The neurosurgeons at Houston Methodist Hospital Neurological Institute Cerebrovascular Center diagnose and treat many kinds of cerebrovascular conditions, including brain aneurysms.
Blood vessels in the brain can develop thin or weak spots. When this happens, the pressure of the blood against the weakened wall of the artery causes it to bulge out, like a balloon. This is called a brain aneurysm, cerebral aneurysm, or intracranial or intracerebral aneurysm (IA).
Brain aneurysms can be caused by congenital (from birth) abnormalities in an artery, genetic diseases, circulatory disorders and malformations, head injuries, smoking, high blood pressure, atherosclerosis (hardening of the arteries), infections, tumors, family history, and other problems. There are two types of brain aneurysms:
Many times, brain aneurysms are very small and do not cause any problems. However, they can rupture and hemorrhage (leak blood). Ruptured aneurysms are a medical emergency because they can cause serious damage, disability, or death.
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Small brain aneurysms usually don’t cause symptoms, so a person may not be aware that they have one until it ruptures. However, a growing aneurysm may put pressure on surrounding areas of the brain, causing symptoms such as:
Ruptured aneurysms may bleed into the space around the brain (called subarachnoid hemorrhage), causing sudden symptoms such as:
Along with an exam and a thorough look at your health history, one or more imaging tests may be used to confirm and evaluate a brain aneurysm. Houston Methodist doctors may order:
When the diagnosis is confirmed, a specialized care team, including neurosurgeons and interventional neuroradiologists, will work with you to develop a personalized treatment plan.
Treatment options are highly individual. Your treatment plan will be based on your age, medical history, size, and location of the brain aneurysm, and whether or not it’s likely to cause problems or rupture. A watchful waiting—-with close monitoring by your Houston Methodist physician—may be appropriate for small brain aneurysms that are not causing problems.
When treatment is needed, there are many more options available today than in the past, including surgical, microsurgical and endovascular techniques. Most of these are less invasive than treatments used in the past. If a brain aneurysm has ruptured, the neurosurgeons at Houston Methodist Neurological Institute Cerebrovascular Center treat it with advanced, specialized surgery.
Below are some common treatment options for brain aneurysms.
Clipping is one of the most common treatments for brain aneurysm. In this procedure, a neurosurgeon places a small metal clip (or clips) around the aneurysm’s stem. This cuts of its blood supply, preventing the aneurysm from bleeding and causing it to shrink. The clip stays in place for life.
Coiling is another way to safely cut off the blood flow to an aneurysm to prevent rupture or rebleeding. Although similar in purpose to clipping, some patients may be better candidates for coiling.
During coiling, the surgeon uses continual X-rays, high-speed radiographic filming, and angiogram to locate and measure the aneurysm. Then, a microcatheter is used to place a platinum coil inside the aneurysm. Sometimes more than one coil may be needed to pack the aneurysm. The coils keep blood from flowing into the aneurysm sac.
Stents may be permanently placed to act as scaffolding for the artery and to keep the coils in place. A stenting procedure may be done separately, before coiling surgery.
If an aneurysm has severely damaged an artery, it may be best to stop the blood flow to that part of the artery (occlusion) and reroute the blood flow (bypass). A small blood vessel may be taken from another part of the body (usually the leg) and grafted to a healthy brain artery to supply the brain with blood without using the damaged artery.
A new treatment uses liquid—a type of surgical glue—to embolize brain aneurysms. Right now, only Onyx HD 500 is available in the United States. This liquid solidifies when it comes into contact with blood. It is injected into the aneurysm sac and held in place temporarily with a balloon to keep the liquid from leaking back into the blood vessel.
Patients recover in the Intensive Care Unit after neurosurgery treatment for brain aneurysms. Recovery time and rehabilitation after surgery is different for everyone, depending on each person’s overall health, personal risk factors, size and location of the aneurysm treated, and they type of treatment received.
Generally, recovery is quicker for unruptured aneurysms. These patients typically have shorter hospital stays and return to work more quickly. Patients who have suffered ruptured aneurysms tend to have longer recovery times and may need more extensive rehabilitation, depending on the extent of damage or disability caused by the rupture.