Brain Aneurysms

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Neurological Institute Cerebrovascular Center

The neurosurgeons at Houston Methodist diagnose and treat many kinds of cerebrovascular conditions, including brain aneurysms. A brain aneurysm occurs when the blood vessels in the brain develop thin or weak spots; the pressure of the blood against the weakened wall of the artery then causes it to bulge out. Other terms used to describe aneurysms located in the brain include cerebral, intracranial or intracerebral aneurysm.

Brain aneurysms are characterized by the type of the bulge in the artery:
  • Saccular (often called ‘berry’) aneurysms account for 80 to 90 percent of all brain aneurysms. These small protrusions look like a berry on a stem and often occur in large arteries at the base of the brain.
  • Fusiform aneurysms expand the artery wall in all directions, but rarely rupture (tear or burst).

Perhaps the best way to learn about our highly trained neurosurgeons and neurologists at Houston Methodist is through our patients. We invite you to read about their inspiring patient stories and about their experience being a patient at Houston Methodist. Heather, a brain aneurysm patient, shares her recovery story. 

Potential causes of brain aneurysms can include the following:
  • Congenital (present at birth) abnormalities
  • Genetic diseases
  • Family history
  • Circulatory disorders, malformations 
  • Atherosclerosis (hardening of the arteries)
  • High blood pressure
  • Smoking
  • Head injuries
  • Infections
  • Tumors

Symptoms of Brain Aneurysms
Small aneurysms may be present for many years and never cause any problems; however, if aneurysms rupture or hemorrhage (leak blood), this is a medical emergency and can cause serious neurological damage, disability and even death. 

A growing aneurysm may put pressure on surrounding areas of the brain, resulting in several symptoms as it expands. Symptoms to be aware of for a growing aneurysm include the following:
  • Headaches
  • Pain above and behind the eye
  • Dilated pupils
  • Numbness or weakness
  • Decreased feeling in the face
  • Blurred or double vision 

Ruptured brain aneurysms may bleed into the space around the brain (called subarachnoid hemorrhage), causing the following sudden symptoms:
  • Sudden, severe headache (often described as the worst in your life)
  • Sudden pain above and behind the eye
  • Vision problems — sudden blurred or double vision — or just trouble seeing
  • Light sensitivity
  • Seizure
  • Stiff neck
  • Drooping eyelid
  • Nausea and/or vomiting
  • Sudden mental confusion or lack of awareness
  • Sudden weakness, numbness, dizziness or trouble walking
  • Loss of consciousness 

Diagnosis of  Brain Aneurysms
At Houston Methodist, our doctors will conduct an examination that includes a thorough review of your medical history, and one or more imaging tests to confirm and evaluate a brain aneurysm:
  • Magnetic resonance imaging (MRI)
  • Computed tomography (CT) scans
  • Cerebral angiography (creating a map of your blood vessels)

Once a specific diagnosis is made, our specialized care team, which includes neurosurgeons and interventional neuroradiologists, will work with you to develop a personalized treatment plan.

Treatment Options for Brain Aneurysms 
Treatment options for brain aneurysms are highly individualized based on several factors: 
  • Age
  • Medical history
  • Size and location of the brain aneurysm
  • Likelihood (probability or odds) that the aneurysm is likely to rupture or cause other problems 

For small brain aneurysms that are not causing problems, your Houston Methodist physician will monitor your condition closely to observe the size and what happens over time.

When treatment is needed, the many available options include surgical, microsurgical and endovascular (within the blood vessel) techniques. Most of these are less invasive than treatments used in the past. If a brain aneurysm has ruptured, the neurosurgeons at Houston Methodist treat it with advanced, specialized surgery.

Surgical Treatment of Brain Aneurysms
Clipping is one of the most common treatments for a brain aneurysm. In this procedure, a neurosurgeon places a small metal clip (or clips) around the aneurysm stem, cutting off its blood supply. This prevents the aneurysm from bleeding and causes it to shrink. The clip stays in place for life. 

Coiling (endovascular embolization)
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.

Like clipping, coiling is an embolization procedure — it seals off the connection between the aneurysm and the blood vessel. The coiling procedure fills the aneurysm from inside the blood vessel instead of from the outside, as in clipping. During coiling, the surgeon uses continual X-rays, high-speed radiographic filming and angiogram to locate and measure the aneurysm. Then, a microcatheter (very thin flexible tube that acts as a guide) is used to place a platinum coil inside the aneurysm. Sometimes more than one coil may be needed to pack (fill) the aneurysm. The coils keep blood from flowing into the aneurysm sac.

Stents (very thin short mesh tubes) may be permanently placed (inserted) to act as scaffolding for the artery and to keep the coils in place. A stenting procedure may be done separately, before coiling.

Liquid embolics
A new treatment uses liquid, a type of surgical glue, to embolize brain aneurysms. 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.

Occlusion and bypass
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 or bypass the blood flow. 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 instead of the damaged artery.

Recovery and Rehabilitation
After neurosurgery to treat a brain aneurysm, you will be moved to the intensive care unit (ICU) to recover. Recovery time and rehabilitation after surgery is different for each patient, and depends on several factors:
  • Overall health
  • Personal risk factors
  • Size and location of the aneurysm treated
  • Type of treatment received

Generally, recovery is faster for patients with aneurysms that have not ruptured. These patients typically have shorter hospital stays and return to work sooner. Recovery from a ruptured aneurysm tends to be longer and may require more extensive rehabilitation, depending on the extent of damage or disability caused by the rupture.

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