An aneurysm is a bulge that forms in the wall of a weakened blood vessel. Aneurysms can occur anywhere in the body, including in the heart, aorta and brain.

Sometimes aneurysms are familial, and you can be at risk if aneurysms run in your family health history. Prevention isn’t always possible, but you can lower your chance by avoiding smoking and high blood pressure.

More information specific to cerebral aneurysms (also known as intracranial aneurysms) is available here.

There are two types of aneurysms: saccular and fusiform. A saccular aneurysm balloons into sacs, or pouches, in the walls of blood vessels and is the most common kind of aneurysm. Fusiform aneurysms are an expansion of both sides of a blood vessel, producing a widening of the artery.

Aneurysms are very dangerous if they rupture or burst; however, even unruptured aneurysms may cause dizziness, loss of concentration, neck pain, fatigue, headaches and vision problems. If you’re suffering from any of these neurological symptoms, you should seek out medical assistance.

After the recent tragic death of BMO Bradley Harris Center chairman Marc Marotta, Dr. Ahuja was interviewed by Milwaukee’s TMJ4 regarding the warning signs for brain aneurysms.

How are Aneurysms Found?

Most asymptomatic intracranial aneurysms are found incidentally by MRIs or other imaging techniques. In some cases where there are signs of an aneurysm, Dr. Ahuja can form the best diagnosis using an imaging technique.

Magnetic Resonance Angiography (MRA) or Computerized Tomography Angiograms (CTA) are noninvasive imaging services that can be used to initially diagnose or to follow intracranial aneurysms.

Specific patient situations may make one or the other of these tests not appropriate in a given situation. For example, patients with pacemakers cannot have MRAs, and patients with an iodine contrast allergy may not be able to have a CTA.

Doctors perform cerebral angiography to fully evaluate the aneurysm in preparation for treatment.

Dr. Ahuja will discuss with you which screening is recommended for your condition. In some cases more than one test may be needed.

  • Angiogram: An angiogram is a very accurate imaging technique used to see how blood flows in the arteries and veins in real time. During an angiogram, a catheter is placed through an artery in the groin and advanced to a blood vessel in the brain. From there, dye is injected into the artery, which can be seen by a fluoroscope. This is the best technique for evaluating aneurysms of any size.
  • MRA: Much like an MRI, an MRA is a 2-dimensional, non-invasive imaging technique that allows Dr. Ahuja to study the blood vessels in the brain and detect any problems within the vessel walls. This test is not radiation-based.
  • CTA: A CTA is a 3-dimensional, non-invasive imaging technique that allows Dr. Ahuja to see the structure of the blood vessels in the brain by combining CT scanning and imaging after dye is injected through an IV. This is a radiation-based test.

How do I Know Which Test to Get?

Dr. Ahuja will help you with that decision. Angiography is the most specific technique, but sometimes an MRA or CTA would be a better option.

MRAs and CTAs are relatively similar, but people with pacemakers cannot get an MRA. People who have a severe allergy to iodine, which is the contrast dye used with a CTA, should not get a CTA scan. Also, people who have severe kidney disease should not have a CTA.

How are Aneurysms Treated?

The treatment of intracranial aneurysmal disease is a special focus for Dr. Ahuja.

A cerebral, or intracranial, aneurysm is a defect in the wall of an artery to the brain. The wall of the artery stretches out and becomes very thin, like a fully inflated balloon.

This thin wall can rupture, causing severe bleeding in the brain called subarachnoid hemorrhage. A subarachnoid hemorrhage is a very dangerous condition; it is much safer to treat an aneurysm before it ruptures.

Left untreated, a ruptured intracranial aneurysm will cause death or significant disability. The treatment may be either microneurosurgical aneurysm clipping or endovascular treatment. Dr. Ahuja is able to help determine which type of procedure is best for the patient’s specific condition, and he has extensive experience in both surgical modalities.

A cerebral angiogram is a diagnostic test that is required before treating any cerebral aneurysm. During a cerebral angiogram, contrast dye is injected into the arteries traveling to the brain. This helps define the contours and position of the aneurysm and assists in determining the most appropriate treatment.

Observation

If your aneurysm is at a low risk of rupturing, or if an intervention wouldn’t be appropriate, Dr. Ahuja will recommend close follow-up and monitoring of the aneurysm to reduce the chances of a rupture.

This treatment most likely involves controlling blood pressure, as high blood pressure increases the risk of an aneurysm rupturing. Dr. Ahuja would also likely want a patient in this situation to get follow-up imaging done every 1-2 years to monitor the size of the aneurysm.

If you suddenly begin to experience worsening symptoms such as headache, dizziness, or vision problems, seek help immediately and call 9-1-1 for your emergency.

Endovascular Treatment

Endovascular treatment is treatment of the aneurysm through the blood vessel. A cerebral angiogram is performed, but instead of limiting the procedure to an image of the aneurysm, a catheter is advanced to the aneurysm and coils may be placed directly into the aneurysm.

In some cases a stent may be used to assist with the treatment of the aneurysm. Most of these procedures are done under general anesthesia. There is no incision in the head and no hair is shaved from the patient’s head.

Patients are observed in the Critical Care Unit after the procedure for 24 hours. If the endovascular treatment is electively done on a non-ruptured aneurysm, the patient can often go home the day after the procedure. If the aneurysm has ruptured, the hospital stay is longer due to the effects of the initial hemorrhage.

Cerebral Aneurysm Surgery

The traditional way to treat an aneurysm is by a surgery that involves placing a clip over the opening of the aneurysm, thereby closing it off and preventing blood from entering it. This is known as a craniotomy for aneurysm clipping.

In this procedure, the hair on the head over where the aneurysm lies is shaved. An incision is made into the skin and the scalp is pulled back, exposing the skull. A small portion of the skull is removed to allow the surgeon to find the aneurysm and clip the opening. After that is done, the skull is replaced, the scalp is brought back together, and the incision is closed. The incision is made behind the hairline and after everything is healed only a small incision line exists which is easily covered by the patient’s hair.

Patients usually spend around three days in the hospital. The first night is spent in the ICU. Patients are encouraged to increase their activity as their condition permits and are often up and about beginning the day after the surgery.

Patients may return to work when they feel up to it. Sometimes fatigue can limit activity for up to 4 weeks postoperatively.

If an aneurysm has ruptured, the surgery is performed the same way. However, the damage from the initial bleeding requires 3 weeks in the hospital and recovery can be lengthy. The best time to treat an aneurysm is before it ruptures.