Update on Dad; The Next Steps

We spent the last few days in Seattle where Dad underwent another angiogram so the surgeons could have a better idea of what we are working with.

On Monday, Dad checked in at the hospital bright and early to get his labs done and then to get the angiogram done.  Turns out he did not need to get there so early because they did not get him in until almost 3:00 p.m.!  It made for a long day for everyone.  It went fairly well after that and the surgeons were able to get very detailed 3D imaging of the aneurysm and the arteries around it.  Dad was left with a bit of soreness in his leg/groin region, where they inserted the the tubes that let out the dye and he had to lay flat for 6 hours after the procedure so he didn't get back to the hotel until around 10:00 pm.

On Tuesday, we met with the surgeons to discuss the results of the angiogram and plan out the next steps.  As we already knew, the aneurysm measures at about 11mm x 13 mm, which is classified as "big".  Unfortunately, we got some bad news.  Based on the type and location of the aneurysm they will not be able to "simply" go in through the groin and coil it off.  They will have to do two surgeries, and the first will be an "open" surgery, where they will actually have to remove a small window of his skull and operate on the surface of his brain.  I have made some sketches to help illustrate what we have going on here:

 Ok, so the sketch above shows the problem.  As you can see, the aneurysm is on the right vertebral artery which supplies the brain stem and the PICA (don't ask me what it stands for, it is an artery, and apparently it is quite an important one).  Coiling the aneurysm does not present a problem to the blood flow to the brain stem (Sidebar: Coiling is the process of putting a coil into the aneurysm that stops all blood from flowing into or out of the affected area.) because the left vertebral artery also supplies blood to the brain stem.  However, it does present a problem with regard to the PICA because the PICA has no other blood source besides the right vertebral artery.  If they were to go in and coil the aneurysm without taking other precautions there would be no blood flow to the PICA and this would almost certainly cause stroke and damage to his balance, speech, swallowing ability, and who knows what else.  So before they can coil they have to do another procedure.

 The sketch above illustrates the procedure.  So what they need to do is find another blood source for the PICA before they cut off the blood source from the right vertebral artery.  This blood source will be a scalp artery that they will "swing down" and suture to the PICA.  This means they will make an incision in the scalp and pick one of the arteries (apparently his scalp won't miss it because there are many redundant blood supplies there), the attach it to the PICA through the window made in the skull.  They claim that it will be very well protected  by the rest of his skull.  The process I just described is known as bypass surgery, and this should take around 4-5 hours and he will do it on a Thursday.

Once the first procedure is complete they will give him a few days to rest up and get more tests done, MRI's and all that, and then the following Monday they will go in and coil the aneurysm.  In this process they will go in through his leg/groin, the same way they did for the angiogram.  Once this is done the aneurysm will be blocked off and no blood will flow through it.  Easy, right?

I was surprised to find out that the hospital recovery time for all this is actually pretty short.  They said he could be released as early as the Wednesday directly following the second surgery on Monday.  Literally less than a week after he has open brain surgery he should be able to walk right out of the hospital!  Amazing!  So, even though this is not the best news we hoped for, I left the hospital feeling confident that Dad was in really good hands with his surgical team at Harborview.  The surgeries are going to take place at the beginning of September.  Please keep us all in your prayers.  Especially Dad.  He is understandably very anxious about having to undergo open brain surgery.  Thanks everyone for the outpouring of love and support.  It really helps!