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Aneurysms

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A brain (cerebral) aneurysm is an abnormal bulging, weak area in the wall of an artery that supplies blood to the brain. Most aneurysms are small and are not at risk to break. These aneurysms cause no symptoms and usually go unnoticed. However, in some cases, the aneurysm may rupture, releasing blood into the skull, causing a stroke. When a brain aneurysm ruptures, the result is a subarachnoid hemorrhage. Brain damage or death may result depending on the severity of the rupture. Most aneurysms occur at the base of the brain.

Causes

There are varying causes of brain aneurysms however an aneurysm is considered an acquired or inherited condition. Some risk factors that can lead to brain aneurysms can be controlled and some can't. Risk factors that may increase a person's chance of developing an aneurysm or may increase the chance of a rupture if you already have an aneurysm may include:

  • Family history of brain aneurysms are more likely to have an aneurysm than those who don't.
  • People who have had a previous aneurysm are at a higher risk to have another.
  • People who have inherited disorders such as polycystic kidney disease, Ehlers-Danlos Syndrome or Marfan's Syndrome.
  • Neurofibromatosis – eight genetic disorders of the nervous system that affect the development and growth of nerve cell tissues.
  • Other risk factors include:
  • Elderly population
  • Prolonged smoking
  • High blood pressure
  • Heavy alcohol and/or drug use
  • Head injuries
  • Gender (females are more likely than males to develop brain aneurysms)
  • Race (African Americans are more likely than Caucasians to experience hemorrhages)

Symptoms

Most brain aneurysms cause no symptoms so they remain undetected. They are usually discovered during tests for other unrelated conditions. However, if an unruptured aneurysm causes problems by pressing on areas in the brain it may cause various symptoms including:

  • Severe headaches
  • Blurred vision
  • Neck pain
  • Possible changes in speech

Because a ruptured aneurysm comes on suddenly, you should be aware of the following symptoms and seek emergency medical treatment right away if you experience any of the following:

  • Sudden, severe headache that is very different than past headaches.
  • Sudden neck pain
  • Sudden nausea or vomiting
  • Seizures
  • Loss of consciousness
  • Light sensitivity

Diagnosis

Diagnosis of brain aneurysms begins by collecting a full medical history to determine if a patient is in a high risk category. Family history of aneurysms (or strokes) and detail of symptoms are very important in the diagnostic procedure. If your doctor suspects a possible aneurysm, you may also have the following tests done to verify the diagnosis.

  • CT scan – this will reveal any bleeding in the brain.
  • CTA scan – this method is more precise in evaluating blood vessels.
  • Magnetic Resonance Angiography (MRA ) – this technique is similar to a CTA however it uses a magnetic field and uses pulses of radio wave energy to provide pictures of the blood vessels.

Treatments

The treatment for a brain aneurysm depends on whether the aneurysm is ruptured or unruptured. A ruptured aneurysm requires immediate surgery. There are two common surgery options used to treat a ruptured brain aneurysm:

  • Surgical Clipping: This is a procedure to close of an aneurysm and should only be performed by an experienced neurosurgeon. The neurosurgeon will need to remove a section of your skull (craniotomy) to access the aneurysm and locate the blood vessel that is feeding the aneurysm. The surgeon will then place a tiny metal clip on the base of the aneurysm. This prevents blood from entering the aneurysm and causing growth or further bleeding.
  • Coiling: Although less invasive than surgical clipping, it should still only be performed by an expert it the field. The surgeon inserts a catheter (hollow tube) into an artery (this is usually done in the groin area) and threads it through your body to the aneurysm. Once in place, the surgeon uses a wire to push a soft platinum wire through the catheter into the aneurysm. The wire will coil up inside the aneurysm preventing further blood from entering the aneurysm.

In the case of an unruptured, both surgical clipping or coiling can be used to seal off an the aneurysm and prevent it from rupturing however each case is evaluated on an individual basis to weigh the benefits versus the potential risks. Our expert neurosurgeons at SCCNS will help you determine whether surgery is the best option for you.

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