Treatment for Brain Aneurysms
Doctors tailor treatment for a cerebral (brain) aneurysm to the individual patient and aneurysm—it’s not a one-size-fits-all procedure. There are three basic types of treatment: medical treatment without surgery; open surgery (craniotomy); and endovascular surgery.
The best brain aneurysm treatment for you will depend on many factors. These include:
Whether your aneurysm has ruptured
The size, shape and location of your aneurysm
- Your overall health
You or your loved ones should talk with your neurologist and your neurosurgeon about the risks and benefits of treatment options for you.
Medical treatment that does not include surgery may be the best choice if you have a small aneurysm that has not ruptured. Your doctors will try to reduce the risk of a rupture. They will check your aneurysm with brain imaging studies to check whether it is growing. You may have these tests about once a year.
Other aspects of your treatment may include:
- Help to stop smoking, if you smoke
- Taking blood pressure medication, if your blood pressure is high
- Not taking blood thinning medications, since this can increase the risk of bleeding
- Avoiding physical and emotional stress
- Eating a healthy diet and exercising to reach and maintain a healthy weight
- Treatment for cholesterol, if your cholesterol is high
It will also be important for you to let your doctor know if you develop any symptoms of a brain aneurysm. These can include headache, weakness, numbness, vision changes, confusion, nausea or vomiting, stiff neck, seizures, and loss of consciousness.
If your aneurysm is small, there is a good chance it will never cause symptoms or rupture. Medical treatment may reduce the risk of the aneurysm getting worse or rupturing.
If your aneurysm has ruptured or if your doctors think there's a good chance that it will, open surgery may be your best treatment option. The surgery involves opening the skull—a craniotomy—to find the aneurysm and close it. Doctors sometimes refer to this as clipping.
For this procedure, your surgeon will:
- Make an incision and remove a piece of your skull.
- Locate the aneurysm within the brain.
- Place a metal clip at the base of the aneurysm to close it.
- Replace the piece of skull and close the incision.
Complications from this surgery can include rupture of the aneurysm, infection, and decreased blood supply to another part of the brain. If the aneurysm ruptures during surgery, you could have a stroke. Symptoms of stroke include weakness, vision loss, loss of speech, and possible coma or death. Decreased blood supply to another part of the brain could also cause a stroke. The chance of a serious complication from open surgery for a brain aneurysm is about 2 to 4%.
If there are no complications, the success rate of this surgery is very high. There is very little chance that you will have future bleeding from your aneurysm.
Endovascular surgery is a less invasive type of surgery to treat problems involving blood vessels. The type used to treat an aneurysm is called coiling because of the coils used in the procedure. It may be an option for you if your aneurysm has ruptured or if your doctors think there's a high risk that it will.
A neurosurgeon or a neuroradiologist might do this procedure:
- The doctor makes an incision in your groin area.
- The doctor places a long thin tube (catheter) into an artery that leads to your brain. The catheter will go all the way up to your brain and into the aneurysm.
- Then, tiny titanium coils will be released inside the aneurysm. The coils will cause blood to stop flowing into the aneurysm. Over time, the aneurysm will fill with a blood clot, preventing blood from entering the aneurysm. Another name for this procedure is endovascular embolization.
- The doctor withdraws the catheter and closes the incision in your groin.
Complications from this surgery are the same as with open surgery. Success rates for brain aneurysm coiling seem to be as good as for clipping the aneurysm. However, the long-term success of coiling is still being studied.