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Neuroscience Center

Aneurysm Treatment Options

A small brain aneurysm that is intact (unruptured) may only need to be monitored. Scans of the affected area may be recommended every 6 to 12 months to watch the aneurysm's growth.

If the aneurysm is large, has high-risk features, or has burst, the patient requires treatment. Aneurysm rupture is a serious event. The initial bleeding often causes brain injury or even death. Treatment is either a surgical clipping or endovascular embolization. A surgical clipping is an operation. An endovascular embolization is a less invasive procedure. Both treatments have risks, and both have benefits. Some people are best treated with open surgery and others with endovascular methods. Your overall health and age, and features of the aneurysm, help us determine which method is best for you.

Microsurgical Clipping

This surgery is performed by a neurosurgeon. It requires the neurosurgeon to remove a section of the skull and use a microscope to locate the artery feeding the aneurysm. The neurosurgeon places a small metal clip at the neck or opening of the aneurysm. This stops its blood supply and prevents it from bleeding.

Sometimes, but rarely, the neurosurgeon needs to clamp the entire artery leading to the aneurysm. In this case, a bypass procedure may be required to reroute blood to vital areas of the brain.

Aneurysm Clipping Aneurysm Clipped

Our neurosurgeons are experienced in all aspects of microsurgical treatment of brain aneurysms. We perform several unique and specialized techniques that improve the effectiveness and safety of aneurysm surgery. Our center boasts one of the most modern operating-room environments in the world with specially trained neuro-anesthesiologists. Every microsurgical clipping is followed by an imaging test called an angiography to confirm that the aneurysm has been completely repaired.


Endovascular Treatment

Endovascular treatments are performed inside the blood vessels by doctors called interventional neuroradiologists, and our physicians are some of the most experienced and well respected in the nation.

Endovascular techniques are minimally invasive, and they are an alternative to surgery. They are performed while the patient receives general anesthesia.

A small plastic tube is placed into the artery, usually in the groin, and guided into the arteries of the neck with X-rays. Detachable coils are then inserted into the tubes and placed in the aneurysm to fill and reinforce it. Sometimes tiny stents (metal tubes) are used.

AngiogramAneurysm Coil 



Possible Complications

Patients with a ruptured brain aneurysm are also at risk for complications, including hydrocephalus and cerebral vasospasm.

Hydrocephalus is a buildup of cerebrospinal fluid that puts pressure on the brain. It is typically treated with a ventriculostomy — a bedside procedure in which a small tube is used to drain excess cerebrospinal fluid. Some patients need a permanent drainage tube called a shunt. Placement of a shunt requires surgery.

Ventriculostomy

Cerebral vasospasm is an abnormal narrowing of brain blood vessels. It can reduce blood flow to the brain and cause a stroke. This condition is treated with medications and sometimes with procedures designed to open up the narrowed blood vessel.

Vasospasm

Several management treatments can help reduce the effects of and complications following burst aneurysms:

  •   Painkillers to ease the severe headache symptoms.
  •   Calcium channel blockers reduce the amount of widening and narrowing of blood vessels.
  •   A vassopressor is an injected drug to increase blood pressure and widen blood vessels in order to prevent stroke.
  •   Anti-seizure drugs can prevent seizures from happening after an aneurysm ruptures.
  •   A ventricular catheter eases the pressure on the brain.
  •   Rehabilitation therapy

Ralph Dacey, MD

Neurosurgeon, Barnes-Jewish & Washington University Neuroscience Center

 

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