Second opinion leads to less-invasive aneurysm treatment

By Jeff Carlton

The aneurysm diagnosis was difficult for Stacie Markley to hear. The solution was even worse.

A neurosurgeon at a Plano hospital wanted to perform a craniotomy on the 35-year-old mother of two. The incision would run from her widow’s peak to her ear and involve removing a piece of bone from her skull. The surgeon would have to work under her brain, clip off the aneurysm and then put everything back.

Stacie Markley

 “I didn’t know if I would be incapacitated or if I would die,” she said. “I broke down crying. I have two young girls at home. All I could think about was losing them.”

She sought a second opinion at UT Southwestern Medical Center, where the Neurological Surgery Department is ranked among the top programs in the nation by U.S. News & World Report. UTSW’s cerebrovascular program treats more patients and performs more procedures than any other program in the region.

Mrs. Markley met with Dr. Babu Welch, Associate Professor of Neurological Surgery and Radiology. After an evaluation, he determined she was a candidate for coil embolization.

In this endovascular procedure, a surgeon places a catheter into an artery near the patient’s groin, runs it up into the brain and fills the aneurysm with platinum alloy coils that displace the blood and help a clot to form. If all goes well, a patient whose aneurysm once required traditional brain surgery and weeks of recovery can instead go home the next day.

Though the treatment isn’t unique, the expertise in neurological surgery found at UT Southwestern is. Dr. Welch, a dual-trained neurosurgeon, spent four years in medical school and another seven years in residency. Then he came to UTSW for an additional three years of training in cerebrovascular and endovascular neurosurgery.

“People need to hear both options from somebody who has experience performing both cerebrovascular and endovascular surgery,” Dr. Welch said. “People need to hear from a surgeon who can say, ‘This is what will be the best option for you.’ ”

At Zale Lipshy University Hospital, Mrs. Markley’s symptoms included an asymmetrical pupil and blurring vision. Images of her brain revealed an aneurysm, approximately 10 millimeters in size, pushing on her optic nerve.

Some aneurysms are small enough that the prudent course is to let it be. But 10 millimeters requires no debate ­ – the aneurysm must go.

After a full workup, UTSW’s neurosurgeons concluded that the craniotomy suggested by Mrs. Markley’s original doctor was an appropriate option. But a better solution was coil embolization. It was less invasive, involved a shorter recovery time, and was just as effective for treating her aneurysm.

“The sort of surgery that was originally suggested was what we would have done in 1990,” Dr. Welch said. “It is still done today, and it’s perfectly fine and it’s the right thing to do if it fits the patient.

“But since then, endovascular surgery has come along, and it means I’m going to make a small incision in your groin, pass a catheter up inside your aneurysm and block it off for good. You’ll go home the next day. Which one would you choose?”

The evaluation was on a Thursday this past January. Surgery was on Friday. On Saturday, a therapist came to Mrs. Markley’s hospital room and ran her through some paces: Raise your hands. Make a fist. Push.

Everything checked out perfectly. Dr. Welch signed her discharge papers that afternoon. Within days, Mrs. Markley was putting on makeup, walking her daughter to school and running errands.

“I feel like a miracle,” Mrs. Markley said. “I love Dr. Welch. I think he is amazing. He saved my life.”