For her first two weeks, little Ashlyn Julian was, according to The University of Kansas Health System neurosurgeon who saved her life by repairing an extremely rare ruptured brain aneurysm, “very rambunctious and attentive and full of energy.” When she suddenly began sleeping and feeding poorly, her parents took her to their local Kansas City-area hospital, where doctors suspected the child was suffering from typical maladies, most likely an upset stomach. But symptoms persisted, and Ashlyn even had a seizure, with her body contracting and stiffening.
She promptly returned to normal, but her parents, Jared and Gina Julian, were concerned enough to take her to Children’s Mercy Hospital, where doctors found that the soft spots on Ashlyn’s skull had become tense. An ultrasound detected what was first thought to be a tumor, until pediatric neurosurgeon John Clough, MD, concluded that a tumor would probably not have caused her symptoms.
More then met the eye
Clough ordered an MRI, which revealed bleeding in the child’s brain, an event so rare in infants less than 28 days old that medical literature had recorded a mere 17 such cases since 1949; Ashlyn was No. 18.
He brought the case to the daily neurosurgery conference at The University of Kansas Health System, where it was agreed the best course of treatment would be to access the aneurysm through the baby’s vascular system. Ashlyn’s body had stopped the bleeding by forming a clot, but the clots are delicate and can rupture when the brain is jostled during a typical open-skull surgery; and, because her body was so tiny, any loss of blood might well have been more than Ashlyn could endure.
As our team – including assistant professor and endovascular neurosurgeon Koji Ebersole, MD, and assistant professor and interventional neuroradiologist Alan Reeves, MD – went through a final discussion of surgical options, the child seized again. They knew her life was in imminent peril and rushed into action.
Working in a specialized operating room equipped with the latest in 3D imaging, the surgeons snaked the tiniest microcatheter they could find into Ashlyn’s blood vessels. Once they progressed from the child’s thigh to the aneurysm in her brain, they inserted into the catheter a micro-wire, about the thickness of a human hair, with which Ebersole delivered a drop of surgical superglue to seal the rupture.
A novel approach
Both Reeves and Ebersole say that although the procedure was exceedingly unusual because of the patient’s tender age, they approached it as they would any other surgery and felt no added pressure with an infant’s life in their hands.
“For me, personally, my anxiety about any procedure has to do with whether or not it’s the right thing to do,” Ebersole says. “Once I’ve decided that I’m doing the right thing, then there’s no nerves at all. ... [And] once she experienced the second bleeding, I was strongly compelled that there was not a better solution, so I was not nervous thereafter.”
Although the use of superglue captured the public’s attention when news about the surgery went out around the world, superglue is actually now a standard tool for sealing aneurysms. For the surgeons and their colleagues, the intriguing aspect of the case was the fact that Ashlyn was just 3 weeks old at the time of the procedure. Our doctors will detail their experience in medical literature so professionals worldwide can learn from the case, but they don’t anticipate that it will be needed anytime soon.
“That’s not just a once-in-a-career case,” Reeves says, “it’s a once-in-a-career case for 100 different surgeons. I don’t ever expect to see a case like this ever again.”
The health system surgeons emphasize that the parents did everything right, as did physicians who initially failed to suspect a brain aneurysm; it is simply too rare of an event to expect it to be immediately diagnosed. For that reason, too, they caution parents who have heard about Ashlyn’s case not to immediately fear a brain bleed if their infant has a turn in health that proves difficult to diagnose.
“That is not the point of broadcasting this situation with this baby,” Reeves says. “It’s just very unique and interesting, and thankfully with a good outcome.”
The relieved Julians brought 3-month-old Ashlyn back for a visit in late August, and her doctors say the bright, happy baby can be expected to enjoy normal childhood development.
“I wasn’t even thinking about anything we went through,” Ebersole said while cradling Ashlyn, who sported a lacy headband and a “My Daddy Rocks” bib. “I was just thinking that she just seems fantastic. I forgot about all those things that we went through.”
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