By Terry Rindfleisch, La Crosse Tribune, May 18, 2011
||Dr. Mouhammed Rami Kabbani, a neurosurgeon, and Maureen Worden look at a brain scan from her surgery. Worden was the first patient to have brain coiling surgery to repair a brain aneurysm in La Crosse. Photo by Erik Daily.
||A stent like this one, shown here next to a key to demonstrate its size, was used to repair an aneurysm in Maureen Worden's brain. Photo by Erik Daily.
A Gundersen Health System neurosurgeon broke new ground recently in La Crosse when he performed coiling surgery to repair a brain aneurysm.
Dr. Mouhammed Rami Kabbani conducted the first cerebral endovascular aneurysm procedure in La Crosse on April 26. In the past, La Crosse area patients usually were sent to Madison or Mayo Clinic in Rochester, Minn., for the surgery.
Kabbani, who started work at Gundersen in October, had done more than 350 brain coiling procedures at Froedtert Hospital in Milwaukee.
An aneurysm is a weak area in the wall of the blood vessel that causes the vessel to bulge or balloon out. It can leak or rupture, causing a stroke or bleeding into the brain.
For many years, clipping was the most common way neurosurgeons repaired brain aneurysms. In clipping, a patient's scalp, skull and coverings of the brain are opened up and a metal clip is placed at the base of the aneurysm to prevent it from breaking open.
Kabbani said endovascular coiling is a much less invasive way to treat some aneurysms.
"Clipping is fading away, and coiling is more cost effective and safer," Kabbani said. "It's the gold standard now."
In coiling, Kabbani said, he places a catheter in the groin and guides a smaller catheter with metal coils through an artery to small blood vessels in the brain and the location of the aneurysm.
The catheter goes inside a stent to the inside of the aneurysm, he said. The coils disrupt the blood flow and causes the blood to clot and prevent the aneurysm from breaking open and bleeding.
"It is a delicate, difficult operation, and you don't want to rupture the aneurysm," Kabbani said. "But the operation has been very successful."
He said major medical centers have done coiling for a few years, and he has done two such procedures in La Crosse and plans to do 50 to 60 operations a year.
His first patient was 67-year-old Maureen Worden, who had a surgeon in Lincoln, Neb., perform the coiling procedure in 2005. Kabbani did another coiling operation on her three weeks ago after a rebleeding of her aneurysm.
"I was fortunate to have a surgeon who could do the procedure the first time, and I again was fortunate to have someone in La Crosse to do my second one," Worden said.
Worden retired from teaching English and drama in Norris, Neb., and moved to La Crosse in June 2010 to be with her daughter, Lisa, whose husband, John Conzemius, is a Gundersen physician.
Six years ago, Worden said, she had "horrible headaches that wouldn't go away." Then one day she collapsed in her home.
"I had a ruptured aneurysm, and I wasn't supposed to make it," Worden said. "It was an emergency coiling repair.
"My life was spared, and I'm sure God had a hand in it," she said.
It is estimated that about 40 percent of people whose aneurysm has ruptured do not survive the first 24 hours and up to another 25 percent die from complications within six months, according to National Institute of Neurological Disorders and Stroke.
Worden said she tried to return to teaching after surgery, but she couldn't keep up with the work.
"It takes the brain a long time to heal," she said.
She went to Gundersen for an aneurysm checkup when a rebleed of the aneurysm was found, Worden said.
She had the two-hour repair surgery and went home from the hospital the next day.
Worden said she was tired after surgery but returned to her normal activities.
"I didn't have any symptoms this time, and Dr. Kabbani was just great," Worden said. "It was wonderful to have a quality surgeon here in
La Crosse that could do it.
"But I hope the surgery is not necessary again," she said.