B ROLL Carol Zielinski Carol Zielinski undergoing routine angiogram Dr. Thompson performing minimally invasive brain surgery procedure for aneurysm Dr. Thompson looks at Carol’s angiogram Inserts to Dr. Thompson’s explanation of Carol’s angiogram Dr. Thompson in office	OVERVIEW: Carol Zielinski was shocked when she was diagnosed with a brain aneurysm, the same condition that killed two members of her family before the age of 40. When she was told she needed surgery to repair the aneurysm, she elected to go to the University of Michigan Health System, where Dr. Greg Thompson, Chief of Cerebrovascular Neurosurgery, performed a minimally invasive, endovascular procedure. Going into an artery near her hip, Dr. Thompson carefully threaded a series of catheters through Carol’s blood vessels, navigating to find the vessels carrying blood to her brain. Once he got to the vessel with the weak spot that became the aneurysm, he carefully placed a small coil in the balloon of the aneurysm, then a stent to hold the blood vessel open. In a short time, a clot formed around the coil, sealing off the aneurysm and preventing blood flow to it, thus preventing rupture. Carol talks about her life-saving minimally invasive brain surgery; Dr. Thompson explains the procedure that allowed him to reach the aneurysm without ever opening her head.
Carol Zielinski Age 68 Had minimally invasive brain surgery for aneurysm	CAROL ZIELINSKI: [za-LIN-ski] [01:00:43] ...we have aneurysms. They run in the family. My grandmother on my father’s side had it and she was 39 when she died from it. My brother died from it when he was 39 and I have a younger sister who was 52 and she died from an aneurysm. [01:01:03] (:20)
	[01:01:08] ...my father’s family has all died at early an early age and after 42, we all felt, my sisters and I felt that we were doing good and we were living on borrowed time (laugh). [01:01:23] (:15)
	[01:01:28] ...last January, I had the flu and I got dehydrated and I fell. I hit my head, split it open and I had to go to the hospital and have it stitched. And when I was there, the doctor decided that I should have a CAT scan and when they did the CAT scan, they noticed the aneurysm there... [01:01:53] (:25)
	[01:01:58] When they told me, I mean my first thoughts were that I probably will die shortly because I knew that, you know, my brother and sister, I mean, I just figured if I got a headache, I was gone. I just really didn’t think there was much chance. [01:02:17] (:19)
	[01:02:22] I came to the University of Michigan where they did the coiling and then the stent to hold that in place... [01:02:36] (:14)
	[01:02:41] I definitely feel the stent procedure saved my life. I know that without it I don’t think I would be here today... [01:02:55] (:14)
	[01:03:00] I have to have an angiogram every six months and if uh things continue to progress as well as they have, then eventually I’ll have to do it every six months now, and then eventually they’re talking a yearly thing... [01:03:19] (:19)
	[01:03:24] The idea of minimally, non-invasive brain surgery and, when I tell people what I had done, they can’t believe it. [01:03:33] (:09)
	[01:03:38] I think about my son getting married and that I might never have seen that. I think about my grandkids now are reaching the age where they’re graduating from grade school and high school and college and to think that I might have missed that. I just am so thankful. [01:03:59] (:21)
Greg Thompson, MD Chief of Cerebrovascular Surgery Department of Neurosurgery University of Michigan Health System	GREG THOMPSON, MD: On brain aneurysms [01:04:13] A brain aneurysm is a weak spot in a blood vessel, in this case blood vessel of the brain, in which case there’s a ballooning, a little weak spot that would appear like a weak spot on a tire when it’s about to blow. [01:04:27] (:14)
	[01:04:32] There are a number of conditions that may contribute to the development of aneurysms – high blood pressure, smoking, and genetic causes. They can be familial. [01:04:41] (:09)
	[01:04:46] Aneurysms are relatively uncommon, but they do occur in about 4- percent of the population. They can be dangerous in that they’re often unseen until they actually hemorrhage, which makes them dangerous because there’s no forewarning. [01:05:01] (:15)
	[01:05:06] When aneurysms rupture, about half the patients don’t survive. That’s why we would really like to prevent the first hemorrhage. [For] patients who do survive, there’s a spectrum of their neurologic conditions such that some patients come in with very few symptoms, such as headache. Other patients are present with a severe stroke-like syndrome. [01:05:27] (:21)
	Treatment of brain aneurysm: Traditional open surgery [01:05:37] Traditionally, aneurysms are treated through open surgery done through an opening in the skull. Nowadays, there’s a minimally invasive treatment that we offer for many of our patients, which is essentially treatment through the blood vessels to the aneurysm itself. [01:05:53] (:16)
	Treatment of brain aneurysm: Minimally invasive endovascular surgery [01:06:02] The gold standard treatment for treatment of brain aneurysms has been microsurgery for the last 30 or more years. Within the last ten years, minimally invasive surgery, i.e. coiling of aneurysms, has become a real option we use for as many as 30-percent of our patients. [01:06:21] (:19)
	[01:06:25] Minimally invasive brain surgery for aneurysms consists of treatment using an endovascular route, that is through the blood vessels rather than through an opening in the skull to get to the aneurysm. [01:06:36] (:11)
	[01:06:41] We use a number of catheters that have curved tips that allow us to navigate through the various turns into the cerebral circulation, the blood flow to the brain, and find the blood vessel using fluoroscopy x-rays where the aneurysm is. Once we get to that, we put a very small micro-catheter into the aneurysm itself and fill it with a number of coils... [01:07:06] (:25)
	[01:07:11] ...the coils incite a clot in the aneurysm and effectively seal it off, preventing blood flow into the aneurysm, and therefore rupture. [01:07:18] (:07)
	[01:07:23] Because it’s a relatively new technique, the technology is changing very rapidly and in fact techniques that we didn’t have three years ago are now available that have made endovascular treatment safer still. An example is the use of stents. Stents bolster the coils and keep them in the aneurysm and out of the native or parent vessel and therefore reduce the risk of stroke from the coil itself. [01:07:51] (:28)
	[01:07:56] By avoiding an open craniotomy, that is an opening of the skull, minimally invasive surgery avoids a lot of the risks that are attendant with opening the skull to expose the brain. [01:08:06] (:10)
	[01;08:11] One of the real advantages of endovascular treatment of aneurysms is it allows us to treat patients who, because of their age or their other medical conditions, could not have been treated before. [01:08:22] (:11)
	Dr. Thompson explains Mrs. Zielinski’s endovascular procedure with angiogram [01:08:32] Here is a view of the aneurysm from the side and here is a view of the aneurysm from in front. This would be as if looking right through her face. This is the base of the brain; this is the base of the skull and you can see that the aneurysm is right in the middle of her head in the deepest possible location. This is the view of the artery and the angiogram done after placement of the stent and the coil. The stent goes from the parent vessel, the basilar artery, out to the posterior cerebral artery, and the coil, which has been placed through the stent, is sitting in the aneurysm and completely filling it. You can see it better on what’s called the unsubtracted view, the coil sits where the aneurysm was and fills it up. [01:09:18] (:46)