What are the treatment options for a brain aneurysm?

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Brain aneurysms don't always need to be treated. But it is sometimes a good idea to close them off using a or surgery, to prevent them from rupturing (bursting) at some point.

Whether and how a brain aneurysm should be treated depends on the individual case. People without symptoms who have a low risk of complications don’t necessarily need treatment. But it is recommended that you see a doctor for a check-up every one to three years.

To minimize the risk of rupture, it also helps to

  • lower your blood pressure if it's too high – for example by changing your diet in order to lose weight, by getting regular exercise, or taking medication,
  • not smoke, and
  • drink only a little alcohol, or none at all.

These recommendations apply to anyone who has an aneurysm – regardless of whether the risk of complications like bleeding in the brain is high or low.

If the risk of the aneurysm bursting is high, treatment is usually recommended. Various surgical or catheter-based procedures can be used to close off the aneurysm. The choice of treatment depends on different factors – like the position, shape, and size of the aneurysm and the age and general health of the person.

What happens during brain aneurysm surgery?

During surgery, neurosurgeons open the skull and expose the affected blood vessel. They then place a small metal clip on the blood vessel to stop blood flowing to the aneurysm. That's why this method is called “clipping.” Surgery is mainly considered if the aneurysm is located in a place where it can be easily exposed and clamped off.

The clip stays in the body. The blood in the aneurysm clots and the body turns it into connective tissue over time. This eliminates the risk of bleeding in the brain due to the aneurysm.

But the procedure itself may damage brain tissue. If it does, it can lead to problems such as paralysis. This is usually temporary, but in rare cases it might be permanent.

And any type of surgery is associated with risks such as bleeding, wound infections, and blood circulation problems. So aneurysm surgery is more suitable for younger people who don’t have any other medical problems. Their bodies can handle the surgery better, and recover faster.

What does catheter treatment (endovascular coiling) involve?

Treatment with a is done without open surgery. The patient is given an anesthetic. The is inserted into an artery in the groin and then moved up into the blood vessel in the brain that has the aneurysm. The doctor can then place small platinum coils in the aneurysm through the . That's why this procedure is also called “endovascular coiling.” Endovascular means "within a vessel." The coils cause the blood inside the aneurysm to clot. This prevents more blood from flowing into the aneurysm. Sometimes stents are put in, too. These tiny tubes made of wire mesh act like a scaffold to prop open the blood vessel: Blood can then flow through the stents and past the aneurysm.

Endovascular coiling is mainly considered when surgery is too risky – for example, in people who have cardiovascular disease (heart and blood vessel problems).

This procedure is associated with risks too: The may damage the blood vessel from the inside, which can cause bleeding and brain damage as well. If the blood in the aneurysm doesn't clot completely, blood can continue to flow into the aneurysm. Further treatment is then needed because there is still a risk of bleeding in the brain.

Balik V, Yamada Y, Talari S, Kei Y, Sano H, Sulla I et al. State-of-Art Surgical Treatment of Dissecting Anterior Circulation Intracranial Aneurysms. J Neurol Surg A Cent Eur Neurosurg 2017; 78(1): 67-77.

Hacke W (Ed). Neurologie. Berlin: Springer; 2016.

Li LR, You C, Chaudhary B. Intraoperative mild hypothermia for postoperative neurological deficits in people with intracranial aneurysm. Cochrane Database Syst Rev 2016; (3): CD008445.

Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 2013; 35(2): 93-112.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on November 29, 2018
Next planned update: 2021

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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