First she felt pain. Then she felt panic. When Stacie Markley was diagnosed with a life-threatening aneurysm, she faced major brain surgery and weeks of recovery. But UT Southwestern doctors offered another path to home and family — one that did not require major surgery. It was the sort of note Stacie Markley never envisioned writing.
The 35-year-old Plano mom’s life always had centered on her husband and their two children. She loved walking 5-year-old Lauren to and from school, hearing about her first loose tooth and an upcoming Valentine’s Day classroom party. She enjoyed hosting playdates for 2-year-old Claire, watching her youngest daughter master new words and skills each day.
But recurring headaches and an asymmetrical pupil — symptoms that unexpectedly had appeared in just the last 10 days — threatened Stacie’s family-focused life. She suddenly faced the terrifying prospect of brain surgery and a future fraught with uncertainty.
In the quiet of her hospital room on the eve of a potentially life-changing operation, Stacie tapped out a series of notes on her phone, one each to her husband and two young daughters.
“Babe,” she wrote to her husband, Craig, “life sure has been amazing with you. I ended up marrying my soul mate and having two beautiful and amazing girls. My life is complete and full of love. Thank you for loving me so much.”
Just in case, Stacie was saying goodbye.
Your pupil is just huge.”
The headache came on Christmas Day. There had been presents under the tree and mimosas at brunch. Stacie and some family members were driving to a family dinner at her brother’s house when it struck.
The headache was unusual, not because it was especially painful, but because its location was so specific.
“It was directly behind my eye,” Stacie says. “I looked over at my sister and she said, ‘Oh my God, your pupil is just huge.’ ”
Stacie — young, fit, and healthy, with nothing especially worrisome in her medical history — waited out the pain. It soon subsided, and her eye returned to normal.
“I just blew it off,” she says.
Ten days later, however, the headache returned, as did the unusual dilation of her right pupil. Stacie was at home, hosting a playdate with a house full of moms and young children. “Just from the reactions on their faces, I knew something was wrong,” she says.
Stacie’s dad drove her to a hospital in Plano, and over the next eight hours, Stacie’s story played out in real time on Facebook. The drama began with a simple post containing an urgent plea: “I’m headed to the ER,” Stacie wrote. “Pray for me.”
At the Plano hospital, the tests began immediately. Through it all, Stacie kept family members and friends apprised online. Her posts chronicle an afternoon of growing doubt and fear.
11:43 a.m.: Waiting for a CAT scan now. They want to rule out some things.
12:24 p.m.: Negative for stroke!
1:24 p.m.: CAT scan showing calcification on the right side of my skull. Doing more tests. Still waiting for neurologist.
1:54 p.m.: Going in for MRI soon. One with contrast and one without.
3:24 p.m.: Waiting on a neurologist to come in. Fingers crossed!
Finally, at 4:23 p.m.: Being admitted to ICU. They found an aneurysm.
Friends and family responded to her updates with notes of concern and support — but also advice. “My mom had an aneurysm and was treated at UT Southwestern, hands down the best hospital for any type of brain injury,” wrote a friend. “They saved my mom twice, and my brother-in-law!” Another similar note appeared the next day. “We highly recommend Dr. Samson and Dr. Welch at UT Southwestern–Zale Lipshy.”
The aneurysm diagnosis was difficult for Stacie to hear. The solution was even worse.
The neurosurgeon at her hospital wanted to perform a craniotomy. The incision would run from her widow’s peak down past her ear and involve removing a piece of bone from her skull. To get to the trouble spot, the doctor would have to work under her brain, clip o the aneurysm, and then put everything back.
Assuming all went well, Stacie was likely to spend up to eight weeks recovering before she was able to return to normal activities.
“I didn’t know if I would be incapacitated or if I would die,” she says. “I broke down crying. I have two young girls at home. All I could think about was losing them.”
She made a decision — to listen to her friends on Facebook and get a second opinion. She would go to UT Southwestern and meet Duke Samson, MD, and Babu Welch, MD.
This is where I’d want to be.”
Dr. Samson literally wrote the book on aneurysms. It’s called Intercranial Aneurysm Surgery: Techniques, and it’s informed throughout by the experiences and expertise of the author, who personally has performed more than 4,000 such surgeries.
Dr. Samson has been Chair of Neurological Surgery at UT Southwestern since 1985. Under his leadership, the department has developed into one of the nation’s premier programs for neurological surgery.
That was Dr. Samson’s goal from the beginning: to create a world-class neurological surgery department capable of tackling the toughest cases and attracting the best faculty.
“I thought if we could assemble the right kind of people to do very complex cases that other people were uncomfortable doing, we could offer a service to the community and to neurosurgery,” Dr. Samson says.
He succeeded. Last year, the Neurological Surgery Department again was ranked among the top programs in the nation by U.S. News & World Report. The Medical Center’s reputation for excellence has a way of attracting the best and brightest. Such was the case with Dr. Welch, an Associate Professor of Neurological Surgery and Radiology who is trained in both cerebrovascular and endovascular neurosurgery.
“Dr. Samson is the reason why I came here and trained,” Dr. Welch says. “If somebody is going into my head and clipping an aneurysm, this is where I’d want to be.”
If cerebrovascular surgery is traditional brain surgery, then endovascular surgery is its minimally invasive counterpart. Some aneurysms require the former, but some are treatable through the latter.
One such endovascular technique is coil embolization, where the surgeon places a catheter into an artery near the patient’s groin, runs it up through that artery into the brain, and fills the aneurysm with platinum alloy coils that displace the blood and help a clot to form. Barring complications, a patient whose aneurysm once required traditional brain surgery and weeks of recovery can instead go home the next day.
“People need to hear both options from somebody who has experience performing both cerebrovascular and endovascular surgery,” Dr. Welch says. “People need to hear from a surgeon who can say, ‘This is what will be the best option for you.’”
Which one would you chose?”
At Zale Lipshy University Hospital, images of Stacie’s brain revealed an aneurysm, approximately 10 millimeters in size, pushing on her optic nerve. Some aneurysms are small enough that the prudent course is to let it be. But 10 millimeters requires no debate — the aneurysm must go.
That it was pressing on her optic nerve was fortunate. Many aneurysms stay hidden until they explode with no warning. This one made its presence felt. (See story at right.)
“If it hadn’t pushed on that nerve, I never would have developed headaches or vision problems,” Stacie says. “I am extremely lucky that it was where it was.”
After a full workup, UT Southwestern’s neurosurgeons concluded that the craniotomy suggested by Stacie’s original doctor was an appropriate option. But a better solution was coil embolization. It was less invasive, involved less recovery time, and was just as effective for her aneurysm.
UT Southwestern treats more aneurysms than any other facility in North Texas and has pioneered major advancements in the field. When an aneurysm ruptures, patients often describe the feeling as “the worst headache in my life.” Other symptoms may include:
- Nausea and vomiting
- Stiff neck or neck pain
- Blurred vision or double vision
- Pain above and behind the eye
- Delated pupils
- Sensitivity to light
- Loss of sensation
“The sort of surgery that was originally suggested was what we would have done in 1990,” Dr. Welch says. “It is still done today, and it’s perfectly fine and it’s the right thing to do if it fits the patient.
“But since then, endovascular surgery has come along, and it means I’m going to make a small incision in your groin, pass a catheter up inside your aneurysm, and block it off for good. You’ll go home the next day. Which one would you choose?”
Any doubts Stacie had disappeared when she saw the steadfastness of her UT Southwestern surgeons.
“I met with Dr. Welch and Dr. Samson and some of the other doctors, and they explained the procedure,” she says. “They told me that if I was their mother or wife, this is still the option they would choose.”
That was on a Thursday. Surgery was on Friday. On Saturday, a therapist came to Stacie’s room at Zale Lipshy and ran her through some paces. Raise your hands. Make a fist. Push.
Everything checked out perfectly. Dr. Welch signed her discharge papers that afternoon. Stacie was going home. Within days, she was putting on makeup, walking her daughter to school, and running errands.
“Any decision I make, I am thinking about how I can get a patient back to doing what he or she does best,” Dr. Welch says. “A 35-year-old mom? She needs to get back to her kids.”
Six months after surgery, Stacie will return to UT Southwestern for an angiogram and further imaging tests. At 12 months, she’ll be back again. If all checks out well, her aneurysm would be considered treated, although, because her aneurysm was found at such a young age, Stacie will require follow-up visits every 10 years.
“I feel like a miracle,” Stacie says. “The other route was really so scary to me. Go in, get your head cut open, and they move your brain? There are so many things that could have gone wrong.
“I love Dr. Welch. I think he is amazing. He saved my life.”