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A surgeon’s rare skills heal a man in need

Medicine@Yale, 2011 - July August


International medical organization brings a patient from Haiti to a Yale neurosurgeon, who successfully treats a dangerous brain aneurysm

While still in high school in Haiti in 2001, Norbert Tibeau began having severe headaches, but it would be seven years before he finally saw a doctor. By then Tibeau’s headaches were lasting for up to a week. He was seeing flashes of light, his vision was impaired, and the pain was incapacitating. “I would have to lie down,” Tibeau, now a 28-year-old studying for the priesthood, recalls. “Sometimes I couldn’t eat.”

In January of last year, the international health care nonprofit organization Partners in Health (PIH), which had organized Tibeau’s doctor visit, made arrangements for him to travel to the neighboring Dominican Republic for an MRI scan, which revealed a brain aneurysm that could kill or cripple him if left untreated.

Through its Right to Health Care Program, PIH searched for physicians and hospitals across the United States willing to donate their services to treat Tibeau, finally settling on Yale because of the unique skills of Ketan R. Bulsara, M.D., associate professor of neurosurgery at the School of Medicine and director of neuroendovascular and skull-base surgery at Yale-New Haven Hospital (YNHH).

Bulsara, who came to Yale in 2007, is one of a handful of neurosurgeons in the world who is dual-fellowship trained in both traditional cerebrovascular/skull base microsurgery and in endovascular neurosurgery, a minimally invasive method in which a catheter is inserted through a leg artery into the brain to treat aneurysms, strokes, tumors, and other ailments. Along with YNHH and medical device manufacturers, Bulsara agreed to donate his services to treat Tibeau.

At YNHH on April 26, Bulsara, guided by state-of-the-art imaging technology, threaded a catheter less than 1 millimeter wide from the femoral artery in Tibeau’s thigh into the aneurysm, which had grown to a diameter of 2 centimeters and bordered on critical structures, including the optic nerve and pituitary gland. “Platinum coils about as fine as human hair were placed inside the aneurysm to allow it to clot,” Bulsara says, adding that, until recently, the standard treatment for aneurysms such as Tibeau’s involved 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.”

Two days after the procedure Tibeau was sitting up in bed and joking with one of his nurses. He said he was feeling better and that his headaches had not recurred. Bulsara says he was glad to help, and attributed the successful outcome to close collaboration among colleagues in neurosurgery, anesthesia, radiology, intensive care, nursing, and surgical and radiological technologists. He says Tibeau was doing well, and that he expected he would make a full recovery.

“It can be difficult to find a hospital that can fix this kind of problem, let alone agree to do the surgery for free,” says Sybill Hyppolite of PIH, who accompanied Tibeau from Haiti and served as his interpreter during his stay in New Haven. “We are very grateful to Yale and Dr. Bulsara for offering to do this case.”