Brain Surgeons Drop Patient’s Skull Piece During 16-Hour AVM Operation

Q: What happens when doctors almost prescribe a deadly treatment for a brain bleed, and who ultimately saves the patient?

Doctors were on the verge of giving her high-dose blood thinners for what they wrongly suspected was a clot-related stroke, but that treatment could have been catastrophic because she was actually suffering from a major brain bleed caused by a ruptured arteriovenous malformation, or AVM. The patient was ultimately saved by her partner, Luke, then an ICU nurse, who challenged the initial assumption and insisted she be scanned before any anticoagulants were prescribed. The CT scan revealed the hemorrhage, allowing doctors to stop the dangerous course and transfer her to King’s College Hospital for specialist care. There, specialists identified a high-risk grade 4 AVM near the area controlling limb movement. Despite the danger of surgery, a team of three neurosurgeons operated for more than 16 hours and removed a much larger and more complex tangle of abnormal blood vessels than expected. The near-miss shows how critical imaging and clinical advocacy can be in neurology cases. Blood thinners can be lifesaving for clot-related strokes, but in a hemorrhage they can sharply worsen bleeding. In this case, Luke’s intervention led to the correct diagnosis in time, and the neurosurgical team then carried out the operation that saved her life.

3 articles · Updated · The Guardian · Sep 25

A London patient said surgeons told his partner after a 16-hour 2017 operation that the section of skull removed during brain surgery had been knocked to the floor.
The team cleaned the bone flap and gave extra antibiotics instead of replacing it later with a 3D-printed piece, because infection was the main concern.
The surgery followed a ruptured arteriovenous malformation, or AVM, that caused stroke-like symptoms at age 34; a consultant had rated it grade 4 of 6, usually considered too risky to remove.
King’s College hospital specialists later found the AVM was larger and more complex than expected, but the patient recovered after relearning how to walk and still has limited control of his left foot.
Nine years later, he says he finds the skull-drop episode funny and views the operation as life-changing, adding that his case is now used as evidence that larger AVMs can be removed successfully.