There are two main types of treatment for a brain aneurysm:
- preventative treatment: where an aneurysm is treated to prevent it from rupturing
- emergency treatment: where an aneurysm is repaired after it ruptures
The mainstay of preventative treatment is surgery, though as with any type of surgery, it carries a risk of complications, some of which are serious, such as brain damage or a stroke.
Therefore, preventative surgery is usually only recommended if it's thought that the risk of a rupture is significant enough to justify the risk of surgery.
Preventative treatment
If you are diagnosed with a brain aneurysm, a risk assessment will be carried out to assess the risk of the aneurysm rupturing.
The assessment process is usually based on the following factors:
- your age
- the size of the aneurysm
- where in the brain the aneurysm is located; brain aneurysms that are located near larger blood vessels have a high risk of a rupture
- whether you have a family history of ruptured brain aneurysm
- whether you have an underlying health condition that increases the risk of a rupture, such as autosomal dominant polycystic kidney disease or poorly controlled high blood pressure
The decision to surgically repair an aneurysm will be based on a number of factors individual to you, such as:
- your age – research has found that in older adults the potential benefit of surgery in terms of extending natural lifespan is often outweighed by the risks associated with surgery
- the size of the aneurysm – aneurysms larger than 7mm often require surgical treatment as do aneurysms larger than 3mm in cases where there are other risk factors
- the location of the aneurysm – as mentioned above, aneurysms located near larger blood vessels have a high risk of a rupture
Your surgical team should be able give you a detailed assessment of whether the benefits of surgery outweigh the potential risks in your individual case.
Active observation
If it is thought that the risk of rupture is small then a policy of active observation is normally recommended.
Active observation means that you won't receive immediate surgery, but you'll be given regular check-ups so that your aneurysm can be carefully monitored.
You'll be referred for regular angiograms so that the size of the aneurysm can be carefully monitored.
You may also be given medication to lower your blood pressure as well as discussing lifestyle changes, such as losing weight and reducing the amount of fat in your diet.
Surgery
Two surgical techniques have proved to successfully treat brain aneurysms: neurosurgical clipping and endovascular coiling.
Neurosurgical clipping
Neurosurgical clipping is a procedure carried out under general anaesthetic (you're asleep throughout). A cut is made in your scalp and a small flap of bone is removed to reveal your brain underneath.
When the aneurysm is located, the neurosurgeon (an expert in surgery of the brain and nervous system) will seal it shut using a tiny metal clip. After the bone flap has been replaced, the scalp is stitched together.
Endovascular coiling
Endovascular coiling involves inserting a catheter into an artery in your leg or groin. The tube is guided through the network of blood vessels into your head and finally into the aneurysm.
Tiny platinum coils are then passed through the tube into the aneurysm. The coils block the flow of blood into the aneurysm. Over time this should seal the aneurysm off from the main artery to prevent it from rupturing.
Coiling or clipping?
Coiling is thought to be slightly more effective in preventing death in the long term than clipping.
One study found that 1 in 10 people treated with coiling died in the first five years after surgery compared to 1 in 7 people treated with clipping.
Both techniques have similar levels of effectiveness in reducing the risk of a person becoming disabled as a result of bleeding inside the brain.
An advantage of coiling is that it's less invasive so it has a faster recovery time. Also, due to the less invasive nature of treatment, there's a reduced risk of a person having seizures (fits) after surgery, which is a common complication of invasive brain surgery.
Though there may be circumstances when coiling is not technically possible or suitable – e.g. the aneurysm is located in a part of the brain that can't be reached using a catheter.
Your surgical team will be able to provide more information about the pros and cons of both techniques.
Emergency treatment
Emergency treatment is based on the same principles as preventative treatment. Coils or clipping are used to repair ruptured brain aneurysms.
Due to the urgent nature of a ruptured aneurysm, the decision to perform open or endovascular surgery may be determined by the expertise and experience of the surgeons available.
Additional medication and treatments may also be used to prevent blood loss and organ damage. For example, nimodipine may be recommended. This medication is used to prevent ruptured blood vessels going into spasm and causing further blood loss.
