At the Edward Neurosciences Institute, patients with aneurysms in the brain are evaluated by a team of specialists, including a vascular neurologist, neurointerventional surgeon and neurosurgeon. They review the results of each patient's CT scan and other tests to determine the best course of treatment.
What is a Cerebral Aneurysm?
Aneurysms in the brain occur when there is a weakened area in the wall of a blood vessel. An aneurysm may be present from birth (congenital) or it may develop later in life, such as after a blood vessel is injured. Atherosclerosis and infection can also cause aneurysms.
There are many different types of aneurysms. A berry aneurysm can vary in size from a few millimeters to over a centimeter. Giant berry aneurysms can reach well over two centimeters. Other types of cerebral aneurysm involve widening of an entire blood vessel, or they may appear as a "ballooning out" of part of a blood vessel.
VIDEO: CEREBRAL ANEURYSM
About 5% of the population has some type of aneurysm in the brain, but only a small number of these aneurysms cause symptoms or rupture.
What are the Risk Factors for an Aneurysm?
Risk factors include a family history of cerebral aneurysms and certain medical problems, such as polycystic kidney disease, coarctation of the aorta and high blood pressure.
For patients who experience symptoms, or have medium or large aneurysms that are expanding, surgical or endovascular treatment is recommended.
How the Edward Neurosiences Institute Treats Cerebral Aneurysms
Not all aneurysms need to be treated right away. In some cases, like when the aneurysm is very small and less likely to break open, the Edward Neurosciences Institute's neurointerventional surgeon may determine it's best to monitor the aneurysm with advanced imaging to ensure the aneurysm is not getting bigger.
Some patients may be too ill to have surgery or it may be too dangerous to treat the aneurysm because of its location. In those cases, treatment may include bed rest and restrictions on activity, drugs to prevent seizures and medicines to control headaches and blood pressure.
Aneurysm coiling is a minimally invasive technique to treat unruptured aneurysms in the brain. Aneurysm coiling is performed in a special neurointerventional biplane lab under general anesthesia or moderate sedation.
To treat a cerebral aneurysm using coiling, a neurointerventional surgeon inserts a catheter into the artery in the groin and threads it up to the brain. Using injected dye, the neurointerventional surgeon is able to see the artery and the aneurysm. The neurointerventional surgeon carefully inserts tiny platinum coils into the aneurysm, packing the aneurysm so that blood can no longer fill the space. The platinum coils seal off the aneurysm preventing it from rupturing. Remaining blood in the aneurysm forms a clot around the coils. That combination prevents further blood flow into the aneurysm.
After the procedure, patients receive care in the Neuro Intensive Care Unit where the typical stay for cases with no complications is two days.
Aneurysm Clipping is an open brain surgery performed by a cerebrovascular neurosurgeon. The location and shape of the aneurysm will be evaluated to determine if this is the right treatment option. The patient is under general anesthesia. The surgeon removes a small portion of the skull to gain access to the brain (craniotomy), and then uses microscopes and small instruments to isolate the aneurysm and secure a clip at its neck. The delicate nature of the surgery requires the expertise of a cerebrovascular surgeon to protect healthy brain tissue and prevent compromising blood flow to other areas of the brain.
Following the procedure, patients spend an average of ten days in the Neuro Intensive Care and Neuro "Stepdown" Units. Highly trained Neuro ICU nurses monitor patients for changes in neurological function.
Doctors of the Edward Neurosciences Institute and the Neuro ICU nurses are especially on the lookout for vasospasm (constriction) of the brain vessels, which is a frequent complication following aneurysm surgery or aneurysm rupture. They use medications to treat vasospasm.
Beginning the first day after surgery, neuroscience-trained physical therapists and occupational therapists work with patients to assist them in returning to maximum function.
Ruptured Cerebral Aneurysms
A small percentage of patients with aneurysms in the brain will experience a rupture, something that a patient may describe as "the worst headache of my life." A ruptured aneurysm is a medical emergency that requires immediate medical treatment. The combination of blood in the brain tissues – a subarachnoid hemorrhage – and elevated pressure inside the skull causes symptoms including nausea, vomiting, seizures, confusion and changes in neurologic function that can be as serious as coma.
Up to half of the patients who experience a ruptured aneurysm die within six months, 10-15% don't make it to the hospital. There's also a risk of re-rupture, so doctors treat the aneurysm either with coiling or clipping.
Recovery from a ruptured aneurysm is a lengthy process requiring complex care in the Neuro Intensive Care Unit. Dr. Mohammad Sajed, Medical Director of Edward Hospital's Neuro ICU, is a neurocritical care physician who's also board certified in vascular stroke neurology. Under his direction, critically ill neurological patients receive the latest in medical management, including frequent neurological assessments that can detect subtle changes in neurological function and potential for complications.