Over time blood vessels tend to enlarge and bulge, and, finally, they could rupture. In the brain it is especially dangerous as any cerebral hemorrhage leads to extremely heavy condition up to disability and death. That is why the treatment of aneurysm in brain (above mentioned enlargement of cerebral vessels) is one of the main subjects of neurology.
In Germany, around 6 to 16 residents of 100,000 per year suffer from a special form of stroke, the so-called subarachnoid hemorrhage. A total of 15,000 new diseases occur each year, of which around 12,000 are due to cerebral vascular aneurysms. Around 30 percent of patients die before they get to the hospital. About a third of the survivors die during the hospital stay, a third remains permanently disabled.
The symptoms of brain aneurysm are often hidden but there are a few sings that you might have this disease:
- Permanent headache in the same location
- Distorted vision (double or blurred)
- Enlarged pupils
- Pain behind and above eyes
- Speech problems
- Numbness and weakness
But those symptoms also could be related to others neurological issues, so it is better to have an appointment with a doctor for examination. If you have cerebral aneurysm, it is to be treated surgically and there are two main methods to do this:
- Open clipping;
- Endovascular surgery.
What is a cerebral vascular aneurysm?
Aneurysms are vascular sacs of different shapes and sizes. If these sags occur in the brain vessels, the disease is known as the brain vessel aneurysm. The size of the mostly sack-shaped or berry-shaped aneurysms varies between 1 mm and 10 cm. Depending on their size, they are divided into small, large and giant aneurysms.
Their development is mostly caused by congenital weaknesses in the vascular wall. Disturbances in the structure of the vessel wall, under the influence of blood pressure, lead to bulges or dilations of the vessels. The cause can also be inflammatory vascular changes or infections caused by fungi (so-called mycotic aneurysms) or vascular wall injuries. Because congenital or acquired causes are based individually or in combination on the development of the aneurysm, you cannot protect yourself. However, there are certain risk groups: These include, in particular, patients with polycystic kidney disease, type 1 neurofibromatosis or Marfan syndrome. Relatives of patients with an aneurysm rupture are also at higher risk. In these risk groups, it probably makes sense to look for aneurysms with the help of MR angiography. The method is completely painless and has practically no side effects.
Aneurysms are initially asymptomatic as long as they do not burst. The risk of rupture increases with age. Rarely, there are no bleeding-related symptoms, for example when an aneurysm presses on important nerves and thus u. a. restricts the mobility of the eyes. The rupture of an aneurysm is characterized by a very severe headache. This dramatic headache event causes some of the patients to pass out directly.
It is crucial for the treatment of subarachnoid hemorrhage that the aneurysm be switched off as quickly as possible from the blood circulation. Until a few years ago, the only method of treatment was neurosurgical clipping. H. after opening the skull, a metal clip was placed on the aneurysm to prevent rupture.
Traditional aneurysm therapy
Classical treatment for aneurism is "clipping", when a surgeon clips aneurism preventing so the blood from flowing through it. To reach a diseased area the neurosurgeon performs craniotomy, open brain surgery. First, he or she makes an incision, then, opens the skull, and, finally, dissecting through the brain finds aneurysm and places a clip. It takes 1-2 month to recover after this kind of operation.
Today, more advanced ‘mini’ craniotomy is also possible. The principle of surgery is the same but the surgeon makes a small hole, less than 5 cm, and operates via this opening. It is less traumatic method but still invasive and it has the same recovery time as previous one.
Endoscopic aneurysm treatment
Modern approach is to perform aneurysm surgery with minimally invasive methods. Endoscopy is allows to make treatment both with general or local anesthesia. The specific operation for cerebral aneurysm is named ‘endoscopic coiling’. A neurosurgeon makes a small incision and, then, catheter is introduced into a vessel. The catheter is filled with radio agent, which allows the surgeon to see what is happening in the vessels on monitor.
Then, a thin metal wire (platinum) is introduced into the vessels via catheter. This wire is just not more than twice thicker (sometimes even thinner) than human hair. When the wire reaches aneurism, it enters into it and is packed inside as a coil not giving a blood to flow there. Something it is also needed to introduce a stent or balloon helping the coil to pack aneurysm. It makes aneurysm disappearing over time.
The advantages of endoscopic treatment of brain aneurysm not only that it is less traumatic but also with endoscopic coiling it is possible to reach some places that were unreachable before and, thus, to heal the conditions that were considered as inoperable in the past. At the same time, the skull remains intact. Recovery time could be less than 1 month.
A new treatment method: Coiling
A new and effective therapy for the treatment of the cerebral vascular aneurysm, the so-called coiling, was developed in the early 1990s. With this type of therapy, an approximately 1 mm thick, specially marked microcatheter with X-ray monitoring is maneuvered into the aneurysm. An open operation is therefore not necessary. Depending on the size and shape of the aneurysm, a specially selected platinum spiral is pushed through the microcatheter into the aneurysm. The aneurysm can be completely laid using one or a combination of several spirals. The aneurysm is thus switched off from the blood stream. Various clinical studies indicate that the treatment was highly effective and safe in both the short-term and long-term view.
Ruptured Aneurysm Treatment
More severe condition arises when aneurysm has been ruptured. The burst causes a subarachnoid hemorrhage (SBH), when blood spread in a brain. This might be revealed in the following symptoms:
- Very bad sudden headache
- Nausea or/and vomiting
- Faint
- Dizziness
- Sudden pain behind and above eyes
- Photophobia
- Drooping eyelid
- Sudden changes in vision
- Sudden trouble with moving
- Stiff Neck
- Loss of awareness
- Seizure
- Weakness and numbness
Having some of above symptoms you should immediately turn to qualified medical help as you might be in need of emergency lifesaving measures. Treatment of ruptures aneurysm includes relieving of the symptoms, surgical correction of hemorrhage area, supporting medicine and prevention of further complications. The patient stays in intensive care unit for 1-2 weeks. The methods of treatment are chosen based on a number of factors as location of the ruptured aneurysm, its type, the size of lesion, general state of patient’s health etc.
At present both open surgery and endovascular method are used. Based on International Subarachnoid Aneurysm Trial, the life risk or risk of disability in one year after treatment is lower of 22.4% in patients with endovascular coiling against those who had traditional open surgery. So, today, many medical centers turn to endovascular surgery as to more effective and less invasive method. Clinics in Germany have necessary technical and professional base for qualified diagnostic and treatment of cerebral aneurysm. The best treatment is a timely treatment, as preventive measures allows significantly reduce mortality in patients and give the patients all the chances for normal life.
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