Surgery Brain aneurysm surgery
Mayo Clinic surgeons performing an endovascular procedure for brain aneurysm
There are two common treatment options for a ruptured brain aneurysm.
- Surgical clipping is a procedure to close off an aneurysm. The neurosurgeon removes a section of your skull to access the aneurysm and locates the blood vessel that feeds the aneurysm. Then the neurosurgeon places a tiny metal clip on the neck of the aneurysm to stop blood flow into it.
Endovascular treatment is a less invasive procedure than surgical clipping. The surgeon inserts a catheter into an artery, usually in your wrist or groin, and threads it through your body to the aneurysm.
The surgeon then uses a device — a flow diverter, an intraluminal flow disrupter, a stent or coils — or different combinations of various devices to destroy the aneurysm from inside the blood vessel.
Both procedures pose potential risks, particularly bleeding in the brain or loss of blood flow to the brain. The endovascular coil is less invasive and may be initially safer, but it may carry a slightly higher risk of needing a repeat procedure in the future due to the aneurysm reopening.
Newer treatments available for brain aneurysm include tubular stent-like implants (flow diverters) that work by diverting blood flow away from an aneurysm sac. The diversion stops blood movement within the aneurysm and stimulates the body to heal the site, encouraging reconstruction of the parent artery. Flow diverters may be particularly useful in larger aneurysms that can't be safely treated with other options.
Your neurosurgeon or interventional neuroradiologist, in collaboration with your neurologist, will make a recommendation based on the size, location and overall appearance of the brain aneurysm, your ability to undergo a procedure, and other factors.
Other treatments for ruptured aneurysms
Other treatments for ruptured brain aneurysms are aimed at relieving symptoms and managing complications.
- Pain relievers, such as acetaminophen (Tylenol, others), may be used to treat headache pain.
Calcium channel blockers prevent calcium from entering cells of the blood vessel walls. These medications may lessen the risk of having serious symptoms from the erratic narrowing of blood vessels (vasospasm) that may be a complication of a ruptured aneurysm.
One of these medications, nimodipine (Nymalize), has been shown to reduce the risk of delayed brain injury caused by insufficient blood flow after subarachnoid hemorrhage from a ruptured aneurysm.
Interventions to prevent stroke from insufficient blood flow include IV injections of a drug to dilate the blood vessels, which elevates blood pressure to overcome the resistance of narrowed blood vessels.
An alternative intervention to prevent stroke is angioplasty. In this procedure, a surgeon uses a catheter to inflate a tiny balloon that expands a narrowed blood vessel in the brain caused by vasospasm. A drug known as a vasodilator also may be used to expand blood vessels in the affected area.
- Anti-seizure medications may be used to treat seizures related to a ruptured aneurysm. These medications include levetiracetam (Keppra), phenytoin (Dilantin, Phenytek, others), valproic acid and others. Their use has been debated by several experts, and is generally subject to caregiver discretion, based on the medical needs of each individual.
Ventricular or lumbar draining catheters and shunt surgery can lessen pressure on the brain from excess cerebrospinal fluid (hydrocephalus) associated with a ruptured aneurysm. A catheter may be placed in the spaces that are filled with fluid inside the brain or in the area surrounding the brain and spinal cord to drain the excess fluid into an external bag.
Sometimes it may then be necessary to introduce a shunt system — which consists of a flexible silicone rubber tube and a valve — that creates a drainage channel starting in the brain and ending in the abdominal cavity.
- Rehabilitative therapy. Damage to the brain from a subarachnoid hemorrhage may result in the need for physical, speech and occupational therapy to relearn skills.
Treating unruptured brain aneurysms Aneurysm clip Open pop-up dialog box Close Aneurysm clip Aneurysm clip
A surgical procedure to treat brain aneurysms involves opening the skull, finding the affected artery and then placing a metal clip over the neck of the aneurysm.
Endovascular coiling Open pop-up dialog box Close Endovascular coiling Endovascular coiling
With endovascular coiling, the surgeon feeds a soft, flexible wire into the aneurysm via a catheter. The wire coils inside the aneurysm and seals off the aneurysm from the artery.
A surgical clip, an endovascular coil or a flow diverter can be used to seal off an unruptured brain aneurysm and help prevent a future rupture. However, in some unruptured aneurysms, the known risks of the procedures may outweigh the potential benefit.
A neurologist, in collaboration with a neurosurgeon or interventional neuroradiologist, can help you determine whether the treatment is appropriate for you.
Factors to consider in making treatment recommendations include:
- The aneurysm size, location, degree of irregularity of the aneurysm and overall appearance of the aneurysm
- Your age and general health
- Family history of ruptured aneurysm
- Congenital conditions that increase the risk of a ruptured aneurysm
If you have high blood pressure, talk to your health care provider about medication to manage the condition. If you have a brain aneurysm, proper control of blood pressure may lower the risk of rupture.
In addition, if you smoke cigarettes, talk with your care provider about strategies to stop smoking since cigarette smoking is a risk factor for formation, growth and rupture of the aneurysm.
Lifestyle changes to lower your risk
If you have an unruptured brain aneurysm, you may lower the risk of its rupture by making these lifestyle changes:
- Don't smoke or use recreational drugs. If you smoke or use recreational drugs, talk to your health care provider about strategies or an appropriate treatment program to help you quit.
- Control your blood pressure if you have high blood pressure.
- Eat a healthy diet and exercise. Changes in diet and exercise can help lower blood pressure. Talk to your health care provider about changes that are appropriate for you.