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Treatment / Brain Aneurysm Treatment

A brain aneurysm is a bulge or ballooning in a blood vessel in the brain. A brain aneurysm can leak or rupture, causing bleeding into the brain (hemorrhagic stroke). Most often a ruptured brain aneurysm occurs in the space between the brain and the thin tissues covering the brain. This type of hemorrhagic stoke is called a subarachnoid hemorrhage.

A ruptured aneurysm is life-threatening and requires immediate medical treatment.

Most brain aneurysms, do not rupture, create health problems or cause symptoms. These aneurysms are often detected during tests for other conditions.

Am I a Candidate for Treatment?

With advancements throughout the neurosurgical/neurological and endovascular fields, there are more effective and less invasive treatment options for patients, who in years past would have had inoperable aneurysms. Decisions regarding management of an unruptured brain aneurysm are based on the careful comparison of the short and long term risks of aneurysmal rupture, compared to the risk of intervention whether surgical or endovascular.

If an aneurysm is detected but has not ruptured, either treatment or observation will be recommended. Once an aneurysm ruptures, treatment options will either be open surgery or endovascular approach. Intervention is recommended as early as possible after hemorrhage, to prevent re-bleed of the aneurysm. The treatment goal is to prevent rebleeding by sealing off the aneurysm completely.

Your physician will consider the following factors when deciding which treatment option is best.

  • Age
  • Aneurysm size
  • Aneurysm location
  • Aneurysm shape
  • Patient’s neurological condition
  • Previous history of SAH or family history of aneurysm

Aneurysm Treatments

Surgical clipping

is a procedure to close off an aneurysm. The neurosurgeon removes a section of the skull to access the aneurysm and locates the blood vessels that feed the aneurysm. Then a tiny metal clip is placed on the neck of the aneurysm to prevent blood flow.

Endovascular coiling

uses the natural access to the brain through the bloodstream via arteries to treat brain aneurysms. The goal of the treatment is to safely seal off the aneurysm and stop further blood from entering into the aneurysm and increasing the risk of rupture or possible re-bleed.

During endovascular coiling, a catheter is passed through the groin up into the artery containing the aneurysm. Platinum coils are then released. The body responds by forming clots around the coil, limiting blood flow within the aneurysm and reducing the risk of rupture or re-rupture.

The coils used in this procedure are made of soft platinum metal, and are shaped like a spring. The coils are very small and thin, ranging in size from about twice the width of a human hair to less than one hair’s width.

Many aneurysms that are amenable to surgery for clipping can also be considered for coiling. In some patients, because of advanced age, serious medical problems or other factors that increase the risk of brain surgery, coiling is the preferred treatment.

Balloon remodeling

is used in combination with endovascular coiling to treat aneurysms. During balloon remodeling a small balloon is threaded through your blood vessels to the base of the aneurysm, which is also called the neck. The balloon creates a scaffold and allows the coils to stay within the aneurysm. The coils fortify the walls of the aneurysm, reducing the chance of rupture. After the protective coils have been placed, the balloon and catheter are removed.

Intracranial stenting

is used to treat people with aneurysms that have a complex shape. The stent is a metal tube that provides structural support enabling the protective coils to better strengthen the site of the aneurysm so it does not burst.

When a stent is used to treat brain aneurysms, the doctor inserts a catheter into an artery and threads it through the body to the site of the aneurysm. Using a guide wire, detachable coils are passed through the catheter and released into the aneurysm. The coils fill the aneurysm; block it from circulation, and cause the blood to clot, which obliterates the aneurysm. The stent is placed to stabilize the artery either before or after the coil placement to serve as a scaffold or barrier to prevent the coils form protruding back into the parent (main) blood vessel.

Pipeline embolization device(PED)

is a breakthrough and potentially life-saving treatment for patients with brain aneurysms. The PED is designed to treat aneurysms that were once considered inoperable. This minimally invasive therapy remodels the parent artery using a flexible structure that conforms to the ruptured vessel.

Using a technique known as flow diversion, the physician can treat large or giant wide-necked brain aneurysms by placing the Pipeline Embolization Device into the parent blood vessel rather than in the aneurysm sac. The Pipeline Device restores original natural blood circulation while providing permanent long-term sealing to the affected area.

During the procedure, the Pipeline Device is implanted across the aneurysm neck. The open wire mesh scaffolding-structured design of the device slows the flow of blood into the aneurysm, which allows for the diseased vessel to heal. Eventually, during the healing process, the aneurysm will be reabsorbed by the body.

These minimally invasive technique allows patients to heal quicker and return home sooner.

Recovery

Recovery for patients who receive endovascular treatment for an unruptured aneurysm is very quick. The majority of patients will go home the following morning and resume normal activities in a week.

Recovery from surgical treatment or rupture may take weeks to months.

Recovery from a ruptured brain aneurysm is influenced by many factors. The most important consideration is the patient’s clinical condition on admission based on the extent of the initial hemorrhage.

If you have been diagnosed with a brain aneurysm and are exploring your options for treatment, call IVC today at 503-612-0498 to schedule an appointment for consultation.

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