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Baby's brain aneurysm halted -- by superglue

Baby's brain aneurysm halted -- by superglue
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Monday, June 10, 2013 - 5:38pm

Chalk it up to a win for ingenuity: Doctors are crediting surgical superglue for saving the life of a 20-day-old girl in Kansas.

Ashlyn Julian was born healthy and happy on May 16. Shortly after returning home from the hospital, however, her parents noticed something was wrong with their newest addition.

"She was probably around 10 days old, and she was sleeping a lot, and I understand that babies sleep a lot, but to the point that you couldn't wake her up to feed her," said Ashlyn's mother, Gina Julian.

Then abruptly, her behavior changed. "We (went) from a baby that was very quiet to a baby that was screaming all the time and throwing up, and at that point we knew something was very wrong," Julian said.

Ashlyn's parents twice rushed her to the emergency room at Children's Mercy Hospital in Kansas City, where doctors noticed her fontanel (the soft spot on a newborn's head) was raised. Undecided between meningitis and something in her head, doctors decided to conduct an ultrasound.

"The ultrasound was as far as we made it because they saw something in her head at that point in time, so they decided to transfer her to a hospital that was better equipped for what was going on," said Julian.

That place was The University of Kansas Hospital, also in Kansas City. Once there, doctors found an aneurysm the size of an almond lurking in Ashlyn's newborn brain.

"We did not know what the right answer was. This was not a textbook case," said Dr. Koji Ebersole, an endovascular neurosurgeon. "If you try to treat the baby without closing the aneurysm ... most of those babies can't survive. So we had a strong reason to develop a plan to close the aneurysm."

By the time doctors at KU Hospital got to Ashlyn, she had already experienced one bleed from the aneurysm, and before her surgery she would experience a second. The standard treatment for brain aneurysms is to open the skull, but in a baby as young as Ashlyn, that wasn't the preferred option.

"It was absolutely a strong consideration for us, and possibly even the primary plan," Ebersole said. "The difficulty is, on a child so small, any amount of blood loss represents a significant percentage of her overall blood volume. So a surgery on the brain to approach something that wants to bleed -- we could have been in a situation with bleeding we could not keep up with, and that would have been life-threatening."

After studying MRI images of Ashlyn's brain, Ebersole was fairly certain that he would be able to image the aneurysm itself using an angiogram -- a process that allows doctors to view the flow of different blood vessels in the body. Based on the location of Ashlyn's aneurysm, he decided to take an unorthodox course of treatment.

Ebersole was determined to close the aneurysm using surgical superglue - a method previously utilized only on adults.

Because bleeding in the brain is so rare in infants, there aren't even tools for the procedure. So Ebersole improvised, using a micro-catheter as thin as a strand of hair inserted into Ashlyn's neck to access the aneurysm and deposit the glue.

The minimally invasive, groundbreaking procedure worked. Just one day after her aneurysm was eradicated, Ashlyn's breathing tube was removed -- exceeding even the expectations of her surgeon.

"Oh, we're thrilled! The breathing tube was taken out the very next day," Ebersole said. "I did not know that she'd be ready that fast, and I think she's been making steady strides since, so we're all very happy."

Doctors expect Ashlyn could be released from the hospital in as little as a week and a half, and even more amazingly, they expect her long-term prognosis to be just fine.

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