Surgeon puts focus on brain aneurysms
Wendy Harris
The Post-Crescent

Statistically speaking, Judy Williams should probably be dead or significantly impaired.
But luck was on her side the day of Oct. 23 when an aneurysm in her head - a bulging artery - burst and bled into her brain.

Williams, who is the director of Princeton Ambulance Service, was at work when she collapsed. Her colleagues promptly transported her to Berlin Memorial Hospital, where she was stabilized and then flown by the ThedaStar helicopter to Theda Clark Medical Center in Neenah.

A team of specialists, including northeast Wisconsin's only neurointerventional radiologist, was waiting for her upon her arrival.

"One of the flight nurses said, 'You are so lucky, this guy is so awesome and he just got here,'" said Williams, 50, recalling those reassuring words as she feared for her life.

"She was the first aneurysm case I did here," recalls Dr. Todd Peebles, of Radiology Associates of the Fox Valley, who moved to Appleton in September. "She was very fortunate and it went really well."

Peebles is one of only about 150 physicians in the United States who specialize in neurointerventional radiology, a relatively new but growing specialty that uses minimally invasive techniques to treat blood vessel disorders of the head, neck and spine.

Rather than traditional surgery, doctors like Peebles do their handiwork through a thin catheter that is snaked up through a patient's femoral artery near the groin.

"The way I treat aneurysms and vascular malformations is from inside the vessels by using tiny micro-catheters, tiny coils or liquid embolic agents like glue," Peebles said.

Peebles' specialty got a bit of press recently when Sen. Tim Johnson, a South Dakota Democrat, was hospitalized for a type of brain hemorrhage known as an "arteriovenous malformation." An AVM, as it is known, is an abnormal, tangled cluster of veins and arteries. A congenital disorder, an AVM can lie hidden in the brain for decades. But over time, the fragile veins can spring leaks, causing bleeding in the brain.

An estimated 300,000 Americans have AVMs, according to the National Institutes of Health. Only about 2 to 4 percent of them will hemorrhage.

A ruptured brain aneurysm, statistically speaking, is a much more serious problem. About half of people who suffer one will die within minutes. Of those who survive, about 50 percent will then likely die within 30 days. And the remaining 25 percent typically face long-term deficits, ranging from mild to severe.

An estimated 3 to 6 million people in the United States have unruptured brain aneurysms, with more than 30,000 ruptures per year.

"She was lucky in a lot of ways," said Peebles, an Oshkosh native who moved here with his family from Burlington, Vt. "It didn't kill her first and she was able to get here where we have the coordinated team to take care of her."

Time is of the essence following a ruptured aneurysm, though doctors do have a little more time to intervene than, say, after a stroke.

"I cannot stress enough how rapid intervention is the reason I'm here," said Williams, who has made a 100 percent recovery and is back at work. "If I was at home I probably would have laid down on the couch and died."

Once at Theda Clark, an angiogram - where die is injected into the catheter - revealed the location of the tiny ruptured sac in her brain.

The neurosurgery team determined she was a good candidate for the noninvasive surgery, and Peebles filled the broken vessel with tiny coils.

"They promote the stasis of blood flow and clot formation," he said.

Not everyone is a good candidate for the noninvasive surgery. Some patients will still require traditional surgery to clip an aneurysm or remove a blood clot.

But the key to effective care is the team approach, Peebles said.

"You have to have the neurologist, neurosurgeon and neurointerventional radiologist to provide the full gamut of care," Peebles said. "It's amazing what we are able to treat."

Wendy Harris can be reached at 920-993-1000, ext. 526, or at wharris@postcrescent.com.

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