On Tuesday, April 26, Ketan R. Bulsara, MD, using state-of-the-art technology, threaded a catheter less than 1 millimeter in width from the femoral artery in Norbert Tibeau’s thigh into an aneurysm in his brain. The aneurysm had grown to a diameter of 2 centimeters and bordered on such critical structures as the optic nerve and pituitary gland. If left untreated chances were high that within five years it would either kill Tibeau or devastate him neurologically.
Dr. Bulsara, director of neuroendovascular and skull-based surgery for Yale Medical Group, is one of a handful of neurosurgeons in the world who is trained in both skull-based cerebrovascular microsurgery and in endovascular surgery. Along with Yale Medical Group, Yale-New Haven Hospital and medical device manufacturers, he donated his services to treat Tibeau, 28, a native of Haiti who’s studying for the priesthood there.
Poor vision, flashes of light
Ask him about his life and Tibeau will tell you not only the date of his birth, but the date of his baptism. The middle of seven children—he has three older sisters and three younger sisters—Tibeau comes from a religious family in the Artibonite, Haiti’s central plateau. His parents are farmers who raise beans, corn, bananas, sweet potatoes and manioc. “When I was little, my father used to teach the catechism,” Tibeau says. From an early age Tibeau helped out in church, singing and reading during mass.
His headaches began in 2001, when he was still in high school. By 2008, when he saw a doctor for the first time, the headaches were lasting for up to a week. He was seeing flashes of light, his vision was impaired, and the pain left him bedridden. “I would have to lie down,” Tibeau says. “Sometimes I couldn’t eat.”
Finding the right hospital
In January of 2010 his plight came to the attention of an American physician visiting Haiti who contacted Partners In Health, the medical nonprofit, and arrangements were made for Tibeau to travel to the neighboring Dominican Republic for an MRI. The trip saved his life in more ways than one. While he was away, an earthquake struck Haiti. Among the victims were all nine of his seminary classmates. They were in an underground parking garage, leaving class for the day when the school crashed down on them. “The reason I was saved is because I was sick,” Tibeau says. He also learned what his MRI had revealed—the potentially deadly or crippling aneurysm.
Through one of its initiatives, the Right to Health Care Program, Partners In Health searched for physicians and hospitals willing to donate their services. Once Yale agreed to provide charity care for Tibeau, Partners In Health brought him to the United States for treatment.
“It can be difficult to find a hospital that can fix this kind of problem, let alone agree to do the surgery for free. We are very grateful to Yale and Dr. Bulsara for offering to do this case,” says Sybill Hyppolite, a coordinator with the program, who accompanied Tibeau and served as his interpreter during his stay in New Haven.
Treatment is less invasive
“Using a technique that is less invasive than other options, platinum coils about as fine as human hair were placed inside the aneurysm to allow it to clot,” Dr. Bulsara says of the procedure he performed on Tibeau. Until recently the recommended treatment was opening the skull, clamping off the artery, and performing a bypass. “Without treatment the risk of this aneurysm bleeding within five years would be close to 50 percent. If the aneurysm bled, the chances of him being severely incapacitated or dead would be 30 to 50 percent,” he says.
Two days after the procedure, Tibeau was sitting up in bed, joking with one of his nurses, and sitting for an interview. He was to leave the next day for a seminary in Bloomfield, Conn., where he would remain for a month and be available for follow-up visits. He says he was feeling better and that his headaches had not recurred. Dr. Bulsara says Tibeau was doing well, and that he expects he will make a full recovery. Tibeau plans to return to Haiti, where he will complete his studies and wait for an assignment to a parish.
To contact the Yale Neuroscience Center, please call 203-785-2805.