Kolkata, 12th October, 2026: The neurosurgery team at Manipal Hospital, Dhakuria has successfully treated a 42-year-old farmer, Mr. Ramesh Kumar (name changed), from Bihar, who arrived at the hospital with a life-threatening brain haemorrhage caused by a ruptured anterior communicating artery (ACOM) aneurysm. ACOM is a weak, balloon-like bulge in a blood vessel connecting the two main arteries supplying the front part of the brain. The patient was initially presented with severe headache, repeated vomiting anddrowsiness. Imaging tests subsequently confirmed, bleeding around the brain caused by a ruptured aneurysm, medically known as aneurysmal subarachnoid haemorrhage (SAH). Given the seriousness of the condition and the risk of re-bleeding, the team led by Dr. Nirup Dutta, Consultant – Neurosurgery, Manipal Hospital, Dhakuria, decided that urgent surgical intervention was necessary to secure the aneurysm.
Mr. Ramesh had no previous diagnosis of a brain aneurysm, which can remain undetected for years without causing any noticeable symptoms. A CT scan confirmed bleedingaround the brain, while a further specialized test called Digital Subtraction Angiography (DSA), which provides detailed images of the blood vessels in the brain, revealed a complex, wide-neck aneurysm measuring approximately 8.9 × 3 mm in the anterior communicatingartery. The aneurysm also had a hypoplastic left A1 segment, meaning one of the blood vessels supplying the area was smaller than usual, making the procedure more challenging and requiring careful surgical planning.
A brain aneurysm is a weak, balloon-like bulge in the wall of a blood vessel that can remain silent until it ruptures. Once it bursts, it can cause bleeding aroundthe brain and become life-threatening. Following the first bleed, the risk of bleeding again is particularly high during the first 48–96 hours. A second bleed can be much more dangerous and may lead to severe brain damage or even death. According to the treatingdoctor, around 50–70% of patients may not survive a second bleed, making it extremely important to treat a ruptured aneurysm as quickly as possible. A ruptured aneurysm can also lead to complications such as vasospasm, a narrowing of the blood vessels thatcan reduce blood flow to the brain and potentially cause another stroke.
The doctors performed a specialized procedure known as microsurgical clipping to secure the ruptured aneurysm and prevent it from bleeding again. The patient underwenta left pterional craniotomy, a surgical approach that involves opening a small part of the skull to reach the affected area of the brain. The aneurysm was then carefully identified and clipped to stop blood from entering the weakened portion of the blood vessel.While both surgical clipping and endovascular coiling are established treatments for brain aneurysms, the choice depends on the patient's condition and the size, location and shape of the aneurysm. In this case, the team selected surgical clipping based onthe characteristics of the aneurysm and the patient's condition.
The surgery demanded exceptional precision because the aneurysm was in a delicate region of the brain and had a wide neck with complex vascular anatomy. Followingthe procedure, the patient required close monitoring in the ICU/HDU, serial neurological assessments and repeated imaging. Postoperative scans showed some bleeding and swelling in the brain, along with a small area of stroke and a collection of blood beneaththe brain covering. However, with comprehensive medical management and close neurological monitoring, the patient gradually improved and progressed towards independent mobilization.
Speaking about the case, Dr. Nirup Dutta, Consultant – Neurosurgery, Manipal Hospital, Dhakuria, said, “A ruptured brain aneurysm is a life-threatening emergency where timely intervention is critical. The risk of re-bleeding is particularly high during the first 48–96 hours,and a second bleed can have serious and potentially fatal consequences. In this case, the aneurysm had a complex anatomy, with a wide neck and a hypoplastic A1 segment, making the surgery technically challenging. Our priority was to secure the aneurysm atthe earliest possible opportunity and prevent further bleeding. With careful microsurgical clipping, close postoperative monitoring and comprehensive medical care, the patient has made a favorable recovery despite the severity of his condition. It is alsoimportant to recognize the warning signs of a ruptured aneurysm. A sudden, extremely severe headache, often described as a ‘thunderclap headache’, particularly when accompanied by vomiting, loss of consciousness or seizures, should never be ignored and requireimmediate medical attention. Thus, early diagnosis and timely treatment can play a crucial role in preventing re-bleeding and serious neurological complications.”
