Who should get treatment for a brain aneurysm?

A leaking or ruptured brain aneurysm requires emergency surgery. But you might only find out about a brain aneurysm when you have an imaging test for an unrelated condition.

If you have a small brain aneurysm that isn’t causing symptoms, and you do not have other relevant risk factors, your healthcare provider may recommend not treating it. Instead, your provider will order regular imaging tests to rule out any change or growth over time. They will also recommend you quit smoking (if you are a smoker) and require that your blood pressure control is under control. You’ll need to get help right away if you develop symptoms, or aneurysm change/growth occurs on follow-up imaging.

If you have symptoms, positive risk factors, and/or the aneurysm is large, you and your healthcare provider will discuss the benefits, risks and alternatives of surgical and/or endovascular treatment. The decision depends on several factors, including but not limited to your:

  • Age
  • Overall health and your medical conditions
  • Aneurysm location, size and other characteristics
  • Vascular anatomy
  • Family history
  • Risk of a brain bleed (rupture)

How are brain aneurysms treated?

Surgery and/or endovascular therapy are the treatment for brain aneurysms, whether they are ruptured or unruptured.

Open surgical (microvascular) clipping

During this procedure, your surgeon cuts a small opening in your skull to access the aneurysm. Using a tiny microscope and instruments, your surgeon attaches a small metal clip at the base of the aneurysm to pinch it off. This blocks blood from flowing into the aneurysm. The surgery can stop a brain bleed or keep an intact aneurysm from breaking open. Recovery time is different for ruptured (several weeks to months) and unruptured (usually two to four weeks) aneurysms. This procedure is considered to be durable with a low recurrence rate.

Endovascular therapy (coil embolization, stenting, balloon remodeling, flow diversion, intraluminal web device)

For this procedure, your surgeon doesn’t need to create an opening in your skull. Instead, a doctor inserts a catheter (a flexible tube) in a blood vessel, usually in the groin or wrist, and threads it to your brain.

Through the catheter, your doctor places a ball of wires (it looks like a tiny ball of yarn), most often made of platinum, in the aneurysm, sometimes with the help of small stents or balloons. Recently another small device (called Web), which looks like a mesh ball, made of nickel titanium, also became available, and works in a similar fashion as coils. Both methods result in blood clot formation around and inside the wire ball or web device, and block blood flow into the aneurysm, reducing or eliminating the risk of rupture.

Another technique, called ‘flow diversion’ also involves weaving a catheter up a blood vessel from the groin or wrist to the brain. Then your doctor uses the catheter to place a mesh tube in the part of the blood vessel that contains the aneurysm. The mesh encourages or diverts the blood to flow over instead of into the aneurysm.

Your doctor will recommend the best treatment option(s) to you based on and tailored to your vascular anatomy, aneurysm size and location, and several other characteristics.

Just like with open surgery, recovery time can be several weeks to months for ruptured aneurysms. However, a much shorter recovery, only a few days, is expected for unruptured aneurysms treated with endovascular therapy. Depending on the specific endovascular method, some may have a low risk of aneurysm recurrence.

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