Brain Aneurysm Treatment

Brain aneurysms can bleed and cause stroke and even death. Brain aneurysm treatment, including surgery and less invasive procedures, may help prevent rupture.

A brain aneurysm (also called a cerebral aneurysm) is a thin or weak area of an artery. Much like a balloon, it can fill up with blood and expand outward. Some brain aneurysms, especially very small ones, may not bleed and cause other problems. However, a brain aneurysm can burst or rupture, spilling blood into brain tissue. The result can be a hemorrhagic stroke, brain damage, coma, and even death. 

Fortunately, there are several types of brain aneurysm treatment available. But which one is used, and how successful it is — and whether a brain aneurysm treatment should be performed at all — depends on an individual’s personal situation and whether a rupture has already occurred.

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Brain aneurysms can exert pressure on tissue and nerves in the brain but, until they leak blood or burst, they rarely cause symptoms. When they do, neurological problems such as weakness of an arm or leg, difficulty speaking, a severe headache, pain over and behind an eye, dilated pupils, and blurred or double vision can occur and should alert you to seek urgent medical care, the Brain Aneurysm Foundation warns. These signs can be critical warnings that a brain aneurysm is in danger of rupturing and treatment is needed ASAP.

About 30,000 Americans suffer from ruptured brain aneurysms every year, mostly without any forewarning, according to the National Institute of Neurological Disorders and Stroke (NINDS). But when an aneurysm does burst, there is always what is typically described as the “worst headache ever.” Nausea, vomiting, seizures, double vision, loss of consciousness, and even cardiac arrest may occur, too.

Clearly, brain aneurysms can be disastrous, and treatment can save lives. However, when and how to treat aneurysms depends on several factors.

Brain aneurysm treatment isn’t always needed

Most brain aneurysms are not discovered until they rupture, or they are spotted during imaging tests for some other medical problems.

If a very small, unruptured brain aneurysm is discovered, your doctor may monitor it regularly with imaging tests to detect any changes suggesting it is increasing in size and likely to rupture.

Even if there are no changes, the NINDS explains, it is crucial to aggressively treat any other medical problems and risk factors that could increase the odds the aneurysm might burst. For example, someone with an aneurysm should bring their high blood pressure under control and stop smoking stopped and using stimulant drugs (including amphetamines and cocaine).

Your doctor may advise treating an unruptured cerebral brain aneurysm, especially if it is growing or causing symptoms — but the risk needs to be weighed carefully against the potential benefits, according to the NINDS.

Factors to determine the best unruptured brain aneurysm treatment include the person’s age and health; their personal and family medical history; the type, size, and location of the aneurysm; and the risk of treating the patient.

Tests for diagnosing and planning brain aneurysm treatment

Certain conditions - including atherosclerosis, trauma, and infections — can injure or weaken blood vessels and cause cerebral aneurysms. A family history of brain aneurysms and medical problems, including polycystic kidney disease and narrowing of the aorta (the body’s largest artery), can also raise your risk, the American Stroke Association explains.

Your doctor may test for a brain aneurysm depending on your medical history and, especially, if you develop any potential symptoms of a ruptured aneurysm, such as a severe, sudden headache.

Tests to diagnose brain aneurysms and to determine and plan the best treatment include:

• Computed tomography (CT) scan. This is often the initial test a doctor orders to see if blood has leaked into the brain. Sometimes a contrast dye is injected into the bloodstream before the test. This procedure, called CT angiography, provides detailed images of the size, location, and shape of an unruptured or a ruptured aneurysm. 
• Magnetic resonance imaging (MRI). An MRI uses computer-generated radio waves and a magnetic field to create two- and three-dimensional detailed images of the brain that show any bleeding and the shape and location of an aneurysm.
• Cerebral angiography. Injected contrast dye combined with x-rays is used to create images of an aneurysm, revealing bleeding and blockages.
• Cerebrospinal fluid analysis. A small amount of cerebrospinal fluid, collected with a spinal tap, is tested for blood. A positive test suggests bleeding around the brain and indicates more imaging is needed to see if an aneurysm is leaking blood.

Bottom line? Brain aneurysm treatment varies

Treatments recommended to manage symptoms and prevent damage from both ruptured and unruptured brain aneurysms include surgery and less invasive treatments, too.

Microvascular clipping requires open brain surgery. A neurosurgeon locates the neck of an aneurysm and attaches a clip (much like a clothespin). This blocks the aneurysm’s blood supply and prevents future bleeding.

A related treatment, known as occlusion, involves clamping off the entire artery leading to the aneurysm. This is often the treatment of choice for an aneurysm that has damaged a blood vessel.

Endovascular procedures, which are less invasive than open brain surgery, may be the appropriate brain aneurysm treatment for some patients. Using imagery as guidance, the neurosurgeon threads a small catheter to the site of the aneurysm where coils made of platinum wire are released. This blocks the aneurysm from receiving circulating blood.

Another endovascular procedure using flow diversion devices — small stents (flexible mesh tubes) — is sometimes the best treatment for very large aneurysms. A catheter carrying a small, flexible mesh tube is inserted, usually in the groin area, and threaded through the body to the location of the artery with the aneurysm. Then the neurosurgeon places a stent in the artery, reducing the amount of blood flowing into the aneurysm. 

It’s important to understand a doctor’s decision to use a specific treatment depends on the patient’s individual case. All aneurysm procedures carry some risks of damage to other blood vessels, a risk of stroke, and the possibility an aneurysm will recur and bleed again, according to the NINDS.

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