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 catheter 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 catheter is done without open surgery. The patient is given an anesthetic. The catheter 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 catheter. 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 catheter 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.