A brain aneurysm is a bulge or ballooning in a blood vessel in the brain. Most brain aneurysms don’t rupture, create health problems or cause symptoms. However, a brain aneurysm can leak or rupture, causing bleeding into the brain (hemorrhagic stroke). A ruptured brain aneurysm most often occurs in the space between the brain and the thin tissues covering the brain. This type of hemorrhagic stroke is called a subarachnoid hemorrhage.
A ruptured aneurysm quickly becomes life threatening; it’s imperative to seek prompt medical treatment.
Aneurysms are usually treated in one of two ways:
- Coiling: Sometimes an aneurysm is not in an area where a clip can be applied, so an alternate therapy called coil embolization or coiling is used to get into the blood vessel. In contrast to surgery, endovascular coiling does not require open surgery. Instead, the physician inserts a catheter (small plastic tube) into the femoral artery in the patient’s leg and navigates it through the blood vessels into the brain and into the aneurysm. Tiny platinum coils are threaded through the catheter into the aneurysm. A small electrical current heats the coils and allows them to expand and block off the aneurysm. The catheter is then taken out, and the patient is sent to intensive care for observation.
- Clipping: To get the aneurysm, the neurosurgeon must go through the skull with a procedure called a craniotomy. A craniotomy means a piece of bone will be removed from the skull during the surgery. In this type of procedure, a surgeon locates the blood vessel with the aneurysm and places a spring loaded metal clip across the base of the aneurysm where it comes off of the artery. This clip cuts off the blood flow into the aneurysm, thereby minimizing the risk that the aneurysm could rupture in the future. The bone is reattached, and the skin sutured closed. Use of this surgery depends on the location and size of the aneurysm, as well as the overall health of the patient.
In aneurysms with large openings from the artery (known as "wide-neck" aneurysms), our team may elect to use additional devices such as a metal stent (a tiny hollow metal tube with holes in it that acts as a scaffold within the vessel) or a balloon. These devices are designed to help to keep the coils in place inside the aneurysm. In stent-assisted coiling, a permanent stent is placed in the artery where the aneurysm branches off of to help keep the coils in place. Balloon-assisted coiling involves temporarily placing a removable balloon where the aneurysm branches off of the artery in order to help keep the coils in place.