Cynthia Reynolds: Her Own Miracle
Cynthia Reynolds was enjoying a quiet evening at home on New Year’s Day 2014, when the sudden onset of a severe headache prompted her to ask her husband and daughter to drive her to the emergency room. “Right away I knew this was not a normal headache,” says Reynolds, who is 54.
When a CT scan at Memorial Hermann Memorial City Medical Center revealed a
subarachnoid hemorrhage, she was transferred by ambulance to the Memorial
Hermann Mischer Neuroscience Institute at the Texas Medical Center.
Neurosurgeon Arthur Day, M.D., was on vascular call that night, backed up by endovascular neurosurgeon Mark Dannenbaum, M.D. They tucked her into the Intensive Care Unit at Mischer
Neuroscience Institute and scheduled a diagnostic angiogram early the next
morning. The angiogram revealed the cause of the brain bleed – a basilar tip
Located deep in the brain, the basilar artery supplies brain tissue with oxygen-rich
blood. Years ago, an aneurysm in that location was considered extremely difficult to treat.
“As recently as the 1970s and 1980s, the only option for treatment was open surgery,” says Dr. Dannenbaum, who has expertise in minimally invasive endovascular coiling of aneurysms. “Patients who survived ruptured basilar tip aneurysms would be sent to one of only a few experts in the world. This type of aneurysm was once considered the Holy Grail of neurosurgery because of its location in a deep, dark corridor of the brain where surgical manipulation is very difficult.”
Advances in technology have changed that paradigm in a relatively short period of time. Today, in appropriate cases, endovascular coiling has largely replaced open surgery with microsurgical clipping for the treatment of basilar tip aneurysms.
A dramatic evolution, endovascular coiling involves the placement of platinum coils in the aneurysm. The procedure begins with the insertion of a very long catheter into a blood vessel,
typically the femoral artery in the leg. The catheter is passed through the aorta and other blood vessels until it reaches the neck, where it is directed into one of the arteries that supply the brain. Once the catheter is in place, the neurosurgeon uses contrast material – a special dye – that allows visualization of the blood vessels on x-ray images.
"Everyone at the hospital was awesome. I can’t say enough about the care I was given. After everything I went through, I came out just normal. Now I can provide for my lovely family. I consider that my very own miracle."— Cynthia Reynolds
“After we have good images and make the diagnosis of aneurysm, the next step is to analyze its shape,” says Dr. Dannenbaum, who is an associate professor of neurosurgery at UTHealth Medical School. “If it has a favorable geometry, it is effectively treatable with endovascular coiling as opposed to surgical clipping.”
During the procedure, a smaller microcatheter is guided through the larger catheter. “Once the microcatheter is in place, we can deposit the coil, which comes in a variety of spherical shapes. Usually we deliver more than one coil, packing one inside the other until there’s no space left in the aneurysm. The fact that we can do the entire procedure working inside the vascular system offers a
significant advantage in the treatment of aneurysms in some locations – and much faster recovery for the patient. If we discover that the shape of the aneurysm isn’t favorable for coiling, surgical clipping becomes the preferred option, especially if performed by an experienced open cerebrovascular
A Team of Experts
In addition to benefiting from advances in technology, Reynolds was the beneficiary of the multidisciplinary approach used by neurosurgeons affiliated with Mischer Neuroscience Institute. “We collaborate as a team,” Dr. Dannenbaum says. “Cynthia came in under the care of Dr. Day, an internationally known expert in the surgical clipping of aneurysms. After the angiogram revealed an
aneurysm, we discussed the merits of all possible treatment options. Many hospitals have either a neurosurgeon who specializes in endovascular coiling or one who specializes in open surgery with microsurgical clipping. We have both, which means we can make the right decision for the patient, rather than fitting the treatment to our specific area of expertise.”
Reynolds’ recollection her experience is “a bit gray. They told me I had a brain aneurysm and needed surgery,” she recalls. “Dr. Dannenbaum explained that mine was one of the most lethal types of aneurysm, and that it was located in the middle of my brain. Then I remember waking up after surgery and feeling much better.”
After seven more days of close monitoring in intensive care, Reynolds underwent a second angiogram before being discharged. “Later that day Dr. Dannenbaum came in and told me I was good to go,” she says. “I went home and recovered well. A month later I went back to his office and again he took the time to explain everything that had happened to me. He showed me before-and-after pictures of my brain and advised me to keep the stress down and avoid stimulants.”
Returning to Work
By mid-March, Reynolds had returned to her job as a legal assistant at an oil and gas company on a part-time basis, and today she’s back full time.
“I do a substantial amount of computer database work,” she says. “I’m so blessed that I could come back and do the same job – recovered and well with no disabilities. This sounds crazy but all in all, it was a wonderful experience. I’m so grateful that Dr. Dannenbaum was there for me and truly appreciate the work he does. He’s professional, courteous, genuinely friendly, and I completely trust his judgment. Everyone at the hospital was awesome. I can’t say enough about the care I was given. After everything I went through, I came out just normal. Now I can provide for my lovely family. I consider that my very own miracle.”