Brain Aneurysm
A brain aneurysm also known as a cerebral aneurysm or intracranial aneurysm is ballooning of a blood vessel in the brain. An aneurysm often looks like a berry hanging on a stem.
Brain aneurysms form and grow because blood flowing through the blood vessel puts pressure on a weak area of the vessel wall. This can increase the size of the brain aneurysm. If the brain aneurysm leaks or ruptures, it causes bleeding in the brain, known as a haemorrhagic stroke.
Most often, a ruptured brain aneurysm occurs in the space between the brain and the thin tissues covering the brain. This type of haemorrhagic stroke is called a subarachnoid haemorrhage.
Unrupruptured aneurysms are most of the time detected incidentally while investigating for some other complaints. However, a ruptured aneurysm quickly becomes life-threatening and requires treatment right away.
If a brain aneurysm hasn’t ruptured, treatment may be appropriate in some cases. Treatment of an unruptured brain aneurysm may prevent a rupture in the future.
Types :
- Saccular aneurysm, also known as a berry aneurysm. This type of aneurysm looks like a berry hanging from a vine. It’s a round, blood-filled sac that protrudes from the main artery or one of its branches. It usually forms on arteries at the base of the brain. A berry aneurysm is the most common type of aneurysm.
- Fusiform aneurysm. This type of aneurysm causes bulging on all sides of the artery.
- Mycotic aneurysm. This type of aneurysm is caused by an infection. When an infection affects the arteries in the brain, it can weaken the artery wall. This can cause an aneurysm to form.
Symptoms:
Most brain aneurysms that haven’t ruptured don’t cause symptoms. This is especially true if they’re small. Brain aneurysms may be found during imaging tests that are done for other conditions.
However, a ruptured aneurysm is a very serious condition, typically causing a severe headache. And if an unruptured aneurysm presses against brain tissue or nerves, it may cause pain and other symptoms.
Ruptured aneurysm:
A sudden, severe headache is the key symptom of a ruptured aneurysm. This headache is often described by people as the worst headache they’ve ever experienced.
In addition to a severe headache, symptoms of a ruptured aneurysm can include:
- Nausea and vomiting
- Stiff neck
- Blurred or double vision
- Sensitivity to light
- Seizure
- A drooping eyelid
- Loss of consciousness
- Confusion
Leaking aneurysm:
In some cases, an aneurysm may leak a slight amount of blood. When this happens, a more severe rupture often follows. Leaks may happen days or weeks before a rupture.
Leaking brain aneurysm symptoms may include :
- A sudden, extremely severe headache that may last several days and up to two weeks.
Unruptured aneurysm:
An unruptured brain aneurysm may not have any symptoms, especially if it’s small. However, a larger unruptured aneurysm may press on brain tissues and nerves.
Symptoms of an unruptured brain aneurysm may include:
- Pain above and behind one eye.
- A dilated pupil.
- A change in vision or double vision.
- Numbness of one side of the face.
Risk factors:
Several factors can contribute to weakness in an artery wall. These factors may increase the risk of a brain aneurysm or aneurysm rupture.
Some of these risk factors develop over time. But some conditions present at birth can increase the risk of developing a brain aneurysm.
Risk factors include:
- Older age. Brain aneurysms can occur at any age. However, they’re more common in adults between ages 30 and 60.
- Being female. Brain aneurysms are more common in women than in men.
- Cigarette smoking. Smoking is a risk factor for brain aneurysms to form and for brain aneurysms to rupture.
- High blood pressure. This condition can weaken arteries. Aneurysms are more likely to form and to rupture in weakened arteries.
- Drug abuse, particularly using cocaine. Drug use raises blood pressure. If illicit drugs are used intravenously, it can lead to an infection. An infection can cause a mycotic aneurysm.
- Heavy alcohol use. This also can increase blood pressure.
- Inherited connective tissue disorders, such as Ehlers-Danlos syndrome. These disorders weaken blood vessels.
- Polycystic kidney disease. This inherited disorder results in fluid-filled sacs in the kidneys. It also may increase blood pressure.
- Coarctation of the aorta.
- Brain arteriovenous malformation, known as AVM. In this condition, arteries and veins in the brain are tangled. This affects blood flow.
- A family history of brain aneurysm. Your risk is higher if you have family members who have had a brain aneurysm. This is particularly true if two or more first-degree relatives — such as a parent, brother, sister or child — has had a brain aneurysm. If you have a family history, you can ask your health care provider about getting screened for a brain aneurysm.
Some types of aneurysms may occur after a head injury or from certain blood infections.
Risk factors for a ruptured aneurysm
There are some factors that make it more likely an aneurysm will rupture. They include:
- Having a large aneurysm.
- Having aneurysms in certain locations.
- Smoking cigarettes.
- Having untreated high blood pressure.
Complications
When a brain aneurysm ruptures, the bleeding usually lasts only a few seconds. However, the blood can cause direct damage to surrounding cells and can kill brain cells. It also increases pressure inside the skull.
If the pressure becomes too high, it may disrupt the blood and oxygen supply to the brain. Loss of consciousness or even death may occur.
Complications that can develop after the rupture of an aneurysm include:
- Re-bleeding. An aneurysm that has ruptured or has leaked is at risk of bleeding again. Re-bleeding can cause further damage to brain cells.
- Narrowed blood vessels in the brain. After a brain aneurysm ruptures, blood vessels in the brain may contract and narrow. This is known as vasospasm. Vasospasm can cause an ischemic stroke, in which there’s limited blood flow to brain cells. This may cause additional cell damage and loss.
- A buildup of fluid within the brain, known as hydrocephalus. Most often, a ruptured brain aneurysm occurs in the space between the brain and the thin tissues covering the brain. The blood can block the movement of fluid that surrounds the brain and spinal cord. As a result, an excess of fluid puts pressure on the brain and can damage tissues.
In many cases, brain aneurysms can’t be prevented. But there are some changes you can make to lower your risk. They include quitting smoking if you smoke. Also work with your health care provider to lower your blood pressure if it’s high. Don’t drink large amounts of alcohol or use drugs such as cocaine.
A ruptured aneurysm will require a different approach because of its emergent nature. Microsurgical clipping or endovascular treatment (coiling/flow diversion etc.) are the available treatment options. When considering treatment of a brain aneurysm, there is no replacement for consulting with a capable neurosurgeon who can make recommendations based on his or her knowledge and experience.
Brain Aneurysm Clipping Procedure
Aneurysm clipping is a procedure where the surgeon accesses the blood vessel directly by performing a craniotomy, then places a metal clip at the base of the aneurysm, cutting it off from the blood supply. This prevents blood from flowing into the weakened pouched area and reduces the risk of future rupture.
Pros :
1. Clipping Is An Established and Safe Procedure
The clipping procedure has been used for decades to treat aneurysms in the brain, so its safety and effectiveness has been clearly demonstrated over time. Clipping has been performed for long enough that studies have been done on outcomes in a large number of patients, and the procedure has been fine-tuned for even better outcomes.
2. Clipping Can Treat Most Aneurysms
Clipping surgery can be performed on most types of aneurysms. The clipping procedure can also be done on aneurysms that are considered difficult to treat by endovascular means, such as those with a wide neck at the base.
3. Clipping Lowers the Risk of Recurrence
Well-clipped aneurysms have an extremely low risk of redeveloping, so for many patients, the clipping procedure successfully resolves the aneurysm. This means that for many patients, especially younger ones, the chance of a recurrence of the aneurysm is very low.
Cons :
1. Clipping Is An Invasive Procedure
Although clipping has been shown to be a safe and effective way to treat aneurysms, it is an invasive procedure that requires opening the skull. To place the clip, neurosurgeons must perform a craniotomy to remove a portion of the skull, and cut into brain tissues in order to access the aneurysm.
2. Clipping Requires General Anesthesia
Because clipping is invasive, it requires general anesthesia for the procedure. General anesthesia poses risks, especially for older patients and those with chronic health conditions. These patients will need to be monitored carefully during recovery.
3. Clipping Requires a Longer Recovery Time
Since clipping is an invasive surgery, recovery typically takes longer. Without complications, recovering from a clipping procedure performed on an unruptured aneurysm can require a two to five-day hospital stay and 3-6 weeks of recovery at home. If the procedure was performed on a ruptured aneurysm, recovery can take considerably longer.
Brain Aneurysm Coiling Procedure
Coiling is an endovascular procedure, which means the surgeon accesses the aneurysm through the vascular system. He or she will make a puncture in the thigh and enter an artery of the leg. The surgeon will then use x-ray imaging and a special dye to guide a catheter to the site of the aneurysm in the brain.
Once the catheter is in place, the surgeon will be able to place small coils, one at a time, into the aneurysm, until the pouch is full and the coils compress into a small metal ball. A clot will ultimately form around the coils, and blood will no longer be able to flow into the aneurysm, reducing the risk of rupture.
Pros :
1. Coiling Is Less Invasive Than Clipping
Aneurysm coiling requires only a single puncture in the leg to access the large femoral artery, so there is no need to open the skull or brain. This incision typically heals quickly with minimal scarring.
2. Coiling Is Safer for At-Risk Patients
Because clipping surgery is invasive, it may not be appropriate for older patients or those with certain health conditions. The minimally invasive nature of coiling may make it a safer option for treating aneurysms in high-risk patients.
3. Coiling Has a Shorter Recovery Time Than Clipping
Since coiling is far less invasive than clipping, patients generally recover faster. With no complications, patients with unruptured aneurysm typically spend a day or two in the hospital, and can return to most normal activities within about a week.
Cons :
1. Some Aneurysms Cannot Be Treated With Coiling
Aneurysms of many shapes and sizes can be treated with clipping, but coiling is not appropriate for some, such as aneurysms with a very wide neck or certain shapes.
2. Coiling Requires General Anesthesia
Although less invasive than clipping, coiling is still a surgical procedure that requires general anesthesia, with the usual risks and concerns.
3. Coiling May Require Blood Thinning Therapy
If assisted with stent or flow diverter, patient needs to take blood thinning, medications to reduce the risk of dangerous clotting. Depending on the circumstances, patients may need to take these medications for long periods of time after the coiling procedure.
4. Imaging Tools Can Be Risky
During a coiling procedure, surgeons use tools, including x-ray imaging and dyes, to guide the placement of the coils. That exposes a patient to risks from radiation for the duration of the procedure, or to allergic reactions to injected dyes.
5. Coiling Is Relatively New
Aneurysm coiling was first used in 1991. While this relatively new technology for treating aneurysms has been shown to be safe and effective, fewer studies have been done on its long-term outcomes and rates of completely resolving aneurysms.
6. Coiling Alone May Not Resolve the Aneurysm
In some cases, coiling alone may not be enough to treat the aneurysm successfully. To resolve the aneurysm, more coils may need to be added, or a stent or balloon may be needed to support the coiling and keep blood vessels open.
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