By Dr Ananya Mandal, MD
Cerebral aneurysm is usually only treated if the aneurysm has ruptured or is at risk of rupturing.
In the majority of cases, aneurysms do not burst and only high risk patients are treated, owing to the fact that the surgery itself is associated with the risk of complications such as stroke or brain damage.
To assess the likelihood that a patient’s cerebral aneurysm may rupture, their age, family history of the condition and general state of health are taken into consideration, along with the size and location of the aneurysm. This will help a physician decide whether the benefits of a patient having surgery outweigh the risks associated with the surgery.
If it is decided that the risk of aneurysm rupture is low, then active observation may be the recommended approach and the patient’s aneurysm is regularly monitored. The patient may also be put on blood-lowering medication and asked to make changes to their lifestyle such as quitting smoking or losing weight.
If the patient is at a high risk of aneurysm rupture, one of two main surgical procedures may be recommended: neurosurgical clipping or endovascular coiling. Both of these procedures cut off the blood flow to the aneurysm to prevent rupture.
Under general anesthesia, an incision is made in the scalp and a small piece of bone removed to allow access to the brain. A metal clip is placed over the aneurysm to seal it shut. The bone segment is then replaced and the incision stitched back up. In cases where the aneurysm is particularly large, the artery in which the aneurysm has formed may be clipped instead. In this case, a simultaneous bypass also needs to be performed and a blood vessel from another part of the body is used to direct blood flow around the clamp.
This procedure is also performed under general anesthesia. A thin tube or a catheter is passed through a blood vessel and guided towards the aneurysm in the brain. Tiny platinum coils are then used to fill the aneurysm until blood can no longer enter it, which prevents the aneurysm’s growth and rupture.
Reviewed by Sally Robertson, BSc