By Gregory Cannarsa, MD, Fellowship-Trained Neurosurgeon
Acerebral aneurysm, also known as intracranial or brain aneurysm, occurs when a portion of an artery wall weakens, allowing it to balloon
out or widen abnormally. The condition can be caused by various factors, including congenital defects, high blood pressure, atherosclerosis, and head trauma. Lifestyle factors, such as smoking and excessive alcohol consumption, can also contribute to their development.
Aneurysms can vary in size and shape, being classified as saccular aneurysms, which have a rounded sac-like appearance and are the most common type; fusiform aneurysms, which involve the entire circumference of the artery and tend to be less prone to rupture; and mycotic aneurysms, which result from infections.
Most cerebral aneurysms do not show symptoms until they rupture. Unruptured aneurysms, however, may occasionally cause symptoms if they are large enough to press on brain tissues or nerves, which could lead to pain above and behind an eye, dilated pupils, double vision, or other changes in vision, and numbness or weakness on one side of the face or body.
When an Aneurysm Ruptures
The rupture of a cerebral aneurysm is a medical emergency that leads to subarachnoid hemorrhage, a type of stroke caused by bleeding into the space surrounding the brain. This can result in sudden severe headache, nausea and vomiting, stiff neck, blurred or double vision, sensitivity to light, seizure, drooping eyelid, loss of consciousness, and even death.
Management and Treatment
The management of cerebral aneurysms is complex and depends on various factors, including the size, location, and shape of the aneurysm, whether it has ruptured, and the patient’s overall health and age.
For Unruptured Aneurysms
Management strategies for unruptured cerebral aneurysms include careful monitoring and controlling risk factors, such as high blood pressure and smoking. Medical therapy may involve the use of medications to lower blood pressure. Neurosurgical intervention may be considered for larger or symptomatic unruptured aneurysms or those in patients with a high risk of rupture. The two main surgical treatments are:
. Microvascular Clipping: A procedure in which a neurosurgeon places a tiny clip at the base of the aneurysm to stop blood flow into it.
. Endovascular Coiling: A less invasive procedure that involves threading a catheter through the blood vessels to the aneurysm and then filling it with coils to prevent rupture.
Microvascular Clipping: Pros and Cons Pros:
. Durability: Microvascular clipping is considered a durable treatment with a low rate of recurrence. Once the clip is securely in place, the aneurysm is permanently sealed off from the blood circulation, which effectively eliminates the risk of future bleeding from that aneurysm.
. Direct Closure: This procedure allows the surgeon to directly visualize and treat the aneurysm, ensuring a complete closure.
. Long-Term Effectiveness: Studies have shown that microvascular clipping has excellent long-term outcomes, with the vast majority of patients remaining free of aneurysm-related complications for decades after surgery.
Cons:
. Invasiveness: Clipping is a more invasive procedure than coiling, requiring a craniotomy (opening of the skull). This generally results in a longer recovery period and carries higher risks of complications.
. Limited Access: Some aneurysms, due to their location or the configuration of surrounding blood vessels, may be difficult or impossible to treat with clipping.
Endovascular Coiling: Pros and Cons Pros:
. Less Invasive: Coiling is less invasive than clipping, as it involves threading a catheter through the vascular system to the aneurysm site. This usually results in shorter hospital stays and faster recovery times.
. Lower Immediate Risks: The procedure generally has fewer immediate risks compared to clipping, such as reduced risk of infection and less impact on surrounding brain tissue.
. Accessibility: Coiling can often treat aneurysms that are difficult to access surgically due to their location in the brain.
Cons:
. Recurrence Risk: There is a higher risk of aneurysm recurrence after coiling, necessitating regular imaging studies to monitor for potential issues.
Some aneurysms may require additional treatments if they start to recur.
. Not Suitable for All Aneurysms: Coiling may not be an option for aneurysms with wide necks or certain shapes, as the coils need to securely lodge within the aneurysm to prevent blood flow into it.
For Ruptured Aneurysms
Immediate treatment is critical for ruptured aneurysms. This typically involves stabilizing the patient, controlling blood pressure, and preventing rebleeding and other complications. Neurosurgical intervention to secure the aneurysm is usually necessary and can be life-saving.
Prevention and Awareness
While some risk factors for cerebral aneurysms cannot be controlled, such as genetic predisposition and congenital conditions, lifestyle modifications can reduce the risk. Maintaining healthy blood pressure, quitting smoking, managing stress, and eating a balanced diet can all contribute to lower risk. Awareness of the signs and symptoms of a ruptured aneurysm is crucial for early intervention and management. Individuals experiencing sudden, severe headaches, especially if accompanied by other symptoms of a stroke, should seek immediate medical attention.
Conclusion
Cerebral aneurysms represent a significant health concern due to their potential to cause life-threatening conditions when they rupture. Advances in diagnostic imaging and treatment have improved outcomes for many patients, but early detection and management remain key. Awareness of risk factors, symptoms, and treatment options is essential for both healthcare providers and the public to mitigate the impact of these potentially devastating conditions.
About Gregory Cannarsa, MD
Dr. Cannarsa completed neurosurgical residency at the University of Maryland Medical Center/Shock Trauma Center, training in all types of neurosurgery both cranial and spinal. He focuses on cranial neurosurgery including brain tumors, hydrocephalus, stroke, brain bleeds, trauma, aneurysms, and other cerebrovascular malformations. He did a further specialized Cranial and Cerebrovascular Neurosurgery Fellowship at Swedish Neuroscience Institute in Seattle, WA. His goal is to ensure patients’ quickest recovery and the longest lasting treatment whenever possible through minimally-invasive and minimally-disruptive techniques. He’s a strong advocate of no-hair-shave neurosurgery such that the patient keeps all of their hair, as well as invisible closures which involves closing all incisions without the use of staples or sutures that need to be removed. He is accepting new patients which are seen within one week of referral at his practice, Apex Brain & Spine, located in Naples, Florida.
239-422-APEX (2739)
3530 Kraft Road, Suite 203 • Naples, FL 34105
www.apexbrainandspine.com