Esteban Delafuente Survives a Ruptured Brain Aneurysm

FOR WEEKS, 13-year-old Esteban Delafuente had been waking up in time for virtual school and then falling asleep during the day, his head on his laptop. Eventually, he moved to the couch and slept the remainder of the day.

“I didn’t know if he was staying up all night on his laptop, and began to think it was time for him to go back to in-person school because his grades were declining,” says his mother, Maribel Castillo.

Around 9:30 p.m. on April 13, 2021, she was talking with him about his grades, when he grabbed the back of his head in pain and the left side of his body collapsed. He sat down hard and told his mother he couldn’t move his legs. “He felt nauseous and threw up on his pants and shirt,” Castillo says. “After a short time he got up with the help of his older brother and cousin, walked a bit, and then had to sit down at the bottom of the stairs.”

Castillo drove Esteban to the emergency center near their home in Humble, Texas, where physicians made assessments and ordered a CT scan. During that time he was able to move unassisted at a slow pace. When the scan revealed a ruptured brain aneurysm, he was transferred to Memorial Hermann-Texas Medical Center, where his ability to move declined rapidly.

After reviewing the scans, neurosurgeon Spiros Blackburn, MD, talked with Castillo about a two-step procedure of surgical bypass combined with aneurysm coiling. “We don’t typically do bypasses for aneurysms, but it was an atypical cerebral aneurysm involving a long segment of the artery,” says Blackburn, associate professor in the Vivian L. Smith Department of Neurosurgery at McGovern Medical School at UTHealth Houston, who specializes in cerebrovascular and skull base surgery.

“These can’t be treated with the typical clip reconstruction or standard coil embolization.”

Patients with ruptured brain aneurysms need very close observation after surgery for early identification of vasospasm – the sudden contraction of the walls of an artery that reduces blood flow – or stroke. “When these conditions are picked up early, we can manage them well with fluids and blood pressure elevation,” Blackburn says. “It was safer for Esteban to be in the care of a highly skilled, experienced team.”

Esteban was in the OR by noon. “Dissecting aneurysms occur in arteries that are inherently diseased. We can’t repair the artery, so we have to eliminate it using a procedure that is rare in adults and even rarer in pediatric patients,” Blackburn says. “We took an artery from the scalp and attached it to the injured brain artery beyond the aneurysm, rerouting blood flow from the scalp to the brain at exactly the spot where we were planning to remove the artery.

First, we did the bypass as an open surgery. Once we confirmed that blood was flowing well through the bypass into the brain artery, we had the green light to occlude the vessel with the aneurysm.

Then we went through the groin to the brain artery and filled it with coils.”

“We were in the hospital just under three weeks,” Castillo says. “Today Esteban is perfect. You could not tell that he had brain surgery. They all did so much for us, and he came out like brand new. We appreciate everything.”