New Image Guidance Reveals Nearly Fatal Misdiagnosis

Carolyn Dennis’ eyes shine with joy as she describes her 9-month-old grandson.

“Everett is adorable,” Carolyn says, beaming. “He’s a little guy who likes to laugh. He likes to dance. I think he got that from me. I like to dance. He is just a bundle of joy.”

This bundle of joy was her impetus for a cross-country move to Mesa, Arizona. Carolyn had retired to Charleston, South Carolina, but with her first grandchild on the way, she wanted to live closer to her son, Brandon, and his growing family.

She adjusted well to life in Arizona when she arrived in November 2018. She set about decorating her new home and meeting neighbors. She found a book club and hosted a weekly Bible study at her house through a new church.

Her true delight was watching Everett each Tuesday.

“To watch him grow was just more than I could have ever wished,” she says.

Carolyn was at home with Everett when she experienced the first in a series of severe nosebleeds that occurred only days apart. Recognizing that such significant blood loss wasn’t typical of a nosebleed, she went to a local hospital emergency department.

“Each time, the emergency staff said, ’Oh, it’s just a nosebleed. You’ll be fine,’” Carolyn recalls.

A Nearly Fatal Misdiagnosis

As a cancer survivor, Carolyn knew in her heart it was something worse.

She decided to seek a second opinion and turned to Mayo Clinic in Arizona where she met neurosurgeon Bernard R. Bendok, M.D., the William H. and Charles J. Mayo Professor and chair of Neurosurgery at Mayo Clinic in Arizona. Dr. Bendok was immediately concerned.

“She had severe bleeding that was coming out of her nose and mouth,” Dr. Bendok says. “This was a very large quantity, so large that her blood pressure was dropping. She was in a very critical condition.” 

The answer behind the two strikingly different responses lies in the details.

Carolyn had a history of a very challenging tumor of the head and neck. She underwent surgery and radiation therapy as an effective means to treat the tumor. However, radiation therapy can lead to weakened tissues over time, specifically tissues that involve the walls of blood vessels. In Carolyn’s case, the combination of surgery, the tumor itself and the radiation left an artery in her skull exposed and the wall weakened.

The flow of blood through the artery eroded the wall over time, causing a potentially fatal leak. To add to the complexity of her case, the leak was located where the artery enters the skull to supply the brain with blood — an extremely difficult  location to access and repair.

Daunting Decisions

The family now faced a harrowing decision — deciding between a risky neurosurgery and a more conservative option that might not solve the problem.

The most aggressive option for treatment carried a 1 in 4 chance of Carolyn sustaining a life-altering stroke that could make her incapable of speaking or using her right side.

“It sounds like decent odds until you’re talking about someone’s life,” Brandon says.

Instead, the family decided to pursue the less invasive option to place a stent and hope it would stop the leak.

“As a family we waited to see and hoped for the best,” he says. “That was all we had at the time — hope.”

A Cause for Hope

Dr. Bendok successfully placed the first stent. Yet, because the wall of the artery was so weak, the stent alone wasn’t enough to keep the artery from leaking again. Carolyn suffered a second leak, and her situation was becoming more serious.

Carolyn’s care team needed to devise a unique approach to stop the leaks and provide a long-term solution. It would be a complicated procedure. Two surgeons would need to work together, one placing a stent and the other reinforcing the tissue wall. Typically, these two procedures would be performed by separate surgeons in separate areas. In Carolyn’s case, both surgeons needed to perform their part of the procedure at the same time, in the same location.

Thankfully, that option came just in time.

“I was happy to hear Dr. Bendok say that he had a solution,” Carolyn says. “That means a lot when you've been going through what I was going through, that there is a solution.”

New Possibilities

Only months before Carolyn arrived at Mayo Clinic, a gift from a generous benefactor enabled Mayo Clinic to open the Neuro-Image Guided Operating Suite. The suite combined a fluoroscopy unit with an operating room and an endoscopic tower. These three technologies allow Mayo Clinic to perform complex procedures with multidisciplinary care teams working together.

In Carolyn’s case, it allowed an ear, nose and throat surgeon to repair the tissue wall, while a neurosurgeon placed the stent, all while using the best available surgical imaging. 

“We were able to image the artery perfectly to show exactly where the pinhole was. Using that data to navigate the scope, we had a precise location and real-time image of where the leak was,” Dr. Bendok says. “That could not have been done without these new ORs (operating rooms) that bring the best of imaging together with the best of traditional surgical technology to do things that were not possible before. I’m convinced Mrs. Dennis would not be alive had it not been for these new image-guided ORs.”

Today, Carolyn is thriving and enjoying her retirement with her family. She is participating in book club, hosting Bible studies and beginning yoga. But, most importantly, she continues to spend cherished time with her grandson.

“I had faith that I was going to make it through,” Carolyn says. “It was scary. But I pleaded with the Lord for this life, because I wanted to stay here. I wanted to see my grandchild, and I want to see more grandchildren in the future.”

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