From Shaping the MGH -- November 1994. Copyright the Trusteees of Massachusetts General Hospital, 1994

Defusing a time bomb in the brain

Suzanne Kellogg thought it was stress. The headaches seemed to begin just about the time she started a demanding new job two years ago. But they began to feel different from anything she had experienced before. 'It felt like there was an object inside my head, the 47-year-old registered nurse recalls.

What was inside her head was an aneurysm, a weak spot in a blood vessel that causes it to swell like a balloon and possibly burst. Although Suzanne was fortunate that her problem was diagnosed before a catastrophic rupture, she was in for an arduous course of treatment.

'Suzanne's situation was very difficult to manage,' says neurosurgeon Christopher Ogilvy, MD , director of the MGH Brain Aneurysm/AVM Center. 'Her aneurysm was almost 4 centimeters in diameter -- anything larger than 2.5 centimeters is considered a giant' aneurysm.

'Also, most aneurysms form a little sac off the main blood vessel that can just be sealed off. Suzanne's involved the entire blood vessel wall. When we tried to close the aneurysm in one area, within a few days another part of the artery would start to expand.'

Dr. Ogilvy collaborated on Suzanne's care with Robert Crowell, MD, the former director of the MGH center who is now at Berkshire Medical Center in Pittsfield, Mass. Twice they operated to reduce the aneurysm by closing off the swollen portions with tiny metal clips. Twice the aneurysm continued to grow.

A two-part strategy finally led to success. First the neurosurgeons constructed a new blood supply for the part of her brain supplied by the weakened vessel. They did this by attaching a graft to an artery that usually supplies blood to the scalp, passing it through a hole in the skull, and connecting it above the aneurysm.

A few days later, In Sup Choi, MD, MGH director of Interventional Neuroradiology, filled in the aneurysm with tiny platinum coils. Inserted through a fine catheter threaded through major blood vessels, the coils cause the aneurysm to be sealed off. Dr. Choi is one of a few of physicians worldwide performing this procedure, which currently is available at about 20 centers in the United States.

It is only with the most advanced facilities that skilled specialists like Dr. Ogilvy and Dr. Choi can accomplish such delicate procedures. Plans are currently in the works for four new neurosurgical operating rooms with the state-of-the-art computers and imaging equipment required by today's surgeons. Generous donor support can help make those plans a reality.

Once the aneurysm was obliterated, Suzanne could begin the process of recovery. Just as any operation can result in discomfort, surgery on the delicate tissues of the brain can disrupt normal functioning. As expected, Suzanne experienced temporary problems with thinking, memory and emotional stability.

'No matter how much support you get from your doctors, nurses, therapists and family, recovering from a brain injury is terribly frustrating,' she says. 'It's hard to process new information; it's hard to express your thoughts. It's really very lonely.'

As she recovered, her participation in an MGH aneurysm patient support group inspired Suzanne to tackle a need she recognized -- disseminating more information about brain aneurysms to patients, their families and the general public. She wrote a brochure about the recovery process, which has recently been published. Now she is serving as president of the newly established Brain Aneurysm Foundation , devoted to education and patient support on a national level.

Suzanne explains: 'I'm a nurse, and it took me a long time to acknowledge that something was really wrong with me. Headaches can appear to be so trivial, and denying that a problem might be serious is natural. Getting out the word about aneurysms, their symptoms and treatment can really save lives.'