What is an aneurysm?
An aneurysm is a weak spot in the blood vessel that expands into a balloon shaped structure over time. As the heart keeps pumping blood in the blood vessels of the brain this balloon (a saccular aneurysm) keeps getting bigger and may rupture. Some aneurysms may not look like balloons but, rather look like elongated tubes (fusiform).
Do all aneurysms need treatment?
No, all aneurysms don’t need to be treated. Treatment depends on the site, size and anatomy of an aneurysm.
What are the symptoms of an aneurysm?
Aneurysms usually cause headaches or blurred vision but, most of them remain silent till they are discovered incidentally on brain imaging.
If an aneurysm ruptures it is a medical emergency called subarachnoid haemorrhage, a kind of brain stroke. This condition presents with sudden, severe headache and sometimes the patient becomes unconscious and may even die.
Does a ruptured aneurysm need treatment?
How are the aneurysms treated?
Aneurysms can be treated by coiling (minimally invasive) or by clipping (open surgery). Minimally invasive endovascular coiling is currently the preferred method for treatment all over the world.
How do we decide the modality of treatment (clipping versus coiling)?
Dr. Chandril Chugh, says the decision regarding the modality of treatment is dependent on many factors, including the age and condition of the patient, the size of an aneurysm, the shape of an aneurysm, and the location of an aneurysm. In our cerebrovascular centre, imaging (MRI/MRA, CTA and/or angiography) is reviewed by a multidisciplinary team including neurosurgeons and interventional neurologists. They will review the films and then decide on the appropriate treatment modality, specifically for each patient and with each patient.
Is there any scar with coiling?
No, there is no scar with coiling.
How long should I expect to be hospitalised?
The length of hospitalisation is significantly different for patients with ruptured (subarachnoid haemorrhage or (bleeding) versus unruptured aneurysms. Patients with unruptured aneurysms typically have a shorter hospital stay of approximately 2 – 3 days with endovascular coiling. The length of hospitalisation of patients who have suffered subarachnoid haemorrhage is variable and is dependent on the condition of the patient on admission and the treatment of concomitant issues such as cerebral vasospasm, hydrocephalus, and ventilatory issues. In patients with severe subarachnoid haemorrhage, hospitalisation may be up to 3 – 4 weeks.
Do my relatives have to be checked for the presence of aneurysms?
Cerebral aneurysms are generally not a familial or genetic disease and in most cases, it is not recommended that family members are screened. In cases where there is a family history of aneurysms (two or more family members), it is recommended that all family members should consult a specialist Interventional Neurologist.
What can I do to have the most successful recovery?
Follow all postoperative instructions regarding medications and postoperative therapy. Call your doctor immediately if there are any issues. Have a positive outlook!
Could I have known about this aneurysm before the haemorrhage?
In most situations, no. If there is a strong family history (two or more first-degree relatives with a known a cerebral aneurysm), it is possible to detect aneurysms in patients with non-invasive means prior to a rupture. Most aneurysms are asymptomatic.
Can I develop another aneurysm?
If you are a heavy smoker and continue smoking, it is possible. If you have polycystic kidney disease, fibromuscular dysplasia, or any other type of elastic tissue disorder, you may warrant screening throughout your lifetime. Otherwise, it is extremely unlikely you would develop another aneurysm. Patients who are quite young (under 40) may be candidates for follow-up imaging later in life. Please discuss with your Interventional Neurologist.
Can I have an MRI after coiling?
Yes, all titanium and platinum coils are MRI compatible.
When can I be physically active again?
A physical therapy program is tailored for each individual patient. Moderate activity after discharge is encouraged.
How soon can I return to work?
This is specific for each patient, their pre-treatment and post-treatment condition, and, of course, the demands of their job.
Are children at risk for aneurysms?
Aneurysms are rare in children.
If an aneurysm has been discovered, for how long has it typically been present?
That is unknown. Aneurysms may slowly enlarge over time, yet the rate of growth is not completely understood. Some aneurysms, typically smaller aneurysms, may remain quiescent for decades.
How long does the coiling procedure take?
Approximately 1½ – 3 hours.
Is general anaesthesia used for surgery and coiling?
General endotracheal anaesthesia is always used for coiling procedures.
How long do I need to be on anti-convulsant medications (Dilantin, Keppra etc.) after endovascular coiling?
You do not need to be on anticonvulsants after endovascular coiling unless you have suffered a seizure.
Will an Intensive Care Unit (ICU) stay be necessary?
All treated aneurysm patients (endovascular coiling or microsurgical clipping) are monitored in the Intensive Care Unit in the immediate post-treatment period. The length of stay is dependent on whether or not the patient has had a subarachnoid hemorrhage and additionally in the presence of other medical and neurosurgical issues. Uncomplicated, unruptured aneurysms are usually in the ICU for 1 – 2 days after treatment.
Will the coils set off a metal detector at an airport?
Can I fly?
Yes. Patients diagnosed with an aneurysm can fly. Always consult your Interventional Neurologist before doing so though.
Do I need a long-term follow-up after my treatment and discharge from the hospital?
This depends on your personal experience including medical and family history. After coiling, imaging follow-up is necessary to confirm persistent occlusion after treatment. Sometimes long-term follow-up is recommended.
A blood relative of mine has had an aneurysmal bleed. Does this increase my chance of having a subarachnoid haemorrhage?
It may. A positive family history of aneurysms or subarachnoid haemorrhage increases the statistical risk associated with unruptured cerebral aneurysms.