The treatment options for brain aneurysms have become promising due to recent advances in the neurosurgical and endovascular fields. Endovascular treatment of aneurysms has improved due to biplane X-ray imaging and newer microcatheters. The advantages of these minimally invasive endovascular procedures include shorter hospital stays and recovery times, lower complication rates, and often, eliminate the need for general anesthesia.
Even with these new advances in treatment, however, surgical experience is still the most important factor contributing to patient outcome. Dr. Arvind Ahuja and his team are well-versed in the latest technology for open craniotomy procedures and endovascular techniques (coiling, flow diversion, stenting, etc.). With over 20 years of experience, Dr. Ahuja has provided extensive treatment to hundreds of patients suffering from cerebral aneurysms.
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A brain aneurysm is a defect in the wall of an artery to the brain. If left untreated, an aneurysm may rupture, which can result in death or significant disability.
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.
After examination, Dr. Ahuja can help determine if observation, endovascular treatment, or brain aneurysm surgery is the best procedure for the patient’s specific condition.
If an aneurysm presents 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 have follow-up imaging done every one to two 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 or call 9-1-1.
Endovascular treatments deal with aneurysms 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 into the blood vessel 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 a 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, a longer hospital stay is required due to the effects of the initial hemorrhage.
Brain Aneurysm Surgery: Clipping
The traditional way to treat an aneurysm is with 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, 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. A surgical microscope is used to view the aneurysm and place a tiny, spring-loaded clip over the aneurysm. Blood flow to the aneurysm is stopped by the clip and the aneurysm collapses, while blood continues to flow through the normal walls of the blood vessel. Afterward 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 intensive care. Patients are encouraged to increase their activity as their condition permits and are often up and about the day after the surgery. Patients may return to work when they feel up to it. Sometimes fatigue can limit activity for up to four weeks after the surgery.
If an aneurysm has ruptured, the surgery is performed the same way. However, damage from the initial bleeding requires three weeks in the hospital and recovery can be lengthy. The best time to treat an aneurysm is before it ruptures.
Brain Aneurysm Surgery: Coiling
Aneurysm coiling is a minimally invasive procedure that uses neuroendovascular surgery techniques to treat an aneurysm in the wall of a blood vessel in the brain.
Aneurysm coiling may be used as an alternative to the more traditional treatment of aneurysm clipping, as many patients are not good candidates for clipping due to their medical condition or the location of the aneurysm.
Instead of the open incision used in aneurysm clipping, a platinum coil is delivered to the aneurysm through a series of tiny catheters (thin, flexible tubes). Catheters are inserted into a small incision in the upper thigh and guided through the bloodstream to the site of the aneurysm in the brain. There, the coil is deployed, forming a clot, which prevents blood from filling up the aneurysm. Instead, blood flows only through the normal walls of the blood vessel.
Sometimes coiling is used in combination with stenting, in which a tiny, tube-like structure is placed near the aneurysm to keep a coiled aneurysm from collapsing the entire blood vessel and cutting off blood supply within the brain.