01, 02: Angiograms showing the large aneurysm prior to surgery. The aneurysm was located at the base of the patient’s skull, making access difficult.Kathy Chavis, a 54-year-old UPS driver from Vass, North Carolina, had been experiencing recurrent headaches for about two years.

“It felt very much like the sinus headaches you get on the side of your eye,” she says. In late April 2008, the headaches became constant -- and when the vision in her left eye grew blurry in June, she went to her eye doctor, who sent her to the local hospital for a CT scan.

“I just assumed it was something I would do and then go home,” she says, “but after the scan they told me they had to admit me to the emergency room.”

What the radiologist found, Chavis later learned, was what he described as the biggest aneurysm he had ever seen. Unable to be treated locally, Chavis was referred to Duke neurosurgeon Gavin Britz, MD, among the country’s most experienced surgeons in handling complex aneurysm repair and reconstructions.

03: A postoperative angiogram showing that the aneurysm is no longer filling with blood. The patient now has a vein bypass that goes from the carotid artery in the neck to arteries in the brain.And Chavis’s case was indeed complex. “Kathy had a very difficult aneurysm in that it was large, had thrombus [blood clotting] inside it, and was located in the skull base,” says Britz.

One of the most common ways to treat an aneurysm is to clip the blood vessels that supply it, making it inert -- unlikely to rupture. But in order to clip this large aneurysm, Britz would have to remove the bone around the affected vessels at the base of the skull.

“It is dangerous and difficult to remove the bone around such a large aneurysm -- it can rupture during the exposure, which could lead to a major stroke and possibly death.”

Even if the aneurysm doesn’t rupture, it can be hard to clip at this size, says Britz. “You often have to clip the carotid artery in the neck and even briefly stop the patient’s heart to collapse the aneurysm enough to be able to clip it.”

The surgery, initially scheduled to last three hours, took more than nine. “The aneurysm was so calcified and hard that we could not clip it, even after multiple attempts,” says Britz.

Instead, the team used a vein from Chavis’s leg to bypass it, cutting off its blood supply from the carotid artery. “Essentially we provided an alternative route for the blood to go from the carotid artery in the neck to the brain.”

Although Chavis says she was prepared to spend several weeks in the hospital for rehabilitation, she was released within 10 days of her surgery -- because her aneurysm never ruptured, her recovery was remarkably smooth.

“My mom and dad call me a miracle child,” she says. It took a month before she felt back her normal self, and she still has some lingering effects from the aneurysm and surgery. “I can’t lift over 25 pounds. And sometimes I have headaches and difficulty remembering things, like how to spell words -- just little stuff. I have to take more time with things I used to take for granted. But my life is good.”

“This case emphasizes how aneurysm treatment has evolved over the years,” says Britz. “Even patients with complex aneurysms can do well.” He notes that in addition to advances in traditional surgical methods, such as clipping and bypass, there are also new, less-invasive procedures including endovascular coiling.

“The important aspect of Kathy’s care was that she had an experienced team looking after her.”

“It matters, how confident and at ease people can make you feel,” Chavis agrees. “I guess you can call it faith -- if you can go into any surgery and feel in your mind and your soul that everything is good, because you really trust the people who are doing all this. Dr. Britz did stress how serious it was, that I might not make it, all that -- but I just felt very comfortable and confident about the whole thing.

“Being able to wake up every day -- I feel like I owe that to the good Lord and Dr. Britz.”