Are there treatments for cerebral aneurysm?
Ruptured aneurysms can be treated with procedures that all have the same goal: to eliminate blood from flowing into the aneurysm. Treatment for ruptured aneurysms includes:
- Surgical clipping closes off the aneurysm by placing a tiny metal clip on the neck of the aneurysm to stop blood flowing into it. The neurosurgeon must remove a small section of skull to reach the aneurysm. This is a technically difficult procedure that carries a very slightly higher probability of death or dependency/disability, compared to endovascular coiling.
- Endovascular coiling is less invasive. It does not require opening the skull, providing lower risk of infection. It takes less time so there’s less time under anesthesia. The risk of needing to repeat the procedure is higher for this method. At one year after the procedure, patients treated with the coiling method had a better chance of disability-free survival, compared to the surgical clipping method. The procedure uses a catheter inserted into an artery and threaded through to the aneurysm. A soft wire is inserted through the catheter into the aneurysm where it coils up inside, disrupting the blood flow. This procedure seals off the aneurysm from the artery. The procedure must be repeated if the aneurysm reopens.
- Flow diverters are a new treatment procedure. These stent-like implants divert blood away from the aneurysm. Stopping blood flow helps the body reconstruct the artery and heal the area. This method is especially helpful with large aneurysms that can’t be treated with other methods.
The most serious complication of any of these treatments is a ruptured aneurysm. Rupture can cause a massive hemorrhage, hemorrhagic stroke, bleeding into the brain, coma or death. Reported rupture rates are only 2% to 3% for either procedure. Surgical clipping provides a better chance to control massive bleeding because the neurosurgeon has direct access to the ruptured aneurysm and can more quickly control bleeding.
Unruptured aneurysms may or may not be treated. This remains a matter of debate among neurosurgeons. Treatment depends on size and location of the aneurysm, age and health of the patient, congenital conditions, and family history of ruptured aneurysms. Most unruptured aneurysms should be treated according to these guidelines:
- Small (less than 5 mm in diameter) aneurysms should be managed conservatively with monitoring
- Medium (larger than 5 mm) aneurysms in patients younger than age 60 should be considered for treatment
- Large (larger than 10 mm) aneurysms should be treated in nearly all patients younger than age 70
If treatment is deemed safe and necessary, these methods may be used:
- Surgical clipping is often the best treatment for unruptured aneurysms, even though it’s an invasive and technically difficult procedure.
- Medical therapy can lower the risk of rupture. It includes controlling blood pressure, and stopping smoking and recreational drugs like cocaine and amphetamines. Blood pressure medication, a healthier diet and more exercise will help control blood pressure.
- Periodic monitoring of the aneurysm with imaging scans (CT, MRI or angiography) will be done to track its growth.
