Quick Case Study

Less Invasive, Alternative Treatment Cures Runner's Ruptured Aneurysm

Newer approach associated with lower risk for infection, seizure recurrence

A close up of a woman's feet while running at sunrise

After experiencing a ruptured aneurysm during a long-distance run, a woman in her 20s presented to Duke for emergency treatment, choosing a traditional endovascular coiling procedure that uses an arterial catheter and metal coils to divert blood flow away from the aneurysm. But as may happen in up to 20% of patients who undergo this procedure, the aneurysm slowly began to grow again, and she needed to return for retreatment.

What treatment did her neurosurgeon, Ali R. Zomorodi, MD, recommend? 

Zomorodi recommended a more permanent alternative for treating the aneurysm called supraorbital craniotomy. This treatment makes use of a keyhole approach through the eyebrow to access deep intracranial lesions and is less invasive than traditional surgical approaches. Unlike endovascular treatments, which can require patients to return for multiple procedures, this minimally invasive procedure may cure the patient’s aneurysm in one surgery.

“With this approach, the chances of an aneurysm coming back are less than 1%, and the chances of that patient needing another operation for the aneurysm is less than 1% for the rest of their lives,” says Zomorodi, one of only a handful of neurosurgeons in the United States who routinely perform supraorbital craniotomy for vascular and pathologies of the anterior skull base. Duke is the only institution to offer this technique for aneurysm treatment in North Carolina’s Triangle region.

Compared with traditional surgical treatments for intracranial aneurysm, supraorbital craniotomy is associated with a lower risk for infection and seizure recurrence. Because it does not involve as much brain manipulation, it is also associated with a faster recovery and better cosmetic results for patients.

After the patient is put under anesthesia, Zomorodi makes a 2- to 3-cm incision in the eyebrow, carefully working around the muscles of the eyebrow to preserve function. He then exposes the bone and removes a small piece of the orbital rim.

Next, under a microscope, he opens the meninges and works underneath the brain to access the arteries. Finally, he removes the adhesions around the arteries to expose the aneurysm and places a clip across the neck of the aneurysm before closing the lining, replacing the bone, and suturing the skin of the eyebrow together. The eyebrow swelling decreases after a few days, Zomorodi says.

“With careful selection and experience, most intracranial aneurysms can be treated in this way,” he adds. “The hospital stay and convalescence is as short as other minimally invasive endovascular techniques, but the results are more durable.”

The young woman is now back to running—even marathons—on a regular basis.

To refer a patient, log in to Duke MedLink or call 800-633-3853.