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What You Need To Know About Brain Aneurysms?

By Dr. Himanshu Agarwal in Neurosciences

Aug 25 , 2022 | 2 min read

1

What are brain aneurysms?

Brain aneurysms are ballooning from the weak point in blood vessels supplying blood to the brain.

How common are brain aneurysms?

According to the data from the United States, 1 in 50 people harbour brain aneurysms; 1 in 200 people having aneurysms are at risk of rupture of aneurysm or brain haemorrhage.

What are some risk factors that can cause a brain aneurysm?

  • Smoking
  • Hypertension
  • Diabetes
  • Family history
  • Trauma 
  • Idiopathic causes

Symptoms of a brain aneurysm?

  • They can burst and can cause severe headache, brain bleeding (subarachnoid haemorrhage)
  • They can become very large and compress nearby brain nerves like the optic nerve, causing vision issues
  • They can be detected on MRIs done for other reasons. 

How are brain aneurysms diagnosed?

  • Cerebral digital subtraction angiography (DSA)- Gold standard
  • CT angiography
  • MRI angiography

Do brain aneurysms require treatment?

  • About 20-30% of cases of burst/ruptured brain aneurysms die before reaching the hospital. Hence any brain aneurysm which has ruptured needs urgent treatment in a specialised hospital having all the facilities to treat such patients.
  • Brain aneurysms that have not ruptured may require treatment, depending on location in the brain, size of the aneurysm and other patient-related factors.

How are brain aneurysms treated?

There are two ways to treat a brain aneurysm:

Endovascular (without open surgery)-

  • This is the preferred way to treat brain aneurysms in most hospitals worldwide.
  • In this procedure, no incision is given, a tiny tube is passed through the blood vessels to the aneurysm in the brain from the leg vessel, and the aneurysm is closed. It is the same way cardiologist put stents in the heart.
  • Patients who undergo endovascular treatment usually require a shorter hospital/ICU stay.
  • Endovascular treatment has less risk of significant complications and brain damage. 
  • Endovascular treatment of brain aneurysms can be done by coils, stents, flow diverters or flow disruptors. 
 

Surgical clipping (open surgery)-

Clipping of the brain aneurysm is done by removing a small part of the skull bone, and the aneurysm is approached by dissecting around the brain and the clip is placed at the mouth of the aneurysm to close it.

Who does endovascular coiling?

It is done by trained neurointerventionists, including interventional neuroradiologist/radiologist, interventional neurologist or endovascular neurosurgeons.

Who does surgical clipping?

It is done by neurosurgeons.

What are the complications of ruptured brain aneurysms or subarachnoid haemorrhage?

  • Brain swelling
  • Accumulation of the fluid in the brain (hydrocephalus)
  • Vasospasm (narrowing of the brain vessels)
  • Brain infarction (damage to the brain), which can lead to paralysis
  • Coma
  • Reduced function of the heart
  • Infections

Do patients with burst/rupture aneurysms require prolonged ICU stay or a ventilator?

ICU stay of the patient depends on the degree or grade of the brain haemorrhage/subarachnoid haemorrhage.