Pioneering procedure uses glue to avoid open-brain surgery

Treatment is of particular benefit for older patients suffering brain bleeds due to trauma

Alf Sloan (87) successfully came through surgery to overcome a brain bleed. The procedure was carried out  at Dublin’s Beaumont Hospital. Photograph: Alan Betson/The Irish Times

Alf Sloan (87) successfully came through surgery to overcome a brain bleed. The procedure was carried out at Dublin’s Beaumont Hospital. Photograph: Alan Betson/The Irish Times

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Hundreds of patients a year will benefit from a new procedure that uses glue instead of open-brain surgery for the treatment of head injuries.

The procedure, which has been performed for the first time in Ireland at Beaumont Hospital, will particularly benefit older patients suffering brain bleeds as a result of low falls or other forms of trauma.

Rather than requiring surgery to open the skull so the blood compressing the brain can be drained, the procedure known as middle meningeal artery (MMA) compression is minimally invasive.

An angiogram is performed by inserting a needle in an artery in the groin or wrist. Through this needle, a tube is passed up inside the blood vessels under X-ray control.

Glue is then injected into a blood vessel on the surface of the brain. This cuts off the blood supply to the area where bleeding is occurring. As a result, the blood collection gradually resolves.

The procedure, carried out by interventional neuroradiologists, could potentially help 250 to 300 head injury patients a year, according to Prof Mohsen Javadpour, consultant neurosurgeon at Beaumont.

A recovering Alf Sloan enjoys the company of his great granddaughter Adrianna McCarroll. Photograph: Alan Betson/The Irish Times
A recovering Alf Sloan enjoys the company of his great granddaughter Adrianna McCarroll. Photograph: Alan Betson/The Irish Times

Older people are at risk of bleeding on the surface of the brain, a condition known as subdural haematoma, because their veins are more fragile and can rupture with relatively minor trauma. The bleed can continue for days or weeks, compressing the brain and leading to collapse or stroke-like symptoms such as partial paralysis or the loss of the ability to speak.

Open surgery, needed to drain the collected blood, is risky, and multiple operations may be required.

Last May, Alfred Sloan, an 87-year-old living near Kells, Co Meath, became the first patient in Ireland to undergo the procedure, carried out by doctors Sarah Power and Matt Crockett.

Alf is one of many patients who suffered delayed care as a result of the pandemic. In February 2020, he had a small fall and scraped his head, his daughter Maria recounts. “Although the cut was light, it wouldn’t heal. Because of Covid, we didn’t go to the doctor, and time passed.”

By September that year, when skin cancer was diagnosed, the wound had gone “from the size of a small coin to that of a Yorkshire pudding”.

CT scan

The cancer was successfully treated using grafts of skin from the back of his head and his thigh, but earlier this year Alf’s balance and mobility deteriorated and he suffered several “wobbles” and falls.

“Initially, we thought it was an effect of the antibiotics but when he got a CT scan it showed two bleeds on the brain.”

Alf Sloan (87) with his daughter Maria Moore and great granddaughter Adrianna McCarroll at his home near Kells.Photograph: Alan Betson/The Irish Times
Alf Sloan (87) with his daughter Maria Moore and great granddaughter Adrianna McCarroll at his home near Kells.Photograph: Alan Betson/The Irish Times

Surgeons could not operate on him because of the recovering skin cancer, so he was chosen for the new procedure. Despite his age and other conditions, it went well.

“It’s amazing how it worked. The blood has dissipated and he has come on in leaps and bounds,” Maria says of her father.

“Subsequent CT scans have shown that the blood collection on the surface of the brain has resolved and his most recent scan shows no recurrence,” according to Prof Javadpour.

Over the summer, the procedure has been carried out on a handful more patients with bleeds on the brain, most of them aged over 65.

Only Beaumont Hospital and Cork University Hospital have the specialist staff that can carry out the procedure.

Beaumont is the State’s national centre for neurosurgery and its staff have been highly critical of the Government’s decision to locate a new major trauma centre at the nearby Mater hospital.

As things stand, any patient in the Mater requiring MMA embolism would have to be transferred to Beaumont for the procedure, Prof Javadpour points out.