A stroke averted: Innovative 3D model key in successful aneurysm surgery for William Golden Sr.

William Jerome Golden Sr. tends to fill the room he enters. Well over 6 feet, finely-muscled, at 44 he looks like what he used to be, a basketball player at Godby High School. For the last 24 years he has worn the uniform of a manager at a Super Lube shop. Since 2005, when not running that store, he has managed to also develop what he calls his “entrepreneurial business,” Golden Touch Enterprises, doing home maintenance and landscaping.

No doubt about it, William Golden, a hard-worker and father of four, was a man going places, doing things, filling his future with plans. That is, until he almost had all of those plans cancelled by something deep inside his head. 

Sitting in an office at Tallahassee Memorial HealthCare on a recent Monday, Golden is holding something most people might find macabre. It is white, made of a kind of plastic, and is an exact replica of Golden’s lower skull, cervical vertebrae and curling blood vessels. He turns his “skull” over and over in his hands, quiet as he examines it, perhaps for a moment overcome with memories.

“That’s your head and that is the aneurysm that was repaired,” says Rob Fisher, RN, Neuroscience Service Line Administrator at TMH. Fisher has become a kind of "lynchpin" in TMH’s use of a dramatically new modality and how doctors and patients are able to visualize the body. 

“This is exactly where the doctors were able to thread the stent,” says Fisher pointing to an enlarged section of a blood vessel lying near the base of Golden’s ‘skull.’ “And it’s all made through the use of 3D printing based on CT, MRIs, angiograms or PET scans of the patient.”

 

 

Severe headache symptoms

Prior to coming to Tallahassee, Rob Fisher had been doing international consulting, he says, working with Barts Hospital in London and an Irish company called, Axial. Axial was an innovative organization that had pioneered 3-D printed facsimiles of boney, vascular and soft tissue parts, as well as visualizing metallic appliances for use in complicated surgeries.

These "real life" models allow surgeons to turn their surgical sites any direction in their own hands, to know the anatomy from different angles before entering the body, and which are accurate, says Fisher, to 1/1000 millimeter. Fisher introduced the concept to the stroke team physicians at Tallahassee Memorial HealthCare.

Back in 2017 William Golden had been having trouble with what he thought were sinus headaches. “I’d been to the Emergency Room several times,” he says. “The headaches were really bad… but sinus problems can hurt too.” An alert Emergency Room physician decided that there might be more to the repeat visits, and shortly, a CT scan revealed not an infected sinus cavity, but a dangerous cerebral aneurysm in Golden’s head. 

Aneurysms come in a variety of types and are caused by a weakening of a blood vessel’s wall to make a bulge or distension. The most common aneurysm resembles “a berry” that hangs from a twig. Not all aneurysms require immediate intervention, but some do. 

Planning for surgery

Enter Dr. Matthew Lawson, a neurosurgeon and Stroke Medical Director at the Tallahassee Neurological Clinic and TMH. “Without intervention, Mr. Golden was at risk for two kinds of stroke — thrombotic and hemorrhagic. Based on the size and location of Golden’s aneurysm, it necessitated treatment.”
 
Using modern techniques that allow for intercranial repairs without externally entering the skull, Dr. Lawson threaded a catheter from William Golden’s groin into the vessels of his head. An angiogram was done, injecting dye to show on X-ray exactly the configuration of the vessels that would be treated.

But Dr. Lawson says the angiogram revealed something he hadn’t expected. This kind of aneurysm was different. Called a dissecting pseudoaneurysm, instead of the full thickness of the vessel bulging, here the inner wall had failed, and only thin connective tissue was keeping the entire vessel from hemorrhaging into the brain.

Dr. Lawson realized his plan for treating the problem with traditional aneurysm coiling was not going to be the best option.

For the moment, the surgery was halted and a new plan would be devised.

Rethinking the operation

Back in the TMH office, William Golden, still holding the 3D version of his skull, grows quiet, fighting back the emotions that overwhelm him as he remembers awakening to find he has not been made better; that he and his doctor would have to embark on a new and potentially more dangerous course of treatment.

Dr. Lawson too would pursue all the information he could gather. “I consulted with several surgeons around the country and though not usual, together it seemed that using a different kind of device called a ‘Pipeline’ stent would make sense.” Here, the stent would ‘by-pass’ and ‘wall-off’ the ruptured area allowing the aneurysm to clot and heal on its own. 

For William Golden, the aborted surgery had given him pause and it took a while for him to conclude that he would undergo the second attempt at his aneurysm’s repair. “I had faith in Dr. Lawson,” he says now. “I appreciated that he took the time to do it the right way and not take risks.”

From Lawson’s point of view, he says that, “For surgeons, these 3D replicas are helpful in seeing the exact curvature of blood vessels, their proximity to other brain structures, and importantly, to explain clearly to patients what is involved.”

Faith and success 

The second surgery was performed. Golden says he leaned on his faith — and his trust in his doctors. The second surgery was a success.

Today, as William Golden readies to get a bite of lunch and get back to Super Lube duties, he looks the picture of health. His doctor tells him that his risk for stroke is “close to zero.” Untreated, it would have remained “very high.”

He will stay on blood pressure medication and be monitored for the next four years. Promising to watch his diet and follow a healthy lifestyle, he smiles that he has gained back the 20 pounds he had lost during his ordeal. And that seems just fine.

Golden softly jokes that he just wasn’t “ready to go yet.” But watching him handle the 3-D version of his own head and how he buries his brow in his hands remembering his journey with Dr. Lawson and the TMH Stroke Team, the depth of his gratitude is quietly and powerfully revealed. And the Team says it is only glad to be there for patients like Golden — a man with things to do!

About TMH Stroke Month

May is National Stroke Awareness Month. Throughout the month, the Democrat will be spotlighting stories on survivors, treatment, research and prevention in conjunction with our sponsor Tallahassee Memorial HealthCare.