A gift from a grateful patient will help specialists from the National Neuroscience Institute manage patients with a potentially life-threatening brain condition.
Imagine enjoying a meal with your family then the next moment, you are fighting for your life. Such a dramatic turn of events can occur when an aneurysm bursts in the brain.
An aneurysm is a weak or thin spot on blood vessels in the brain that balloons out and fills with blood. About two per cent of Singaporeans are living with a brain aneurysm. Yet most are unaware because it usually does not affect their daily lives unless it ruptures. Fortunately, most aneurysms do not rupture.
However, in a small minority of people, an aneurysm can rupture, sparking a medical emergency.
“About 120 people suffer from a ruptured aneurysm in Singapore every year, causing them to switch from being well to becoming critically ill within minutes,” said Dr Vincent Ng, Senior Consultant, Neurosurgery, National Neuroscience Institute. “About one third of patients die due to rapid and extensive brain injury caused by the bleeding and many survivors suffer from neurological health problems such as seizures, paralysis and cognitive impairment.”
An aneurysm is usually picked up when a patient undergoes a brain blood vessel scan for a headache or other conditions. It can be treated, either by putting a metal clip across the neck of the aneurysm or by packing it with small platinum coils. Both methods prevent blood from flowing into the aneurysm thereby preventing it from bursting, but such procedures in the brain come with some risks.
“The challenge is balancing the risk of an aneurysm rupturing against the risk of the procedure. In many cases, our preference is to monitor patients through annual scans and only treat the aneurysm if there is a high risk of rupture,” said Dr Ng. “But it can be difficult for patients knowing that they are living with a potentially fatal condition, so we need more accurate ways to assess each patient’s risk of suffering a rupture.”
Doctors currently use several criteria to assess the risk of an aneurysm rupturing. These include its size, shape and location as well as the age of the patient, other pre-existing illnesses such as hypertension and whether they smoke. This looks set to change in the future.
A former patient is now helping Dr Ng to harness technology to improve care. The patient, who wishes to remain anonymous, gave a generous donation to the Cerebrovascular Programme under the SingHealth Duke-NUS Neuroscience Academic Clinical Programme to procure the Computational Fluid Dynamics (CFD) software which can be used to assess the likelihood of a brain aneurysm rupturing.
“CFD provides detailed information about the flow dynamics and wall shear stress within the wall of the aneurysm. With this information, we hope to be able to understand the rupture risk of the aneurysm better and can reassure patients on their need for surgery with greater accuracy,” explains Dr Ng.
The use of CFD to assess blood flow in the brain aneurysm is an evolving technology in the field of neuroscience. Dr Ng and his team are currently gathering more data to identify which risk factors contribute to predict aneurysm rupture, so the mathematic modelling and software can be fine-tuned for the Singapore population. Dr Ng hopes that CFD will be part of standardised care for all patients with brain aneurysms in near future.