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Everything You Need To Know About Brain Aneurysms II

Once you've been diagnosed with a brain aneurysm the next issue you will face is treatment.  So let's take a look at brain aneurysm treatment options, starting with the treatment options for unruptured brain aneurysms.If you've been diagnosed with an unruptured brain aneurysm you have two basic options: watchful waiting; or intervention.  Watchful waiting means that you undergo periodic brain scans to make sure that your unruptured brain aneurysm is not growing and periodic visits with your doctor to make sure that your condition continues to remain stable.  Intervention means either surgical clipping of the aneurysm or endovascular coiling.Clipping of an unruptured brain aneurysm is a surgical procedure that requires the surgeon to first make a small hole in your skull.  This is called a craniotomy.  Once this hole has been made, the surgeon spreads the brain tissue apart to gain physical access to the aneurysm.  Once the aneurysm is located, the surgeon places a tiny metal clip across the neck or stem of the aneurysm to permanently stop blood flow into the aneurysm.  After placing the metal clip on the neck the aneurysm, the skull bone is re-secured in its original place, and the wound is closed.

Endovascular coiling is a newer, less-invasive procedure.  In contrast to surgical clipping, with endovascular coiling, there is no need to make a hole in the skull and directly access the aneurysm.  Instead, doctors use real-time X-ray technology, called fluoroscopic imaging, to visualize the patient's vascular system and treat the aneurysm from within the affected blood vessel.  To do this, doctors insert a catheter (small plastic tube) into the femoral artery in the patient's leg and navigate this catheter through the vascular system, into the head, and into the aneurysm itself. Tiny platinum coils are then threaded through the catheter and placed into the aneurysm.  These coils block further blood flow into the aneurysm, thus preventing future rupture.

If you've been diagnosed with an unruptured aneurysm, deciding between watchful waiting and intervention, and if intervention, surgery vs. endovascular coiling, can be extremely difficult.  There are significant risks associated with watchful waiting and intervention, and determining which option will minimize your specific level of risk is a highly complex process involving careful weighing of a multitude of factors.  These factors include the size, configuration and location of the aneurysm, your medical history, including whether or not you have previously had a ruptured brain aneurysm, your comorbidities (i.e., other illnesses and conditions), your age, your family history, and whether your brain aneurysm is symptomatic.

While only a qualified doctor can provide you with definitive guidance on your unruptured aneurysm treatment decision, here are some general rules that appear to enjoy widespread consensus in the reputable neurosurgical community:

  • Asymptomatic intracavernous aneurysms should only be watched; intervention should not be undertaken in relation to these aneurysms.
  • All symptomatic intradural aneurysms -- regardless of size -- should be treated with surgery or endovascular coiling.
  • Asymptomatic aneurysms of less than 7 mm in diameter should only be watched.  However, surgical clipping or endovascular coiling should be considered in relation to aneurysms approaching 7 mm in younger patients.
  • Surgical clipping or endovascular coiling should be considered for all asymptomatic aneurysms in patients with a history of ruptured aneurysm and for asymptomatic aneurysms that are greater than 7 mm in diameter, especially in younger patients.
  • Surgical clipping or endovascular coiling should be considered for aneurysms located in the posterior communicating artery and those in the poster circulation, especially the basilar tip, because of higher rupture rates in those locations.

One more important point as far as the interventional treatment of unruptured brain aneurysms is concerned:  There is strong evidence that both surgical clipping and endovascular coiling are much safer and more effective when performed by physicians who frequently and routinely perform these procedures.  If you want to minimize the risk of injury associated with these interventions -- and you definitely should want to do so -- you should select such a doctor for your treatment.

Treatment of ruptured brain aneurysms will be addressed in Part III of Everything You Need To Know About Brain Aneurysms.

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