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​Neurointerventional surgery: A minimally invasive brain procedure introduced in the country

<span style="font-family: helvetica;">Neurointerventional surgery, a less invasive procedure offering alternative to craniotomy which involves opening the skull has been introduced in the country at Aga Khan University Hospital, Nairobi. The hospital becomes the first in the region to offer the procedure which is only available in Egypt and South Africa.</span><br style="font-family: helvetica;"/><br style="font-family: helvetica;"/><span style="font-family: helvetica;">The procedure has so far been done successfully on two patients, one, a Kenyan nurse who had a posterior circulation aneurysm and the other, a visiting European tourist with an anterior circulating aneurysm. Both patients responded well to the treatment and have been discharged.</span><br style="font-family: helvetica;"/><br style="font-family: helvetica;"/><span style="font-family: helvetica;">This technique allows the neurosurgeon to access the brain using a catheter inserted through a puncture in the groin (or arm) to stop, or prevent bleeding caused by a brain aneurysm. An aneurysm is a weak area in a blood vessel wall that causes the vessel to bulge, or balloon out and sometimes burst (rupture).</span><br style="font-family: helvetica;"/><br style="font-family: helvetica;"/><span style="font-family: helvetica;">Dr Edwin Mogere, a trained specialist in endovascular and skull base at the University of Cape Town and a neurosurgeon at the Aga Khan University Hospital is the first Kenyan doctor to perform the procedure in the country. Dr Mogere cautions that brain aneurysm is not widely known yet it’s the leading cause of fatal strokes in Kenya.</span><br style="font-family: helvetica;"/><br style="font-family: helvetica;"/><span style="font-family: helvetica;">“Aneurysms affect about one per cent of the population in Kenya annually (about 400,000), but because most people with the condition do not have symptoms, they usually remain unaware that they suffer from it. About 4,000 of those with larger aneurysms (10mm, or more) will have ruptures. Only 500 of these are attended to in the six major hospitals in Kenya capable of handling the condition and the remaining 3,500 stay undiagnosed, or misdiagnosed.”</span><br style="font-family: helvetica;"/><br style="font-family: helvetica;"/><span style="font-family: helvetica;">Explaining the diagnosis, Dr Mogere said, “If a patient is referred to a neurosurgeon with sudden severe headaches, nausea, or vomiting and fainting episodes, he/she will be sent for a CT scan which will show some bleeding in the brain area. To determine the kind of bleeding, the doctor will refer the patient for a specialised scan known as an angiogram (could be CT, MRI, or catheter based) which will map out the exact area where the aneurysm is located.&quot;</span><br style="font-family: helvetica;"/><br style="font-family: helvetica;"/><span style="font-family: helvetica;">“Recently a young man came to see me with drooping eyelids and a very wide pupil on his left eye, which is usually a sign that there is a bulging vessel pressing nerve at the back of the eye. I suspected this could be a brain aneurysm and sent him for tests which confirmed my suspicion.Fortunately for him, we were able to intervene preventing a rupture, which is often a medical emergency and highly fatal.”</span><br style="font-family: helvetica;"/><br style="font-family: helvetica;"/><span style="font-family: helvetica;">“The procedure involves the use of coiling to treat over 90 per cent of aneurysms. At the Aga Khan University Hospital, this is done through the femoral artery in the groin area, though it can also be done using the artery in the arm. Under general anesthesia, a catheter is inserted via the artery to the blood vessel in the brain where the aneurysm is located.”</span><br style="font-family: helvetica;"/><br style="font-family: helvetica;"/><span style="font-family: helvetica;">“Contrast material injected through the catheter allows the surgeon to view the arteries and the aneurysm on a monitor in the operating room. Thin metal wires are pushed through the catheter into the aneurysm forming a mesh ball. Blood clots that form around this coil prevent the aneurysm from rupturing and bleeding. A day, or two after the surgery, the patient is discharged.”</span><br style="font-family: helvetica;"/><br style="font-family: helvetica;"/><span style="font-family: helvetica;">Coiling and other endovascular procedures have become more popular as they have many advantages over craniotomy. They are less invasive, more cost effective, the procedure is done quicker and the patient recovers faster with no mandatory stay in the Intensive Care Unit (ICU) as is the case with open surgery.</span><br style="font-family: helvetica;"/><br style="font-family: helvetica;"/><span style="font-family: helvetica;">People most at risk of developing aneurysms include those with a family history, those with connective tissue disorders, cigarette smoking, or high blood pressure and those using drugs such as cocaine, or amphetamines. Aneurysms can also result from an infection, a traumatic injury caused by a blow on the head, or an accident. Being female and over 40 years of age also increases the risk for brain aneurysm.</span><br style="font-family: helvetica;"/>
 

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