Cerebral Aneurysm - how long to dive again?

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miketsp

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Location
São Paulo, Brazil
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My wife, a regular recreational diver, has just been operated for a
cerebral aneurysm.
She spent 12 days in intensive care after the long surgery and is now in
a normal hospital room due to be released in a few days.
According to the doctors she was operated in time and there will be no
after effects once she has convalesced. One of the advantages of living in a big city where you can quickly get to a major hospital with neurologists on standby.

That made me think:
Will she be able to dive again normally once fully recovered?
What would be a typical safe period to start diving again?

Now I already consulted DAN and they gave her neurologist contact information for medical diving specialists as obviously each case is individual.

What I want at the moment is a ball-park figure.
1 months, 3 months, 6 months, 1 year, never.....

Anyone been through a similar situation?
 
I'm sure there are no data on this question, as the group of people who have had aneurym surgery and are divers would be an extremely tiny one.

But, assuming that the surgery is successful and that there are no neurologic issues, and that the patient does not develop seizures and did not have them pre-op, I can see no reason that after full recovery, someone would be unable to dive. There's nothing about an aneurysm clipping that would be affected by being underwater.

It's difficult to say how long (maybe shakeybrainsurgeon will chime in here) but I would guess somewhere in the three to six month range would be likely.
 
I certainly do no have answers to your questions, however I send Best wishes for your wife's speedy recovery and special thoughts for you to keep your strength strong. SS
 
Questions: 1) was this surgery for a ruptured aneurysm that had hemorrhaged or for an unruptured aneurysm discovered incidentally or discovered because it produced other symptoms (double vision, headache, etc)?
2) where was the aneurysm (anterior communicating, middle cerebral, posterior communicating, internal carotid, basilar, PICA, etc)? The recovery time depends to some degree on the vessels manipulated.
3) any complicating problems (seizure, vasospasm, hydrocephalus, wound problems, infections?)
4) age and general health? and, finally
5) was the aneuyrsm obliterated completely by clipping, or did a portion of it have to be "wrapped" or endovascularly embolized?

Surgery for an aneurysm, with no neurological sequela, should not be a contraindication for diving. The biggest concern I would have would be the delayed onset of a seizure disorder, which is more of a concern in people with subarachnoid bleeding and with anterior circulation aneuryms, such as acomm, IC, pcomm and MCA lesions. If the patient had no seizures pre- or post-op, I think a waiting period of at least 3 months would be reasonable before diving again.

Also, vasospasm can occur up to 4 weeks or longer after surgery, but that risk is gone by three months as well.

If the aneurysm has not been fully obliterated, then lifting heavy tanks or doing other such "valsalva" maneuvers from lifting would be out of the question for an indefinite period of time.

Thus, in a healthy person with no hemorrhage, no seizures, a completely obliterated aneurysm and uncomplicated recovery, if they were my patient, i would release them to all activity, even diving, by 3 months.

Of course, your case must be decided by those physicians providing care... I am speaking generally and not offering specific medical advice.
 
shakeybrainsurgeon:
Questions: 1) was this surgery for a ruptured aneurysm that had hemorrhaged or for an unruptured aneurysm discovered incidentally or discovered because it produced other symptoms (double vision, headache, etc)?
2) where was the aneurysm (anterior communicating, middle cerebral, posterior communicating, internal carotid, basilar, PICA, etc)? The recovery time depends to some degree on the vessels manipulated.
3) any complicating problems (seizure, vasospasm, hydrocephalus, wound problems, infections?)
4) age and general health? and, finally
5) was the aneuyrsm obliterated completely by clipping, or did a portion of it have to be "wrapped" or endovascularly embolized?

Surgery for an aneurysm, with no neurological sequela, should not be a contraindication for diving. The biggest concern I would have would be the delayed onset of a seizure disorder, which is more of a concern in people with subarachnoid bleeding and with anterior circulation aneuryms, such as acomm, IC, pcomm and MCA lesions. If the patient had no seizures pre- or post-op, I think a waiting period of at least 3 months would be reasonable before diving again.

Also, vasospasm can occur up to 4 weeks or longer after surgery, but that risk is gone by three months as well.

If the aneurysm has not been fully obliterated, then lifting heavy tanks or doing other such "valsalva" maneuvers from lifting would be out of the question for an indefinite period of time.

Thus, in a healthy person with no hemorrhage, no seizures, a completely obliterated aneurysm and uncomplicated recovery, if they were my patient, i would release them to all activity, even diving, by 3 months.

Of course, your case must be decided by those physicians providing care... I am speaking generally and not offering specific medical advice.

First, it did rupture and the symptoms were significant headache extending down the back of the neck and so painful that she could hardly move coupled with vomiting.

I got her directly to the hospital, where they recognized the symptoms, called up the neurologist on duty. Then they ran a CAT scan to confirm the bleeding, then a ressonance to map it. Some hours later she went into surgery but already slipping into unconciousness due to the increasing pressure. The surgery was on 4th April and last Sunday she was liberated to move to a normal hospital room. The intervention was left side anterior and according to the surgeon she was lucky in that it wasn't difficult to get at the bleeding and there was little manipulation of brain mass.

Regular post operative CATs and dopplers have shown no complications and no spasms. So physically she's going very well.
Mentally she is oscillating between lucid and confused in cycles but the doctors believe that from the general picture she will make a slow but steady full recovery.

She is 59 and did start to have an increase in BP a few years ago but this was detected by her regular checkups and nowadays her BP is controlled with medicine, cholesterol is low and she does regular daily exercise so this event just came out of the blue. It happened when she was relaxing in a hammock but a little stressed thinking about a problem a family member is going through.

I've been doing quite a bit of reading on the Internet the last few days about the post operative effects of this surgery on mental capacity and the consensus seems to be that the patient's condition just prior to the surgery is one of the best indicators.

So I'm optimistic that she'll be diving again in 3 - 6 months.
 
This is just the thread I was looking for. Hopefully shakeybrainsurgeon is still around!

I just got out of the hospital after having been admitted for a brain aneurysm. The short story is that I had been having migraine type headaches, daily, for approximately 3 weeks. I, and my GP, suspected they were coital (yes, I admit it) headaches, but an MRI / MRA was scheduled. The result was that a 4mm aneurysm was spotted with no rupture / leaking evident. Met with the neurologist, explained the headaches (two were the bone crushing / eye splitting kinds) and his expression changed: he suspected that I had bled. An LP showed blood in the spinal column (although it may be because he hit some other blood vessels - I forgot the term). Immediate admission to the hospital, and the next day a transfer to UVA’s Neuro ICU unit ( the aneurysm was in too bad of a location for the local hospital, plus it’s fat neck didn’t lend itself to coiling) for treatment. Even with it’s size/neck, the UVA team wanted to try to coil it. They shoved 3 coils in there (I know MD’s don’t use the term ‘shove’!), all went well, and they released me the next day. The CAT scan (prior to surgery) didn’t show any blood, either – so the bleed was never proven. The following day release was because 2 weeks had passed since the suspected bleed and the risk of vasospasm was over.

It’s now been a week. I’m taking it easy (not as much as family wants) and want to get back to diving. I have had a transient low-grade headache over the past few days, but I still haven’t taken any of the great pain pills the hospital gave me.

Here’s where I am looking for guidance: I have been cleared for all activities. Of course my non-diver MD’s all said, “go ahead and dive”. I’ll take a few months off, but I want to ‘get wet’ again. You referred to an obliterated aneurysm. I’m not sure what that means. I was coiled, not clipped. I’m not looking for medical advice, just guidance. If I should stop diving, where should I turn to make an informed decision?

Thanks in advance,


Griff
 
My former employer had multiple cerebral anuerisms and was back in the water about six months or so after the last procedure. She owns Splashdown Divers in Boynton Beach and is a very nice person. The anuerisms are public knowlege, and I'm sure she would be interested in helping anyone who is going through what she went through. You can reach her at 561 736-0712. PLease tell her I said "Hi".
 
Just thought I'd give an update on my wife's case above since the thread got revived.
My initial optimism about diving in 3 - 6 months was too optimistic but not because of the aneurysm itself. Mentally she would have been good to dive in 6 months but there were various complications arising from the long stay in hospital (infections etc) resulting in 2 more hospital stays and the final result of all of this was extensive thrombosis in both legs. So she was only cleared to even fly last month. One leg is now good and the other leg is making good progress but it's unlikely she'll be diving for another 3 months.
In the end it will be a year off diving.
 
This is just the thread I was looking for. Hopefully shakeybrainsurgeon is still around!

I just got out of the hospital after having been admitted for a brain aneurysm. The short story is that I had been having migraine type headaches, daily, for approximately 3 weeks. I, and my GP, suspected they were coital (yes, I admit it) headaches, but an MRI / MRA was scheduled. The result was that a 4mm aneurysm was spotted with no rupture / leaking evident. Met with the neurologist, explained the headaches (two were the bone crushing / eye splitting kinds) and his expression changed: he suspected that I had bled. An LP showed blood in the spinal column (although it may be because he hit some other blood vessels - I forgot the term). Immediate admission to the hospital, and the next day a transfer to UVA’s Neuro ICU unit ( the aneurysm was in too bad of a location for the local hospital, plus it’s fat neck didn’t lend itself to coiling) for treatment. Even with it’s size/neck, the UVA team wanted to try to coil it. They shoved 3 coils in there (I know MD’s don’t use the term ‘shove’!), all went well, and they released me the next day. The CAT scan (prior to surgery) didn’t show any blood, either – so the bleed was never proven. The following day release was because 2 weeks had passed since the suspected bleed and the risk of vasospasm was over.

It’s now been a week. I’m taking it easy (not as much as family wants) and want to get back to diving. I have had a transient low-grade headache over the past few days, but I still haven’t taken any of the great pain pills the hospital gave me.

Here’s where I am looking for guidance: I have been cleared for all activities. Of course my non-diver MD’s all said, “go ahead and dive”. I’ll take a few months off, but I want to ‘get wet’ again. You referred to an obliterated aneurysm. I’m not sure what that means. I was coiled, not clipped. I’m not looking for medical advice, just guidance. If I should stop diving, where should I turn to make an informed decision?

Thanks in advance,


Griff

One of the issues here is whether this aneurysm actually ruptured. A small leak may be missed on CT scan, even on MRI. Blood in the spinal fluid may be due to a "traumatic tap", i.e., bleeding from the needle itself. Usually, the fluid is centrifuged to get the red cells out and the fluid examined for "xanthochromia" or a yellow hue. If the centrifuged fluid is yellow, an older (brain) hemorrhage has happened. Was this test done?

HOWEVER, given this information, we have to assume a hemorrhage did occur. In general, the risk of a ruptured aneurysm goes back to the risk of an unruptured one 12 weeks or so after a bleed, even without treatment. Thus, three months after your last severe headache you would be at the same risk as you were prior to this event even if you did nothing about it (not zero risk, just the same risk as if you had an anuerysm you didn't know about). If the aneuyrsm has clotted, which is what he coils do, the risk will be basically zero. (So why treat it at all, if the risk vanishes in 12 weeks? Because HALF of the patients who forgo treatment will DIE in that 12 week waiting period, hence the change in your neurologist's expression and the urgency to treat!)

Thus, if post-coil imaging show oblteration of the aneurysm and you are 3 months out, you should be good as new. It sounds as if the doctors are confident already that the sac has been obliterated --- ask if they plan any more testing to confirm this or if the intra-op pictures already confirmed the clotting of the aneurysm.

The three month window is to cover any possibility that the sac is not completely clotted yet, and the very rare risk of post-bleed seizure or delayed vasospasm which could be a disaster underwater.

Of course, this info is not official advice. That can only come from your own doctors.:D
 
Thanks for the non-official advice, SBS!

The fluid from the LP was not centrifuged prior to the procedure (and performed at a different hospital), so at this point I don't know. I do believe the Neuro group at UVA suspects a traumatic tap. I have my first (and possibly only) follow-up at UVA on the March 5th. I may find out there. Even my GP was really surprised to hear that the original Neuro called it a bleeder as the MRI images were clear and no blood was noticed.

So I am basically 7 weeks out from the suspected bleed, 5 weeks from the procedure, and I feel great. The 'situations' that caused the severe headaches are no longer triggering anything. I really don't know if they are going to run a CT or MRI at the follow-up. I'll ask if they plan on any more testing. I'd also like to know if the original LP fluid was tested at the original hospital.

I'm going to be in Grand Turk in late March - 10.5 weeks after the procedure and 12.5 weeks after the last possible bleed. I'd really like to 'get wet'. I'm thinking I'm good, although will be extra attentive to anything my body tells me.

Thank you again,


Griff
 
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