolization; Prostate embolization; Embolization to treat all types of tumors (liver tumors, kidney tumors, bone tumors, soft tissue tumors, vascular tumors, vascular malformations); Interventional removal of cerebral artery thrombus; Interventional treatment of cerebral aneurysms; Interventional treatment of cerebral vascular malformations; Embolization to treat dural arteriovenous fistula. For more information, readers can contact via the phone number 028 5411 3333 or contact directly at 06 Nguyen Luong Bang, District 7, Ho Chi Minh City.
