Treatment for Brain Aneurysms
Understand the types of treatment options available and the accompanying medical procedures for each.
The Lisa Foundation
Available Treatment Options for Brain Aneurysms
Once a doctor positively identifies a patient’s brain aneurysm, only two options allow for effective treatment:
- Endovascular Treatment. This requires the use of specialized catheters that are inserted into the patient’s arteries and guided by x-ray to the aneurysm, delivering specialized metal coils that plug the aneurysm and prevent it from growing.
- Surgical Treatment. This requires physically treating the aneurysm through a surgical opening in the skull. The surgeon attaches surgical clips that prevent the aneurysm from growing and rupturing.
These treatment options do not necessarily remove aneurysms, as doing so would require repairing damaged blood vessels inside the brain. Instead, these procedures aim to prevent aneurysms from growing and rupturing in the future. It is also possible for doctors to use these procedures to stop a slowly leaking aneurysm from further bleeding, potentially saving the patient from permanent brain damage.
Determining which of these procedures is best suited to a patient depends on several factors. First, the availability of local surgeons with the necessary experience and equipment to perform these procedures may limit a patient’s treatment options. The overall health of a patient and any preexisting and co-occurring medical conditions can also inform the best approach. The location, size, and condition of the patient’s aneurysm also help to determine the best way to treat it.
Endovascular medical technology allows surgeons to treat more aneurysms with this method, but open surgery is the best option for certain types of brain aneurysms. If an aneurysm has already started rupturing, the goal of treatment is to stop the bleeding as quickly as possible and prevent further damage to the brain. If the aneurysm has not ruptured, the treatment team will aim to prevent the aneurysm from rupturing in the future by preventing it from growing any larger and cutting off the flow of fresh blood to the aneurysm.
What Is Surgical Clipping?
When a physician recommends a patient for brain aneurysm surgery, clipping is generally the preferred method to prevent the aneurysm from rupturing in the future. As the name suggests, this procedure involves the use of surgical clips placed at the base of an aneurysm sac to prevent more blood from entering the aneurysm and growing it larger. After the clip is in place, the aneurysm will not grow larger and will start to shrink, eventually scarring down permanently, and the clip will remain in place for the rest of the patient’s life.
What Is Endovascular Treatment?
During an endovascular procedure, the surgeon uses an x-ray display to guide a microcatheter through the patient’s arteries and into the aneurysm itself. Once in place, the microcatheter delivers several small metal coils into the aneurysm, filling its volume and preventing the free flow of blood into it. As these coils fill the space, they will cause clotting, and the combination of the clots and the metal coils will prevent more blood from entering the aneurysm, effectively forming a plug. For some patients, the surgical team may need to use a temporary balloon-like device to keep the coils in place until they arrange in the appropriate configuration.
In some cases, the irregular shape of an aneurysm prevents the endovascular coils from completely filling the structure of the aneurysm; real aneurysms are rarely as perfectly shaped as you might see in medical diagrams. They are often irregular and may go on to rupture if the inserted coils do not clot as intended. In these cases, flow diverters may prevent the flow of blood from reaching the aneurysm. A flow diverter functions like a denser version of a stent that not only diverts blood away from the aneurysm but also encourages the blood vessel to restructure itself and prevent the aneurysm from growing.