Wellness & Fitness

New technology cuts cost for patients with brain swellings

brain

Procedure offers alternative to head surgery as doctors access the brain through the groin or arm. PHOTO | FILE

Patients with brain aneurysms no longer need go through open head surgeries (craniotomies) for treatment or incur the expensive costs involved following the launch of a new procedure in Kenya.

An aneurysm is a bulge that forms on the wall of cerebral arteries, and is as a result of pressure caused by blood flow.

The bulge can happen anywhere in the body, but the blood vessels in the brain are usually the most adversely affected. Any one can get an aneurysm but cigarette smokers, cocaine or amphetamine users are at a higher risk.

The new procedure is done through a puncture on the groin or arm. The doctor uses a tube inserted through an artery in the thigh, to access the aneurysm in the brain, which he then fills with coils that block blood from getting in.

“An aneurysm is a weak area in a blood vessel wall that causes the vessel to bulge or balloon out. It sometimes bursts.

Coiling allows the neurosurgeon to access the brain using a catheter inserted through a puncture in the groin or arm to stop or prevent re-bleeding caused by the aneurysm,” said Dr Edwin Mogere, a neurosurgeon at Aga Khan University Hospital, the only healthcare centre offering the procedure in Kenya.

Rate of occurrence

“One to two per cent of the world population suffers aneurysm. If we localise the statistics and take the lowest percentile (one), this translates to 400,000 Kenyans having aneurysms at any particular time,” said Dr Mogere.

Currently, there is no way of detecting an aneurysm before it raptures.

“There are two main blood vessels, each of which carries 200mls of blood per minute to the brain. At certain places, blood flow is very high and it puts tension on the wall.

The wall is a living tissue and is supposed to keep reforming and growing but it sometimes fails. The combination of flow and shear turbulence (pressure) is what causes the aneurysm,” he said.

The majority of people will never discover they have aneurysm because there is a one per cent rapture rate out of the 400,000 reported cases in Kenya every year.

“Only a large aneurysm measuring 10mm is likely to rapture, and going by the lowest occurrence probability then about ,” said Dr Mogere.

However, only 500 out of the 4,000 emergency cases are detected every year in Kenya leaving the rest untreated and often resulting in death.

Treatment costs

Brain aneurysms may not be well known but are fatal because the moment they rapture, at least 15 per cent of patients will die on the spot.

For the 85 per cent that make it to the hospital, 30 per cent die within the first month out of complications- assuming they do not suffer a second bleed.

A second bleed after the rapture puts the life of the patient at a greater risk. Treatment offered to aneurysm patients is, in most cases, to prevent a second bleed.

“If a patient suffers a second bleed they double the risk of dying (80 per cent chance of dying). Only 10 per cent of patients survive it,” he said.

The 500 reported cases are treated in local hospitals like the Kenyatta National Hospital, Aga Khan University, Nairobi, Mater and Guru Nanak hospitals. However, these hospitals, with the exception of Aga Khan can only clip the aneurysm — an old procedure that is also meant to stop a second bleed.

The new coiling method is also cheaper at Sh600,000, half the amount spent for the clipping procedure.

While patients who have gone through a coiling procedure are admitted in the High Dependency Unit (HDU) in hospitals for observation, there is an Intensive Care Unit (ICU) mandatory stay for patients who have gone through craniotomy, further increasing the treatment costs.

“The patients are graded according to severity and those with a grade four and five have a mandatory stay in the ICU,” said Dr Mogere.

The new method will also save patients, who have for a long time have had to travel to Egypt and South Africa for the advanced medical procedure, incurring extra travelling costs.

“When an aneurysm raptures, you are in no condition to fly. A bleed is an emergency and there is no luxury of planning to fly and there is the risk of a re-bleed in the next 24 hours— and it is important that you to deal with it (aneurysm) before it gets to that.”

Dr Mogere said that the country has the capacity to do these types of complicated procedures but requires well- trained medical personnel.

Lack of awareness

Mass education is also necessary to ensure that the 3,500 unreported cases every year seek medical attention.

“The medical procedure is life-saving to many patients. The new Health minister, who previously worked in a private hospital, is certainly aware of the fact that only five per cent of the population is able to access proper treatment and I hope that he will set up structures to ensure that the services are offered in public hospitals,” he added.

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