Large, rare aneurysm likely needs surgery

DEAR DR. GOTT: My husband has a splenic-artery aneurysm. It is large, measuring 5.7 centimeters. It is on the bottom left side of his rib cage near the spleen and pancreas. In six months, it grew from 5.2 centimeters to its current size. I know little about this condition but have recently learned that it is rare, and not many doctors are familiar with this type of aneurysm. He has seen a heart and vascular physician but didn't feel the doctor knew enough about the situation to do the surgery.

Is this typical enlargement? Is it safe for him to wait and watch, or should he risk having surgery to repair it? What can he do in the meantime that will help him? Do you recommend any specialists for this type of surgery? Do you think it is better to just live with it and hope it doesn't burst or have the high-risk surgery?

In his early 70s, my husband is in good health otherwise. He is not overweight, and his blood pressure is stable. Less than a year ago, he had a partial kidney removed owing to cancer. He did not require radiation or chemotherapy, since it was caught in the early stages. Could he have caught this aneurysm from the surgery? Thank you for any information you can give us.

DEAR READER: Your husband has an abnormally large splenic-artery aneurysm, a stretched portion of the artery that provides blood to the spleen. Most are three centimeters or fewer, but there have been some reported to be 10 centimeters or larger. As with any type of aneurysm, the larger the deformity, the greater the risk of rupture.

Because this type of aneurysm is relatively uncommon, there is little written that a non-doctor could understand. Most available information is from case studies reported by other physicians who have come across the condition, usually accidentally, while testing for other abnormalities.

Splenic-artery aneurysms do not usually cause symptoms, but those that do are generally associated with abdominal pain. An aneurysm is not “caught.” It is caused when the arterial lining becomes weakened and the force of the blood flow causes it to bulge or expand outward.

I urge your husband to be seen as soon as possible by a vascular surgeon. He or she can re-evaluate the situation and recommend treatment. I believe that your husband is a prime candidate for surgery because of the large size of the aneurysm and its rapid growth. At this point, the risk of rupture outweighs the risk of surgery.

DEAR DR. GOTT: I am an 85-year-old almost completely retired surgeon and thought my story may be of interest to you and your readers.

During the 1970s and 1980s, I experienced excruciating tic douloureux on the right side of my face. I had three nerve injections at a hospital in Massachusetts and another at a hospital in Pittsburgh, Pa. Each injection lasted about six months.

Then, some 15 years ago, I returned to Pittsburgh for devascularization of the middle branch of the right trigeminal nerve by a world-renowned surgeon whose name escapes me. It has given me a complete cure in all these years since then, for which I am so grateful.

I thought you might spread the world in your column about this surgery for those who suffer the very, very acute variety of tic douloureux.

DEAR READER: Thank you for sharing your success story.

Tic douloureux, also known as trigeminal neuralgia, is a painful condition caused by abnormal compression or inflammation of one of the trigeminal nerves that supplies feeling to each side of the face. It is best treated by a neurologist, but I can't argue against surgery because of your positive experience.