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Susie Stephan

Aneurysm Patient Undergoes Rare Procedure

By Abby Sinnott

Susie Stephan gave up riding horses because of balance problems and vision trouble in her left eye. "My doctor told me I had a broken blood vessel in the back of my eye," she says. "But after 10 years of visiting the eye doctor and laser surgeries and surgery to remove a cataract, my vision got worse. I knew something else must be wrong."

Her eye doctor in Berkeley, Calif. finally recommended getting a magnetic resonance imagining (MRI) test. The results revealed a rare and complex type of brain aneurysm — a balloon or bubble-like growth — that was pushing up on her optic nerve, which was causing her vision and balance problems. She was diagnosed with a basilar artery aneurysm, the size of a golf ball.

Aneurysms have the potential to rupture, causing bleeding into the brain or area closely surrounding the brain called the subarachnoid space, leading to a subarachnoid hemorrhage. A subarachnoid hemorrhage from a ruptured brain aneurysm can then cause a hemorrhagic stroke, brain damage and death.

Stephan, who lives in Walnut Creek, Calif., visited two doctors who told her that they weren't equipped to perform the necessary surgery to treat her aneurysm. She then went to UCSF Medical Center too see Dr. Michael Lawton, who specializes in the surgical treatment of complex aneurysms, arteriovenous malformations, dural fistulas, cavernous malformations and atherosclerotic disease. Lawton is one of the few specialists in the country who performs an extremely rare procedure called hypothermic circulatory arrest to treat complex aneurysms like Stephan's.

Hypothermic circulatory arrest temporarily stops the circulation of the blood to the patient so that surgeons can clip the giant aneurysm. It can be a dangerous technique since surgeons need to deeply cool patients then stop their hearts and circulation, drain blood from the arteries in the brain and then perform the reverse to return the patient to life.

Stephan was faced with a tough decision. She was told that her aneurysm could burst at any time, which could cause immediate death, and that the procedure was very risky, with a high rate of mortality. "I have a lot to live for and wasn't ready to die," says Stephan. "So I told Dr. Lawton to perform the procedure, even though he said it was extremely risky."

In Nov. 2004, Stephan underwent hypothermic circulatory arrest. During the procedure, surgeons must have a bloodless field with no blood flow through the aneurysm in order to repair it. This requires cooling the patient to 15 degrees Celsius, which causes the heart to stop beating. During the cooling process, the patient is placed on the heart-lung machine to maintain circulation until the critical moments of the operation. Then, the heart lung machine is turned off and the patient's blood circulation is still, leaving the patient in "suspended animation" for a period of time. This allows the surgeon to then place small metal clips at the base of the aneurysm, at the point where it arises from the artery.

Stephan's procedure went according to plan, with the normal arteries repaired and the aneurysm excluded from the circulation. Unfortunately, Stephan developed a rare complication with frequent quiet seizures that kept her in a coma for two months. She spent that time in UCSF's Intensive Care Unit. Her prognosis didn't look good. But then a few days before Christmas, during a visit with her son, the seizures stopped and Stephan finally woke up.

"My son squeezed my hand and told me that it was time to wake up and my eyes suddenly popped open," recalls Stephan. "It's a miracle that I made it through and am alive today."

She then moved from UCSF into a rehabilitation program closer to home. For the next four months, she underwent intense physical therapy to help rebuild her strength, which she had lost during her hospitalization.

After three months at home, Stephan is nearing a full recovery. "I'm physically challenged now but feeling great otherwise," says Stephan. "Dr. Lawton saved my life and I'm just so happy to be alive and have a second chance at life."

Lawton was also pleased with Stephan's recovery. "I enjoy these operations immensely, and results like this one make them even more gratifying," says Lawton.

Story written in September 2005.

Abby Sinnott is a freelance writer in San Francisco.

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