Researching The Future Of Aneurysm Treatments
At U-M we are on the cutting edge of research into aneurysms and related disorders, and are currently studying how to make better coils, evaluating how different coils work and how aneurysms heal with them. We are dedicated to bringing the latest in research, diagnosis and treatment to aneurysm and subarachnoid hemorrhage patients.
What Should You Do If You Think You Have An Aneurysm
If you have a family history of brain aneurysms or you feel like you may have one, speak with your doctor about your concerns. To detect a brain aneurysm, you would have to have a brain scan that allows your doctor to see the blood vessels in your brain as the blood shows through. Possible types of brain scans include:
- Computed tomographic angiography : This type of brain scan follows dye that was injected into your vein as it travels through the blood vessels in your brain.
- Magnetic resonance angiography : An MRA is similar to a CT scan, but while a CT scan uses radiation similar to X-rays, magnetic resonance imaging machines use magnetic and radio waves to make the images on a screen.
- Diagnostic cerebral angiography : Although a DCA can detect smaller aneurysms than a CTA or MRA can, this test is not usually a first choice as it is an invasive procedure. A small incision is made in your groin so your doctor can insert a long catheter that is threaded up to your neck and your brain. A dye is injected through the catheter, and X-rays are taken of your brain as the dye flows through the blood vessels.
What Is A Ruptured Aneurysm
An aneurysm is a balloon-like bulge or weakening of an artery wall. As the bulge grows it becomes thinner and weaker. It can become so thin that the blood pressure within can cause it to leak or burst open. Aneurysms usually occur on larger blood vessels at the fork where an artery branches off. Types of aneurysms include :
- Saccular – the aneurysm bulges from one side of the artery and has a distinct neck at its base.
- Fusiform – the aneurysm bulges in all directions and has no distinct neck.
- Dissecting – a tear in the inner wall of the artery allows blood to split the layers and pool often caused by a traumatic injury.
When an aneurysm bursts, it releases blood into the spaces between the brain and the skull. This space is filled with cerebrospinal fluid that bathes and cushions the brain. As blood spreads and clots it irritates the lining of the brain and damages brain cells. At the same time, the area of brain that previously received oxygen-rich blood from the affected artery is now deprived of blood, resulting in a stroke. A subarachnoid hemorrhage is life threatening with a 40% risk of death.
Enclosed within the rigid skull, clotted blood and fluid buildup increases pressure that can crush the brain against the bone or cause it to shift and herniate. Blockage of the normal CSF circulation can enlarge the ventricles causing confusion, lethargy, and loss of consciousness.
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What Are The Risks Of Coiling
The levels of risk will very much depend on your own individual circumstances, including the size and location of the aneurysm in your brain, whether or not it has ruptured , your age and your overall health.
It is likely that the benefits of coiling will strongly outweigh any possible risks, and your doctor will have discussed this with you fully before you give your consent to go ahead with the procedure.
However, as with any invasive procedure, there are possible complications. These include stroke-like symptoms, such as weakness or numbness in an arm or leg and problems with speech or vision.
There is also a risk of bleeding, infection or damage to the artery at the place where the catheter goes into your groin.
Based upon the evidence available, doctors agree that coiling is a safe procedure.
Treatment Options For Ruptured Or Unruptured Aneurysm
The goals of treatment once an aneurysm has ruptured are to prevent further bleeding and potential permanent brain damage. Treatment and monitoring during the three weeks immediately following the hemorrhage are important, since that is the period when complications are most likely to occur. Medication and sedatives may be prescribed and total bed rest is necessary. If an aneurysm hasnt ruptured, treatment will typically center on preventing an initial rupture using either endovascular techniques or open surgery.
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Our Areas Of Innovation For Brain Aneurysms
At Boston Childrens, our physicians and researchers are among the most published in their field .
Our research aims to improve the diagnosis and treatment of brain aneurysms in children. Through our research, we have built a large database that guides and informs our practice and helps us innovate approaches to diagnosis and treatment. Our doctors have also authored and contributed to professional guidelines for stroke and other cerebrovascular conditions, as well as the American Heart Associations Guidelines for the Management of Cerebrovascular Disorders in Infants and Children.
What Are The Symptoms Of An Unruptured Brain Aneurysm
The most common signs of an intact aneurysm are headaches. Other signs may include:
- Vision changes.
- MRA .
- CTA .
Occasionally, a ruptured aneurysm may not show on the initial imaging test. If your symptoms point to a ruptured aneurysm, your doctor may order a lumbar puncture . This test shows whether theres blood in the fluid surrounding your brain.
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What Causes Brain Aneurysms
Most aneurysms are acquired. However, they are more common in people with certain genetic diseases, such as connective tissue disorders and polycystic kidney disease, and certain circulatory disorders. Other causes include trauma or injury to the head, high blood pressure, infection, tumors, atherosclerosis and other diseases of the vascular system, cigarette smoking, and drug abuse.
Fusiform aneurysms are less common. They consist of an outpouching of the arterial wall. There is no stem.
How Are Brain Aneurysms Treated
Surgery and/or endovascular therapy are the treatment for brain aneurysms, whether they are ruptured or unruptured.
Open surgical clipping
During this procedure, your surgeon cuts a small opening in your skull to access the aneurysm. Using a tiny microscope and instruments, your surgeon attaches a small metal clip at the base of the aneurysm to pinch it off. This blocks blood from flowing into the aneurysm. The surgery can stop a brain bleed or keep an intact aneurysm from breaking open. Recovery time is different for ruptured and unruptured aneurysms. This procedure is considered to be durable with a low recurrence rate.
For this procedure, your surgeon doesnt need to create an opening in your skull. Instead, a doctor inserts a catheter in a blood vessel, usually in the groin or wrist, and threads it to your brain.
Through the catheter, your doctor places a ball of wires , most often made of platinum, in the aneurysm, sometimes with the help of small stents or balloons. Recently another small device , which looks like a mesh ball, made of nickel titanium, also became available, and works in a similar fashion as coils. Both methods result in blood clot formation around and inside the wire ball or web device, and block blood flow into the aneurysm, reducing or eliminating the risk of rupture.
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Why Is A Subarachnoid Hemorrhage Life
If a brain aneurysm ruptures or an artery that passes over the surface of the brain bursts, blood flows into the fluid-filled space around the brain. Doctors call this area the “subarachnoid space.” Bleeding into this space is called a subarachnoid hemorrhage.
Blood can then quickly spread in this space and put pressure on the whole brain. This means that even parts of the brain that aren’t very close to the bleeding blood vessel are damaged. The bleeding quickly causes a severe headache. Left untreated, it often leads to unconsciousness and life-threatening complications like an irregular heartbeat and respiratory arrest .
The brain damage can cause long-term or permanent problems in everyday life, or lead to the need for nursing care for instance because of speech problems or paralysis.
Different types of bleeding in the brain
How Is Brain Aneurysm Treated
Treatment of an unruptured aneurysm may depend on its size and location. If the aneurysm is very small, you will probably be recommended to have regular scans to monitor it, and treatment for any other conditions, such as high blood pressure.
If you have had a burst aneurysm, you will be told to stay in bed and to take pain relief medication for any pain you might have. You will then have surgery to clip the aneurysm so that it does not bleed again.
Another type of surgery involves threading a thin tube through the artery from the groin and using it to insert a tiny metal coil into the aneurysm. This causes a blood clot, which prevents the aneurysm from bursting.
If the aneurysm caused a brain haemorrhage, you may need other treatments for complications, such as reduced blood flow to the brain or fluid on the brain.
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Do Not Take Chances With Your Health
A brain aneurysm can potentially be life-threatening, so head to our clinic for evaluation if you have any of the symptoms.
Request an appointment here: or call Brain and Spine Neuroscience Institute at for an appointment in our Lutz office.
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Brain Aneurysm Treatment And Recovery
An unruptured brain aneurysm is normally found during unrelated tests/screenings. A ruptured brain aneurysm will be diagnosed using computerized scans and dye tests. Once a ruptured brain injury is diagnosed, there are a few different treatment options. Doctors will recommend the one best suited to your situation based on factors such as age, location and severity of the aneurysm. These treatment options include:
- Open surgery which enables the surgeon to place a clip around the base of the aneurysm, preventing blood from entering it
- Endovascular surgery which happens within the blood vessels. Its a smaller, less-invasive surgery to implant shunts or coils
Alternatively, doctors may recommend observation and spend more time monitoring the aneurysm.
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What Happens During The Procedure
The room will have several large pieces of high-tech scanning equipment which are needed to perform the coiling.
A nurse will shave a small area of your groin where the catheter will be inserted.
The radiologist will make a small incision in your groin through which they will insert the catheter into the main blood vessel in your leg . The catheter is then guided through other blood vessels in your body until it reaches your brain and then the aneurysm.
Diagram showing coiling of an aneurysm
The coils are passed through the catheter and, one by one, they are slowly inserted into the aneurysm. The coils are made of platinum, are twice the width of a human hair and can vary in length. The number of coils needed depends on the size of the aneurysm. The largest coil is inserted first and then smaller coils are inserted until the aneurysm is filled. Usually, several coils will be used.
Diagram to show how a stent and coils are placed
Sometimes, an expandable mesh tube, called a stent, may also be put into the artery to hold the coils in place inside the aneurysm. This is called stent-assisted coiling. It is more likely to be done if the aneurysm has a very wide neck that could otherwise allow the coils to escape.
Coiling is a complex and delicate procedure that will take at least three hours and often longer.
What Causes An Aneurysm
Although the exact cause of an aneurysm is unclear, certain factors contribute to the condition.
For example, damaged tissue in the arteries can play a role. Blockages, such as fatty deposits, can harm the arteries. These deposits can trigger the heart to pump harder than necessary to push blood past the fatty buildup. This added stress due to the increased pressure can damage the arteries.
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What Happens Before The Procedure
The coiling procedure is similar to an angiogram and involves a very small tube, called a catheter, being guided from the groin up to the brain through the blood vessels. However, it is a much more complex procedure and is always carried out under a general anaesthetic in the radiology department.
You must not eat or drink anything for four to six hours before the procedure. The staff on the ward will advise you on this.
On arrival at the radiology department, an anaesthetist will give you a general anaesthetic, so you will be asleep throughout the procedure.
Surgical Repair Of Aneurysms
If the aortic aneurysm is less than five cm wide, it is usually left untreated, but closely monitored . If it is larger than five cm, the aneurysm is surgically repaired. In most cases, the aneurysm is cut out and the hole is plugged with an artificial graft.Depending on the location of the cerebral aneurysm, it will be treated either surgically with clipping, or by using fine platinum coils inserted in the aneurysm via an angiogram, which is a radiological procedure used, in this case, to close the aneurysm and preserve the normal flow of blood in the brain.Treatment of a ruptured cerebral aneurysm is an urgent procedure, but treatment of an unruptured aneurysm can be performed semi-electively.
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Endovascular Treatments For Brain Aneurysm
Traditionally, brain aneurysms were treated with open brain surgery. Today, as many as 60 percent of brain aneurysm patients who come to U-M receive minimally invasive treatments through our Endovascular program. These treatments may include using endovascular coils, stents, or Onyx, a liquid glue. Endovascular therapy is a minimally invasive procedure in which a catheter is placed into the body thru a small hole in the patients leg and navigated under real time x-ray guidance through the vascular system to the head and into the aneurysm.
How Do I Decide What Procedure To Have If I Have A Cerebral Aneurysm
The treatment of choice for an intracranial aneurysm, like all medical decisions, should be agreed upon by both the physician and the patient. In the case of either ruptured or un-ruptured intracranial aneurysms, the treating physician should discuss the risks and benefits of each available treatment option. The physician will usually make recommendations for one treatment over another, depending on the facts of each individual case. Seeking a second opinion, when possible, is usually advisable.
Although unresolved controversies remain as to what the best treatment option is for an individual patient, both surgical clipping and endovascular coiling/stenting are considered to be viable treatment options in the management of cerebral aneurysms today.
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How Will My Doctor Know Whether An Aneurysm Will Cause A Brain Bleed
When determining how likely a brain aneurysm is to bleed , your doctor will consider these factors:
- Size of the brain aneurysm
- Location of the brain aneurysm
- Shape of the aneurysm, meaning whether it’s round or irregular
There are many effective treatment options for brain aneurysms today. Because of the nuances of brain aneurysms, care teams tailor treatment to each individual patient. Always be sure to consult with a neurosurgeon with cerebrovascular expertise.
At Johns Hopkins, each of the 300-plus brain aneurysm surgeries we perform yearly are customized specifically to an individual patient’s circumstances.
What Is A Brain Aneurysm
A brain aneurysm, also known as a subarachnoid hemorrhage , is a weak spot in the wall of a blood vessel inside the brain. Think of a weak spot in a balloon and how it feels stretched out and thin. A brain aneurysm is like that.
That area of the blood vessel gets worn out from constant flow of blood and bulges out, almost like a bubble. It can grow to the size of a small berry. There are different types:
Saccular aneurysms are the most common type of brain aneurysm. They bulge out in a dome shape from the main artery. Theyâre connected to that artery by a narrow âneck.â
Fusiform aneurysms arenât as common as saccular aneurysms. They donât pouch out in a dome shape. Instead, they make a widened spot in the blood vessel.
Although brain aneurysms sound alarming, most donât cause symptoms or health problems. You can enjoy a long life without ever realizing that you have one. But in rare cases, aneurysms can grow big, leak, or explode. Bleeding in the brain, known as a hemorrhagic stroke, is serious, and youâll need medical care right away.
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What Happens During A Brain Hemorrhage
The skull protects the brain, but it also limits the amount of available space: Bleeding inside the skull quickly increases the pressure on the brain tissue. This often causes serious complications.
A brain hemorrhage occurs when blood vessels inside the skull are damaged, for instance due to a major head injury. Other causes include problems with blood clotting and/or damage to the blood vessels in the brain due to thickened and hardened artery walls or high blood pressure, for example. Other causes include problems with blood clotting and/or damage to the blood vessels in the brain due to thickened and hardened artery walls or high blood pressure, for example. The bleeding is often caused by a ruptured brain aneurysm. A brain aneurysm is a bulge in an artery in or near the brain.