Dr. Yiping Li Spokane Neurosurgery

Middle aged woman presents with progressive headaches along the top of her head. She has had on and off headaches for a few years but over the past few months they have become more frequent and severe. Further evaluation reveals a brain aneurysm located near the top and front her of head.

Due to her risk factors as well as the aneurysm characteristics, she wished to have preventative treatment of the aneurysm.

The aneurysm has a relatively wide neck and would have historically been best treated with surgical clipping or stent assisted coiling; however, the patient wanted a minimally invasive option but was hoping not to need blood thinners and therefore wanted to avoid a stent.

To work around these considerations, a newer device called the WEB (woven endo bridge) device was thought to be the best option. The WEB is a acts like a pre-shaped plug and works by blocking blood flow along the aneurysm neck and can be placed without the need for heavy duty blood thinning medications.

The patient underwent the procedure which was performed via a puncture in the wrist and a WEB device was delivered to occlude the aneurysm. The patient tolerated the procedure well and was discharged home the following day.

Young woman presents with couple month history of a loud annoying whooshing sound in her right ear. She developed this after heavy lifting and straining. It took almost a year but she was ultimately diagnosed with a spinal fistula.

Although most spinal fistulas present with progressive, slowly developing insidious neurological deficits (usually leg weakness, poor balance, and numbness or tingling). This occurs usually due to congested veins. The spinal cord in lack of a better term "becomes constipated" and malfunctions or has sudden bleeding inside the spinal cord or canal.

Rarely spinal fistulas especially higher up in the neck, can present with pulsatile tinnitus or a constant whooshing in the ear and are often missed on initial evaluation as most people focus on the ear or the brain.

The patient underwent an awake occlusion of the vertebral artery venous fistula which fed directly into the venous plexus at multiple segments within the vertebral artery. Imaging shows before and after treatment.

She tolerated the procedure well and was discharged home the next day. At 3 months follow up she had no neurological symptoms and her whooshing went away.