Treating a Brain Aneurism:

What Can Be Done?

Generally speaking there are three treatment options for a brain aneurism. One is preventive while the other two are curative.

There are some things you and I can do to help prevent the formation of a brain aneurism and reduce the likelihood of a rupture once an aneurism develops. This approach is not the main topic of this page and will be mentioned only briefly.

The focus of prevention is to reduce the pressure that works against the walls of the artery and limit the influences that cause our arteries to become weakened and less flexible. What does this mean in practice? It means…

  • Keeping your blood pressure low
  • Maintaining a balanced cholesterol profile
  • Not smoking
  • Reducing atherosclerosis build-up

If you are concerned about cholesterol... you can learn more in the cholesterol section of this website. 

Click here to learn more about cholesterol health.

You can learn more about atherosclerosis and blood pressure and how they relate to aneurism risk by returning to the main aneurism page and following the links.

But how does one cure a brain aneurism? 

Unfortunately there are not any non-evasive methods for curing a brain aneurism. Once an aneurism has grown to a size that warrants removal, surgery is the only sure option. The two common methods for removal are known as clipping and coiling. Each is described below.

Surgical Clipping of a Brain Aneurism

In 1855 Dr. Victor Horsley was the first to surgically treat a brain aneurism. It wasn’t until 1937 that Dr. Walter Dandy introduced the method of clipping by placing a V-shaped, silver clip to the neck of a carotid artery aneurism.

In the 1960s the microscope was added to the procedure making the clipping method the preferred treatment for both unruptured and ruptured brain aneurisms.

Now there are hundreds of highly sophisticated clip varieties and shapes. However, in spite of the many advances associated with this treatment method, surgical clipping remains an invasive and technically challenging procedure. 

Clipping must be accomplished through a craniotomy. It is a surgical procedure whereby the brain and associated blood vessels are accessed through an opening in the skull.

This is carried out by removing a circular piece ("button") of cranium by a trephine (a circular or cylindrical saw, with a handle like that of a gimlet, and a little sharp perforator called the center pin).

Once the aneurism has been identified it is carefully separated from the surrounding brain tissue. A small clip (usually constructed of titanium) is applied to the aneurism’s base, (neck). A spring mechanism allows the two halves (jaws) of the clip to close around the sides of the aneurism separating it from the parent blood vessel.

Unfortunately this operation carries with it a high risk of infection or death of brain tissue.

Surgical clipping is always performed by a neurosurgeon, particularly one with expertise in cerebrovascular disease. Most cerebrovascular neurosurgeons have had 5-7 years of general neurosurgery training and an additional 1-2 years of special cerebrovascular training.

Surgical clipping is very invasive. There is, however, an alternate method for treating brain aneurisms that is much less invasive. It is known as…

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Endovascular Coiling

Early methods of endovascular coiling involved balloon angioplasty and were associated with a high procedural rate of rupture as well as other complications.

The current method involves inserting a catheter carrying a very thin platinum coil (GDC for Guglielmi Detachable Coil) through the vein in the patient’s groin. The catheter is then guided using an angiogram - a special type of x-ray procedure - through the vein into the affected area of the brain.

The aneurism sac is then fitted with the GDC. Once the coils are released into the aneurism, the blood flow pattern within the aneurism is altered, and the slow or sluggish remaining blood flow leads to a thrombosis (clot) of the aneurism.

In two or three days the aneurism is fully blocked preventing further bleeding. The ultimate goal is that the aneurism would be obliterated instead of a new channel developing through it.

Not every type of aneurism can be treated with this method. For example, wide-necked aneurisms currently still require surgical intervention, though new methods using a type of stent (a tube made of metal or plastic that is inserted into a vessel keeping the passageway open) are already being studied and tested. 

Endovascular coiling is performed by a neurosurgeon or an interventional neuroradiologist. The former has undergone training in endovascular techniques in addition to full neurosurgery training. The latter has undergone extensive training in both radiology and interventional (invasive) procedures involving the brain and spinal cord.

When possible, endovascular coiling is preferred over clipping. Unfortunately this is not always possible.

Preferable to both methods, of course, is prevention. For more information on aneurisms and prevention please return to the main aneurisms page and follow the links. 

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