Last year you did about 700 operative cases and procedures. Is there any particular case you can think about as a good illustration of the combination of endovascular and open brain surgery skills that you apply here in Houston? Dr. P. Roc Chen, MD. This place is a one of very busy places, and probably the busiest place in Texas. Fortunately, we are busy, but at same time, obviously, not all neurosurgery cases we do are very complex. But about half of cases we do are complex cases, including open surgery and endovascular treatment. Some of the cases - I can give example - they really benefit from combination of the surgery methods. I have this child, who I operated on about four years ago. It was his 16th birthday... Yeah, on 16th birthday He had a bad headache around Christmas Eve, It turns out he had a very complicated cerebrovascular structure. He was born with some congenital issues, with connective tissue issues. So he had two giant so-called dissecting aneurysms. One involved the left side of the middle cerebral artery, the other one involved anterior communicating artery. So he had two giant aneurysms in different configuration. Symptoms at the time he presented we due to a quick aneurysm enlargement, more on the left side, the middle cerebral artery dissecting aneurysm was large - about 7 centimeters, which is quite large aneurysm in the brain. For that aneurysm, endovascular treatment was not an option, because the entire vessel was giving way. So the only way to fix it was to do a bypass, so called bypass anastomosis, to replace the blood flow to the left side the brain - to put anastomosis. That's what we did, and then we shut down the aneurysm with the endovascular technique. He did well, he went on a ski trip and then came back a couple months later after recovery, and we did another surgery - we were able to reconstruct the ACom aneurysm successfully, which is open surgery [ACom = Anterior Communicating Artery] So, this is one example. And I treated patients with multiple brain aneurysms in different parts of the brain and these different parts structure-wise would determine the open surgical approach is easier or not, or how high is the risk of treatment. Some patients with multiple aneurysms benefit more from the endovascular techniques, called coil embolization, even putting stents in. In other aneurysms we do surgery, "clipping", so the combination makes patient to have the great result and great outcome, without any complications. These kind of things is what we do frequently. We analyze and assess patient and give the best recommendation based on what is the best for the patient treatment-wise for a long-term outcome, surgical risk and the patient's wishes.
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