Restoring Blood Flow to the Brain

Gilbert Porter didn't have just one aneurysm-he had four. These ballooning walls in the brain's arteries can act like time bombs. An aneurysm that ruptures and bleeds is fatal in 50 percent of cases. In Porter's case, two of his aneurysms were closed off with coils by Hopkins neuroradiologists Kieran P.J. Murphy and Philippe Gailloud. That left two more to repair, which normally would have required two separate brain surgeries. Rafael Tamargo, however, is one of the few neurosurgeons who combines those two big operations into a single procedure. He uses a new contralateral approach that he developed in the lab. Tamargo entered one side of Porter's skull and repaired the aneurysms on both sides.

"One in five patients has multiple aneurysms," Tamargo explains. "With this technique, we save the patient from a second surgery. Recovery is much quicker, and the end result is just as good."

Most neurosurgeons see two or three aneurysms a year. Tamargo's team repairs 170 annually (about three a week), making their treatment of these rare conditions almost routine. "We get better at it every time," Tamargo says. But the cerebrovascular group actually specializes in the whole range of blood vessel malfunctions that can occur in the brain, spinal cord and neck. They are adept at removing plaque from clogged carotid arteries in the neck (which lead from the heart to the brain) to avoid the danger of stroke. And they also treat a whole range of uncommon ailments like genetic arteriovenous malformations-abnormal clusters of vessels that steal blood from the rest of the brain and cause seizures-or moyamoya disease, an unusual condition that strikes children and requires bringing a new supply of blood to the brain often by transferring muscle from other parts of the body.

"But what's really exciting about this field," Tamargo says, "is how much better we have become at identifying people with these problems and intervening before it's too late."