Unruptured Brain Aneurysm Treatment Options Explained

 

What is a cerebral aneurysm?

A cerebral, or brain, aneurysm happens when a portion of a blood vessel in the brain weakens or gets damaged. This causes blood to pool into a sac that bulges out from the artery.

Sometimes, these cerebral or intracranial aneurysms are discovered incidentally during tests for other health issues. Other times, they’re detected when they produce symptoms like headaches, vision problems, or neurological troubles.

Aneurysms can also rupture so that blood floods into the surrounding brain tissues. This is a life-threatening medical emergency that requires immediate intervention. If you’ve been diagnosed with an unruptured aneurysm, your doctors will explore appropriate treatment options aimed at preventing the aneurysm from rupturing or bleeding.

Aneurysms can also rupture, leading to a life-threatening emergency where blood spills into the surrounding brain tissue. This is called a subarachnoid hemorrhage.

Exploring Brain Aneurysm Treatments

If you’ve been diagnosed with an unruptured aneurysm, doctors will consider treatment options to prevent it from bursting or bleeding.

The choice of treatment for an unruptured brain aneurysm depends on various factors, including the size of the aneurysm, your age, overall health, medical history, and the aneurysm’s status. Here are the brain aneurysm treatment options:

Monitoring

If the aneurysm is small and does not cause issues, doctors may opt to simply keep an eye on it. In some cases, medication can be used to manage symptoms if the aneurysm is causing problems.

Endovascular Coiling Procedure

This is a less invasive procedure where surgeons make a small incision in a large artery, usually in the groin, or the wrist. A catheter is then threaded through to the aneurysm site in the brain.

Using X-rays and contrast dyes, a microcatheter is used to insert tiny platinum coils directly into the aneurysm. These coils compact into a tight ball, preventing blood flow to the aneurysm. Once the coils are placed, the catheters are removed, and the incision is closed.

Before a Coiling Procedure

Prior to a coiling procedure, you’ll undergo pre-surgery imaging and blood tests. You may be given aspirin or other blood thinners, and if you have an allergy to contrast dyes, you might receive medications to reduce the reaction.

Recovering From a Coiling Procedure

Coiling surgery is performed in a hospital, usually under general anesthesia, and typically takes about one and a half to three hours.

Without complications, it requires a hospital stay of only one to two days, and you can expect to return to normal activities in about a week.

Pipeline Flow diversion procedure

This procedure treats the parent artery rather than the aneurysm itself, reducing the risk of rupture during the treatment. It involves inserting a catheter into an incision in the groin (femoral) artery or the wrist (radial) artery, and guiding it to the aneurysm site.

A mesh stent, called pipeline device (and there are other kinds as well) is then placed in the artery, to divert blood flow away from the aneurysm, and allowing blood to flow normally. Without blood flow, the aneurysm gradually shrinks and disappears. The procedure takes about an hour and a half to 2 hours under general anesthesia.

Before a flow diversion procedure: Preparation includes blood testing, cerebral angiography, or an MR brain before the surgery. You will be prescribed anticoagulant medications to reduce the risk of blood clots or medications for dye allergies if necessary.

You may also need to stop or modify certain medications and abstain from eating or drinking for several hours before the procedure.

Recovering from a flow diversion procedure: After the procedure, you can expect to spend one to two days in the hospital for monitoring. Without complications, you can resume normal activities and return to work within a week or two.

Pipeline embolization can successfully resolve over 95 percent of unruptured aneurysms, even those considered difficult to treat with other methods. It can also be used when coiling has not been successful, virtually eliminating the risk of a ruptured aneurysm during surgery.

Intrasaccular flow diversion procedure

This procedure is very similar to a pipeline flow diverter procedure in reducing the risk of rupture of an aneurysm. It is considered safe and effective.

A meshed ball, called a WEB or woven endovascular bridge device, is inserted into the sac of the aneurysm itself. It involves inserting a catheter into an incision in the groin (femoral) artery or the wrist (radial) artery, and guiding it to the aneurysm site.

Once the WEB device is placed, it diverts blood flow away from the aneurys. It is similar in prep, length and recovery to the pipeline flowdiverter procedure.

Surgical clipping

This is an invasive surgical procedure where a titanium clip is placed across the neck of the aneurysm. This blocks blood flow from the parent artery, causing the aneurysm to shrink and eventually disappear. The surgery begins with a craniotomy, which involves removing a part of the skull to access the aneurysm site.

After the clip is placed, the skull is replaced, and the incision is closed.

Before Clipping Surgery

Prior to surgery, you’ll undergo various tests, including blood work and imaging scans like MRI or CT scans. You may need to discontinue certain medications, and you’ll be asked not to eat or drink for several hours before the procedure.

Recovering From Clipping Surgery

Clipping surgery is performed in a hospital under general anesthesia and typically requires a hospital stay of three to five days. After discharge, the recovery period lasts from three to six weeks, during which you’ll gradually return to your normal activities, including work or school.

No one brain aneurysm treatment option is right for everyone. If you have been diagnosed with an unruptured aneurysm, your doctors will work with you to choose the best treatment option for your unique circumstances.