Brain Aneurysm
A brain aneurysm, also known as a cerebral or intracranial aneurysm, is where an artery has weakened causing a bulge in the vessel wall. Patients normally do not have symptoms unless the aneurysm ruptures. Aneurysms can occur at any age, but are more likely in adults over age 25 and are more common in women between the ages of 50 and 60. Aneurysms form over time due to simple wear and tear and can form due to a family history, injury or infection.
Unruptured aneurysms can go undiagnosed for years and then rupture without warning. Unruptured aneurysms are normally asymptomatic, but can cause increased pressure on the brain when they grow larger. Patients may complain of headaches around the eye, numbness, tingling and weakness on one side of the face and pupil and vision changes.
Diagnosing an Unruptured Aneurysm
If a patient is diagnosed with an unruptured aneurysm, the doctor will determine if there is a risk of it rupturing based on the age and overall health of the patient, along with the size and location of the aneurysm.
Ruptured aneurysms or bleeding in the brain, are a life-threatening conditions that result in stroke or death, if not treated quickly. Patients typically complain of numbness, constant and severe headache or pressure, and pain that can extend down the neck and back.
Diagnosing a Ruptured Aneurysm
Aneurysms are diagnosed based on a patient's symptoms and confirmed with imaging technology. Aneurysms that have already ruptured are quickly assessed by performing a CT scan that can show bleeding in the brain. To determine and fully assess the location, size and shape of an aneurysm, a neurovascular surgeon can perform a minimally invasive procedure called a diagnostic cerebral angiogram. WakeMed offers this lifesaving test for patients who are suspected of having an aneurysm.
Treating a Ruptured Aneurysm
After diagnosis — which is often completed using cerebral angiogram — a coil or multiple coils can be inserted to help stop the bleeding and repair narrowed vessels. This procedure is performed in cases where a patient has had a hemorrhagic stroke, subarachnoid hemorrhage, an aneurysm or arteriovenous malformation (a congenital condition of tangled, dilated blood vessels that disrupts normal blood flow in the brain).
After an aneurysm has been confirmed, a coil or multiple coils can be inserted to help stop the bleeding, restore normal blood flow and relieve the pressure on the brain. This procedure is performed in cases where a patient has had a hemorrhagic stroke, subarachnoid hemorrhage, an aneurysm or arteriovenous malformation (a congenital condition of tangled, dilated blood vessels that disrupts normal blood flow in the brain) or cerebral vasospasm — a narrowing of the vessels that occurs when a ruptured brain aneurysm ruptures or when bleeding from another abnormality such as an arteriovenous malformation (AVM) occurs. These spasms can be so traumatic that they prevent enough blood from reaching the brain, resulting in a stroke. Time is critical in these cases. Treatment focuses on stopping the bleeding, restoring normal blood flow and relieving the pressure on the brain.
Coiling is a minimally invasive procedure that uses tiny catheters to insert small coils directly into the aneurysm and fill it from inside the vessel. The neurovascular surgeon makes a puncture in the patient’s leg and inserts the catheter, guiding it to the site of the aneurysm. The coil, along with a specialized glue, is positioned in place. Often, the surgeon will pack several coils to fill the weakening so that a clot can form and stop the bleeding.
In some cases, an intracranial stent may be used in aneurysms that are difficult to treat with coils alone. A stent (a flexible mesh tube that looks like a tiny chain-link fence) provides a protective support for the coils. Coiling is a newer, minimally invasive way of treating bleeding in the brain and in other parts of the body.
Endovascular coiling has replaced a craniotomy procedure also known as aneurysm clipping in many cases; however, it is important to consult with the surgeon to determine the best procedure that will best treat the aneurysm. The recommendation to clip versus coil is based on many factors — location, size, status (ruptured or unruptured) and complexity of the aneurysm, along with the patient’s age and overall health.
The length of the procedure is dependent on the complexity of the aneurysm and if stents are used. Most patients go home the same day, but some patients may need to remain in the hospital for further monitoring.