In a remarkable medical breakthrough, doctors at Hannah Joseph Hospital Madurai, the tertiary referral centre for Neurosciences and Trauma in South Tamilnadu have successfully performed a life-saving Neuroendovascular procedure on a 9-month-old male baby diagnosed with a complex brain aneurysmal rupture using Balloon-Assisted Coils in the brain. It is one of the rare medical feat achieved in the city and there are only few such cases been reported in the world literature.
Briefing the Media persons Dr. M. J. Arunkumar, the Chairman and Managing Director of the Hannah Joseph Hospital, Madurai said that “Brain aneurysms are bulges in the thinned out blood vessel leading to a sac like structure which gradually enlarges and ultimately ruptures in the brain causing devastating, life threatening haemorrhages. The incidence of brain aneurysm in children is 0.5 to 4.6% of all intracranial aneurysms in a given population. However it is extremely rare to find one in the infants (less than 1 year old) making it 0.01 to 0.09 % of the cases reported world wide, and the rupture of such aneurysms makes it even worse and survival is extremely difficult. I would like to share a case of an infant brain aneurysmal rupture treated at our institute and how this little child survived from the catastrophe.
A 9 months old infant weighing 7.5 kg was brought to our hospital after the child experienced multiple episodes of uncontrolled seizures, decline in consciousness lapsing into coma with no visible limb movements. The infant was brought to us on Ventilator support with unstable blood pressure and pulse referred from another hospital. The baby was resuscitated first on arrival to our emergency team and was made hemodynamically stable at the Neuro Emergency Department. A CT scan of the brain done showed a diffuse bleed in the brain in this child (diffuse subarachnoid hemorrhage with intraventricular extension).
After stabilising the child the Brain Angiography (Digital Subtraction Angiography - DSA) under general anesthesia was planned in our hybrid Neuro-Cardiac Cathlab. The Angiography done revealed a large, saccular aneurysm which has burst and bleed in the brain; this was located in the anterior communicating artery (ACOM) alongside multiple smaller aneurysms. After discussing the critical nature of the child’s condition to the parents and treatment to her undertaken, we decided to go ahead with the endovascular treatment using Balloon-Assisted Coils by the team of Neuro-radiologist (Dr Vinayagamani), Neuro- Anesthesiologist (Dr N Arunkumar) along with the Cathlab support staffs”.
Dr Vinayagamani added that “Looking at the infant’s age and the complexity of the condition, the Neuro-Endovascular team made a critical decision to treat the aneurysm using an advanced Neuroendovascular technique instead of opening the skull and microsurgically clip the aneurysm. The procedure involved accessing the brain's blood vessels through a pinhole incision in the child’s right thigh. Very tiny micro-catheters were introduced through the right femoral artery and guided to the vessels that supply the brain and to the aneurysms. This minimally invasive approach enabled the team to successfully implant five platinum Hydrosoft coils with Balloon - assistance, which effectively sealed the aneurysms and prevented any further bleeding.
The procedure posed significant challenges due to the child's tiny anatomical structures, demanding extreme precision and delicate intervention. Moreover, infants have limited physiological reserves, making them more vulnerable to blood loss, temperature fluctuations and other surgical and anaesthesia risks. The post-procedure scans confirmed excellent results with no further bleeding or complications. The child was continued on ventilatory support in our Neuro Intensive Care for the next few days and was slowly taken off the ventilator once the child started moving the limbs and became conscious. This happened on the 5th day following the Neuro endovascular surgery. The child made a remarkable recovery, and started taking oral feeds and diet by the 10th day and was moved to the wards from the Intensive care unit. On the 17th day the baby was was discharged in stable condition with no neurological deficits and on normal diet. In the last one month, the child continues to remain normal at home, an outcome that offers immense hope for similar cases in the future”.
This case stands as one of the rare successes in Endovascular treatment for ruptured brain aneurysms in such a young infant, underscoring India's advancements in Pediatric Neuroendovascular care. The innovative approach and positive outcome not only reinforce the country’s position at the forefront of global neurosurgical innovation but also offer hope for future cases involving similar complex conditions.