If you or a loved one has been diagnosed with a brain aneurysm, you will surely want to know what treatment options are available to make an educated decision about your health care. Here, Vascular Neurology of Southern California expert Dr. M. Asif Taqi covers the basics of brain aneurysm treatment.
What are brain aneurysms?
A brain aneurysm—or a cerebral aneurysm, presents as a balloon-like bulge that comes off a brain blood vessel. It is a relatively rare and severe medical condition that requires intervention, often immediately upon diagnosis. The bulges vary in size, shape, and location and are found to either be ruptured (leaking) or unruptured (not leaking).
A brain aneurysm may rupture if the bulge’s blood vessel walls become too thin from blood flow in the arteries. Symptoms of a ruptured aneurysm may include sudden severe headache, nausea, vomiting, blurred vision or double vision, photophobia, and/or loss of consciousness. If an aneurysm ruptures, blood begins to spill into the surrounding tissue; this event is called a subarachnoid hemorrhage and is particularly dangerous as it may lead to brain damage, stroke, coma, and even death. About a third of patients do not survive an aneurysm rupture.
An unruptured aneurysm is more challenging to diagnose because patients often do not experience symptoms as such—it is likely to be caught during brain imaging for a seemingly unrelated symptom. Imaging that can confirm a cerebral aneurysm, include computerized tomography angiography (CTA) or magnetic resonance angiography (MRA) or catheter angiogram. Patients with a family history of brain aneurysms are highly recommended to have a non-invasive vascular study performed to rule out brain aneurysm.
Treatment Options
To effectively manage your cerebral aneurysm, your physicians will need to assess your unique circumstances and risk factors. Most ruptured aneurysms will require emergent intervention to stop the brain bleeding as soon as possible. Unruptured aneurysms may or may not require immediate intervention—some patients opt for a preventive procedure if there is a risk of rupture during their lifetime.
Outside of aneurysm morphology, your age, family medical history, and underlying health conditions must be considered when deciding if the benefits of having treatment outweigh the potential risks.
If intervention is the right option, you may want to know more about the two well-established options: surgical clipping and endovascular repair (also known as embolization). There are potential risks to each procedure; your treating physician will likely discuss these with you during your consultation.
Endovascular Repair
Endovascular treatment for a cerebral aneurysm is a minimally invasive technique to cure an aneurysm. The entire procedure takes only 30 to 60 minutes and does not require opening the skull. Instead, a neurointerventionist places tiny hollow tubes through the groin or wrist all the way up to the brain and inside or along the aneurysm.
Once the brain aneurysm has been located, your physician may choose to use coils to pack the aneurysm until it no longer allows blood flow to course through the bulge.
New age technology for endovascular treatment of brain aneurysms allows an interventionalist to place a flow-diverting stent across the aneurysm. The flow diverter has allowed complex aneurysms that require embolization with coils to be treated simply by placing a stent/flow diverter across the aneurysm. Another option is the placement of a Web Intrasaccular Device which may be inserted into an aneurysm to disrupt the blood flow.
Advancements in endovascular technique with the latest technology, like the flow diverter or the intrasaccular device, have made endovascular treatment even less risky and more efficient. Most brain aneurysms can now be treated with very low risk through these techniques.
Surgical Clipping
Neurosurgical clipping of a cerebral aneurysm requires a neurosurgeon to perform a craniotomy in an operating room under general anesthesia. The procedure involves the temporary removal of a part of the skull to gain access to the aneurysm through the many layers of brain tissue. Once the aneurysm is identified on a vessel, a permanent surgical clip is placed on the aneurysm opening (also called “the neck”) to stop blood flow from entering. After the procedure, you can expect to spend time in the Intensive Care Unit for comprehensive neurological assessments. Recovery time may last a few days to a few weeks.
To more about brain aneurysms and treatment options, visit VNSC.org.
Dr. Asif Taqi is a triple board-certified interventional and stroke neurologist with a background in neuroendovascular surgery, vascular neurology and neurocritical care. He has been treating brain aneurysms for more than a decade and has worked on the front lines to advance brain aneurysm treatments. Dr. Taqi has also conducted several clinical trials and published numerous scientific papers on brain aneurysms.