Steve refers to his two brain surgeries as “the nutcracker” and “the trip-tic.”
Steve’s neurosurgeon used the two very different procedures to neutralize dangerous brain aneurysms, balloon-like bulges on arteries within Steve’s brain. The “nutcracker” involved opening the skull so that two aneurysms could be clamped at their base. The “trip-tic” involved threading a catheter through arteries to reach a third aneurysm and filling it with tiny coils.
Both procedures, which block blood flow into an aneurysm and prevent it from bleeding, were accomplished at Cincinnati’s Good Samaritan Hospital by Dr. Andrew Ringer, a Mayfield Clinic neurosurgeon and the Director of Neuroscience at the TriHealth Neuroscience Institute.
“I’m a guy who’s truly blessed,” Steve says.
In the early fall of 2004, Steve developed what he called “nuisance headache that was not like a hangover.” He took aspirin, but it didn’t go away. Steve scheduled an appointment with his primary care physician, who gave him some stronger medicine and scheduled an MRI.
After reviewing the scan, the doctor told Steve that he thought he detected a small aneurysm. “I said, ‘You’re kidding,’ Steve recalls. “I didn’t even know how to spell it.”
In fact, as a pack-a-day smoker from age 20 to 50 (he began smoking while in the Marine Corps), Steve had one of the most important risk factors for developing brain aneurysms.
Approximately 27,000 individuals suffer a ruptured brain aneurysm in the United States each year, according to the National Institute of Neurological Disorders and Stroke. About 40 percent will die within a month, and most survivors suffer permanent disability.
Steve was referred to the Mayfield Clinic, where he underwent additional screening. An angiogram, a minimally invasive test that allows specialists to look closely at arteries in the brain, confirmed the first aneurysm and revealed two more. Dr. Ringer initially adopted a wait-and-see approach, ordering new scans every six months. In 2006, concerned that the aneurysms had grown, he told Steve that it was time to be pro-active. “He described it as a ‘pre-emptive strike,’” Steve recalls.
Dr. Ringer treated two of the aneurysms in August 2006, opening Steve’s skull in a procedure called a craniotomy. During the 10-hour operation, he placed a clip at the base of both aneurysms. Then he closed up Steve’s head with 38 staples, a number Steve’s wife, Ann, recalls vividly. “We had been married 38 years, and he had 38 staples,” she says. “I was counting when the medical assistant, Shirley, was removing them.”
“The nutcracker,” took time to heal. “It affected my ability to open my jaw,” Steve says. “I couldn’t open my mouth more than a finger and a half. It took four to five months to get to the point where I could have that double cheeseburger again.”
“The trip-tic” was far easier. Steve had the coiling procedure 30 days after his craniotomy. Dr. Ringer chose to coil this aneurysm because he could reach it with a catheter. Dr. Ringer inserted the catheter in the groin and threaded it up through the body to the brain and to the site of the aneurysm. Steve left the hospital the next day.
“The coiling was literally like a trip-tic,” Steve says. “He just guided it up. I had no awareness of when he was inside the skull.”
Steve returned to Good Samaritan Hospital at 6-, 12- and 24-month intervals for routine angiography to determine whether the coiled brain aneurysm had recurred. During the minimally invasive screening, a contrast dye was injected into Steve’s arteries, via a catheter, in order to make them visible. Steve says he could feel the sensation of warmth when the dye was injected. But because arteries contain no nerve endings, the procedure was painless. “I had no side effects, nothing, no pain.”
The news was good. After the 24-month screening, with no sign of aneurysm recurrence, Dr. Ringer told him, “You’ve graduated.” From now on, Steve will undergo an annual MRA, a non-invasive test that depicts arteries in the brain but uses standard MRI technology.
Steve and Ann feel blessed because Steve’s aneurysms were caught while they were small and before they had had time to grow and possibly rupture.
“I wish everyone knew about this,” Ann says. “Some of our friends, after hearing Steve’s stories, had themselves screened”
Hope Story Disclaimer -"Steve's Story" is about one patient's health-care experience. Please bear in mind that because every patient is unique, individual patients may respond to treatment in different ways. Results are influenced by many factors and may vary from patient to patient.
"Dr. Ringer was incredible. He always spoke with us, not at us. He never rushed us. He was direct, but he gave us all the time we needed. I felt I had a better attitude because of the way he was."
Aneurysm clipping: A titanium clip is placed across the neck of an aneurysm preventing blood from entering.