Treatment for Brain Aneurysms

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Endovascular surgery can be used to treat patients with an aneurysm or weakening of a blood vessel wall. As opposed to open surgery that repairs vessels from the outside through an incision and opening in the bone, endovascular surgery can be performed within a blood vessel.

The primary use of endovascular surgery is to prevent and treat the rupture of a cerebral aneurysm that can cause bleeding in the brain. Approximately 30,000 people in the United States per year suffer a brain aneurysm rupture according to the Brain Aneurysm Foundation. 

Risk Factors

Individuals at a greater risk for developing a brain aneurysm include women, African Americans, smokers and patients with uncontrolled high blood pressure. Patients with a prior history of a ruptured aneurysm are at a slightly increased risk for developing or bleeding from a separate aneurysm. Patients with two first-degree relatives with a history of bleeding into the brain from an aneurysm are at greater risk for developing a cerebral aneurysm and should therefore be screened at around 35 or 40 years of age.

Symptoms

The majority of cerebral aneurysms are not discovered until they rupture. A small minority can present with symptoms related to local pressure in the brain. An increasing number of aneurysms are being discovered through symptoms unrelated to the aneurysm.

Symptoms of Ruptured Cerebral Aneurysm

  • Severe headache (usually characterized as the "worst headache of your life")
  • Nausea and vomiting
  • Stiff neck or neck pain
  • Fainting or loss of consciousness
  • Seizures
  • Sensitivity to light

Detection and Diagnosis

Brain aneurysms are identified using imaging techniques, such as CT scan, MRI, MR angiogram, and catheter angiogram. Ruptured aneurysms are commonly diagnosed via a CT scan, which is very sensitive for detecting blood inside the brain. Cerebral angiography or computed tomographic angiography is used to find the exact location, size and shape of an aneurysm. Both of these techniques utilize injected contrast dye and X-rays to visualize the aneurysm. A catheter angiogram is the gold standard test for evaluating the blood vessels of the neck and brain. Rapid identification and treatment of cerebral aneurysms is crucial because of the risk for a potentially catastrophic rebleeding episode. When an aneurysm has ruptured, the highest risk of rebleeding is within the first 24 to 48 hours.

Endovascular surgery

During endovascular surgery, a flexible catheter is inserted into the femoral artery (at the top of the right leg) and advanced directly within the aneurysm itself. Detachable coils and stents can be inserted to block the flow of blood into the aneurysm and cause it to become clotted. Real-time X-ray technology, known as fluoroscopic imaging, is used to visualize the patient's blood vessels and as the coils are placed within the aneurysm, progressive blockage of the aneurysm can be seen.

Although it is a fairly recent technology, endovascular surgery has become widely used in the last 10 years because of the following advantages that it provides to patients:

  • Less discomfort
  • Less invasiveness
  • Smaller incision
  • Less stress on the patient's heart and lungs
  • Reduced need for blood products
  • Fewer risks for older patients with multiple medical problems (e.g. Coronary heart disease or lung disorders)
  • Shorter recovery time