Join Chris Uff and his fantastic team on #OperationLive on 11 April from 10pm - they'll be locating and repairing a brain anneurysm live on Channel 5. Find out more about what the operation entails, and why Chris decided to become a surgeon is his interview.
What is an aneurysm?
An aneurysm is a swelling of a blood vessel. They can come in different shapes and sizes ranging from 2mm to 5cm.
Are aneurysms common?
Yes, small aneurysms occur in about 1 in 30 people but the majority of these are harmless and many people go through life completely unaware they have one.
Larger aneurysms are more likely to bleed, but only 1 in 20,000 aneurysms bleed each year.
Aneurysms are very uncommon in children. They are most likely to develop in early adulthood and most ruptures happen at around 50 years old.
Why do people have aneurysms develop?
We can’t say for sure! Very occasionally aneurysms appear to run in families but this certainly isn’t always the case.
What can someone do to prevent themselves from developing an aneurysm?
Aneurysms themselves can’t be prevented. The majority of aneurysms are harmless and will remain small, however factors such as smoking, high blood pressure, excess alcohol or recreational drug use can cause them to grow and bleed.
How can you prevent an aneurysm from bleeding?
Although you can’t stop yourself from developing an aneurysm, it is possible to have it repaired before it bleeds and this is what Thursday’s operation is all about.
How do I know if I’ve got an aneurysm?
Aneurysms are sometimes discovered by chance when a patient’s brain is being scanned for a separate reason.
The majority are small and never treated as the risks of surgery far outweigh the risks posed by the small aneurysm.
On the rare occasions the aneurysm is big (above 7mm) or we can demonstrate it’s growing, then we will intervene.
If several members of your family have had a bleed from aneurysms, we would advise you to have a screening scan. However we would not recommend this for most people.
If I have an aneurysm, will I definitely need surgery at some point?
No. If we can prove the aneurysm is ‘small’ – which is done by scanning the aneurysm twice, one year apart) we wouldn’t recommend treatment or any need for follow-up.
What are the symptoms?
Aneurysms don’t result in symptoms until they bleed – and that only happens in 1 in 20,000 a year.
Symptoms for a bleeding aneurysm include:
- Severe headache – “thunderclap headache”
- Feeling/being sick
- Unable to look at bright lights
- The patient may also become unconscious or have a seizure
There are lots of reasons why someone might experience a sudden onset severe headache, so it doesn’t necessarily mean that an aneurysm has bled. However, a CT scan tells us the answer.
What is the general pathway for treatment?
Patients are admitted via the Emergency Department and see a neurosurgeon as soon as they arrive.
They have treatment for the headache and their blood pressure is brought under control.
They have special scans to locate the aneurysm and a team of doctors will then decide which treatment to recommend.
The first treatment priority is to repair the aneurysm to prevent it bleeding. This may involve open surgery (repairing the aneurysm from the outside of the blood vessel).
However, these days, aneurysms are more often treated with endovascular surgery, which involves repairing the aneurysm through the inside of the blood vessels. This is done by the radiologists who are sometimes referred to as endovascular surgeons.
What is the recovery time after surgery?
Once the aneurysm has been repaired, the patient is usually in hospital for about 3 weeks and then spends another 3 months recovering at home.
How serious is an aneurysm bleed?
Unfortunately, around 1 in 3 patients with a bleed from an aneurysm will die and only 1 in 6 will go back to how they were before as the impact on their brain can be very severe.
Is surgery always required?
Many aneurysms aren’t treated because the risks of treatment are often deemed greater than the risk posed by the aneurysm.
If we recommend treatment however, then the options are open surgery (which I will be performing on Thursday night) or endovascular surgery.
Preventative surgery is usually only recommended once the risk of rupture is higher than the risk of complications from treating it electively.
How many aneurysm operations do you perform a year?
I am the only surgeon for brain aneurysms at Barts Health.I tend to do around 20 to 30 of these operations a year. My colleagues in radiology who perform the alternative treatment, endovascular surgery, operate on 150-200 per year.
What is endovascular coiling?
Most aneurysms can be treated by endovascular coiling. This involves inserting a thin tube called a catheter into an artery in your leg or groin. The tube is guided through the network of blood vessels, up into your head and finally into the aneurysm. Tiny platinum coils are then passed through the tube into the aneurysm. Once the aneurysm is full of coils, blood cannot enter it. This means the aneurysm is sealed off from the main artery, which prevents it growing or rupturing.
What is the treatment decision based on?
The decision on whether a patient will undergo open or endovascular surgery is based on the size and shape of the aneurysm. If the aneurysm has a wide neck (where it opens onto the blood vessel) then it is often better to repair it with open surgery and clip it rather than coil it.
What does having this procedure mean for patients?
For a simple aneurysm, the chance of serious complications is about 3%. For more complex aneurysms the risks are higher but so are the risks of complex aneurysms bleeding so they often get treated.
If an aneurysm has bled then the risks of treatment are around 10%, but this is versus a 50% risk of re-bleeding.
Why did you want to become a surgeon?
I have always been good with my hands (I made my first violin when I was 16) and I have always loved science! Becoming a surgeon was the perfect way to combine the two.
There’s also an inexplicable calling that all doctors have, telling you to dedicate your life to medicine. Medicine really isn’t just a job, it’s a llifestyle.
Why did you choose to specialise in this area?
It sounds cheesy, but the brain really is the final frontier in medicine. I always find it really exciting seeing the brain once the skull has been removed. It’s the point of no return and when the stakes get really high.
Although patients are often critically ill, seeing a patient who was on the verge of death wake up and be able to go home is fantastic.
Why did you choose Barts Health? What do you enjoy most about working at Barts Health?
Barts Health NHS Trust and The Royal London Hospital are truly amazing. In London, it is one of four Major Trauma Centres and it is the busiest, looking after about 1 in 10 serious trauma cases across the UK.
We have an open acceptance policy here, meaning that it doesn’t matter how bad our bed crisis is, we will always find a way to take a patient if they need to be with us as an emergency. This saves countless lives.
The team spirit throughout the hospital is amazing and the can-do attitude amongst staff is a complete joy to work with. If I need consultants from other surgical specialties in theatre with me at a moment’s notice to save someone’s life, they are there without hesitation. Once they arrive it’s like you’re doing what you love with a group of your best friends, whilst knowing you are making a difference.
What’s your favourite memory from your time at Barts Health?
My favourite memory is teaching junior surgeons to clip aneurysms and then seeing them do it without me for the first time. It’s a very special moment seeing the next generation of surgeons finding their feet!
What would you say to people thinking of training as a surgeon?
It’s the best career imaginable! You have to be OK with a bit of blood and you have to do well at school but apart from that, it’s about finding inspirational role models. Your communication skills also have to be exceptional if you are going to be able to convince someone you have only just met that they should let you operate on their brain.
When I interview prospective medical students they always get asked ‘Why do you want to be a doctor?’ Most say something about liking science and enjoying work experience, but the true reason is usually that you have a mysterious calling to dedicate your life to something you have seen snippets of but know very little about.
I’ve never regretted a second of my career in the NHS and I would gladly do it all again. Putting it simply – I love my job.
“Lots of junior staff come to our neurosurgery department and don’t want to leave. I’ve always valued that immensely. We all take real pleasure in training the next generation of neurosurgeons.
For the last 2 years, the GMC national training survey showed that the Royal London is the best place in the UK to train in neurosurgery.
How important is your team during this procedure? How do the different roles help you?
Without my team, I couldn't be a Neurosurgeon. I don’t know what I would do without them. I would be extremely limited in what I could do without them.
It’s everyone – from the anaesthetist and registrars to the nurses and even the porters!
I actually used to be a porter at Barts and I always tried to put the patient at ease when I was bringing them down for surgery. It’s incredibly important and can impact on their whole experience.