Pioneering procedure uses glue to avoid open brain surgery

Hundreds of patients a year will benefit from a new procedure that uses glue instead of open brain surgery for the treatment of head trauma.

The procedure, which was first performed in Ireland at Beaumont Hospital, will particularly benefit elderly patients with brain hemorrhages from low falls or other forms of trauma.

Rather than requiring surgery to open the skull so that the blood compressing the brain can be drained, the procedure known as middle meningeal artery compression (MMA) is minimally invasive.

An angiogram is done by inserting a needle into an artery in the groin or wrist. Thanks to this needle, a tube is passed inside the blood vessels under radiological control.

The glue is then injected into a blood vessel on the surface of the brain. This cuts off the blood supply to the area where the bleeding is occurring. As a result, the blood collection gradually resolves.

The intervention, performed by interventional neuroradiologists, could potentially help 250 to 300 head trauma patients per year, according to Prof. Mohsen Javadpour, consultant neurosurgeon at Beaumont.

Recovering Alf Sloan enjoys the company of his great-granddaughter Adrianna McCarroll. Photograph: Alan Betson / The Irish Times

Older people are at risk of bleeding on the surface of the brain, a condition known as subdural hematoma, because their veins are more fragile and can rupture with relatively minor trauma. The bleeding can last for days or weeks, compressing the brain and causing collapse or stroke-like symptoms, such as partial paralysis or loss of the ability to speak.

Open surgery, necessary to drain the collected blood, is risky and several operations may be necessary.

Last May Alfred Sloan, an 87-year-old man living near Kells, County Meath, became the first patient in Ireland to undergo the procedure, performed by doctors Sarah Power and Matt Crockett.

Alf is one of many patients whose care has been delayed due to the pandemic. In February 2020, he had a small fall and scratched his head, says his daughter Maria. “Even though the cut was slight, it didn’t heal. Because of Covid, we didn’t go to the doctor, and time has passed. “

By September of that year, when skin cancer was diagnosed, the wound had grown “from the size of a small room to that of a Yorkshire pudding”.

computed tomography

The cancer was successfully treated with skin grafts on the back of his head and thigh, but earlier this year Alf’s balance and mobility deteriorated and he suffered several “Oscillations” and falls.

“At first we thought it was an effect of the antibiotics, but when he had a CT scan he showed two bleeds on his brain.”

Alf Sloan (87) with daughter Maria Moore and great-granddaughter Adrianna McCarroll at his home near Kells.Photograph: Alan Betson / The Irish Times

Alf Sloan (87) with daughter Maria Moore and great-granddaughter Adrianna McCarroll at his home near Kells.Photograph: Alan Betson / The Irish Times

Surgeons were unable to operate because of the healing skin cancer, so he was chosen for the new procedure. Despite his age and other conditions, everything went well.

“It’s amazing how it worked. The blood dissipated and it came in leaps and bounds, ”Maria says of her father.

“Subsequent CT scans showed that the collection of blood from the surface of the brain had resolved and that his last scan showed no recurrence,” according to Professor Javadpour.

Over the summer, the procedure was performed on a handful of additional patients with bleeding brains, most over the age of 65.

Only Beaumont Hospital and Cork University Hospital have specialist staff who can perform the procedure.

Beaumont is the state’s national neurosurgery center and its staff have strongly criticized the government’s decision to locate a new major trauma center at the nearby Mater Hospital.

As it stands, any Mater patient requiring MMA embolism should be transferred to Beaumont for the procedure, says Professor Javadpour.

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