May 22, we arrived at Shands Hospital in Gainesville and had further testing. A CT angiogram had been scheduled before the appointment with Dr. Hoh. We then met with Dr. Hoh and his fellow Dr. Fox. They confirmed the aneurysm in the exact location and size the radiologist in Vero Beach had reported. The aneurysm is located on the middle cerebral artery (MCA) between the cerebrum and cerebrellum lobes. Treatment options were discussed with alot of statistics. 90% of patients never know they have an aneurysm until it ruptures, 50% of those die immediately or within a month, another 25% have long term serious neurological problems (vegetative state), and another 25% survive with little or no side effects. Of the fortunate 10% who find the aneurysm about 3% find it for unrelated reasons such as headaches or being in a car accident and having associated MRI or CT scans. Or as I believe, because of an Awesome God looking out for his child!!

Treatment options include observation over time (the ticking time bomb option), using a coiling procedure where they go through the femoral artery in the leg with a catheter and place coils of platnum wires in the aneurysm causing reduced blood flow and scabbing over, or open surgery where they place a titanium clip at the base of the aneurysm and eliminate blood flow. Coiling has a 20% reoccurance rate and is a great option for high risk patients and those aneurysms in positions which are very difficult to reach through open surgery. Clipping, although a more invasive crainotomy, has a <1% reoccurance rate and as it turns out is the best option for my aneurysm because of the location, size, my age and general good health.

Dr. Hoh performs over 800 aneurysm surgeries per year, about half coiling and half open brain surgery. His procedures consists of only surgeries of the blood vessels of the brain. The sucess rate is 96-97%. If we chose the option to wait and monitor, the likelihood of rupture is 1-3% annually, and is additive. Therefore, if we were to do nothing for 10 years the likelihood is 10-30% for a rupture. Comparing these statistics makes it clear that for long term the annie must be clipped.

I said to Dr.Hoh, "thanks for the great news" in my best playful joking voice. His response, "actually I am giving you very good news." Then he said, "I can fix this, but if you wait until it ruptures and you show up in the emergency room in a coma, it is too late, all I can do then is stop the bleeding, the damage will be done." He said this with almost a tear in his eye and with conviction in his voice. We have thought greatly about this. This man has dedicated his life to helping people with aneurysms and related problems and 90% of his patients show up when it has ruptured and it is too late for 75% of them.

We opted to call back to schedule an appointment for surgery and traveled 3 hours back to Vero Beach praying and thinking.