An aneurysm is a blister that forms off the side of a blood vessel. There are certain risk factors for harboring cerebral aneurysms, patients with long-standing hypertension, poorly controlled blood pressure, smokers definitely have predilection not only to have cerebral aneurysms, but also have worse outcomes if an aneurysm were to cause bleeding in the brain.
On occasion, we do see aneurysms run within families. If there are two first degree relatives with a cerebral aneurysm, we become more concerned that there might be involved within the rest of the members of the family.
People with unruptured cerebral aneurysms generally won't have any symptoms at all. They're often discovered incidentally, they might have headaches which over time starts to affect their quality of life, and they'll go see their regular doctor to help manage that, and the doctor will order some type of scan, like a CT scan or an MRI scan. And during the course of the workup for this other condition, they'll find the aneurysm.
The top concerns that individuals have when faced with an aneurysm is, what are the chances that this aneurysm is going to bleed? What's the chances of the aneurysm rupturing? That discussion relies on multiple factors, such as the size of the aneurysm, the shape of the aneurysm, and the location of the aneurysm, as well as patient specific factors, such as their age and their general health status. That helps us decide whether or not we need to treat it.
Certain aneurysms are more amenable to having surgical clipping, while other aneurysms are more amenable to treatment with endovascular techniques, such as coiling. Clipping of aneurysms is a surgical procedure where we attempt to exclude the aneurysm from the normal circulation. That involves making an incision along the scalp and removing a small portion of the bone. We place a little titanium clip right where the aneurysm arises off of the blood vessel. In that way we can keep the aneurysm from filling with blood, which drastically reduces its chances of causing a bleeding event in the future.
Another way to treat aneurysms is to do something called coiling. In that procedure we actually go through really long small catheters and we can access either the wrist or down in the hip area and navigate catheters all the way from out in that area up to the vessels in the brain. From there, we can enter into the aneurysm and deploy tiny little platinum coils, and what they do is they fill up the aneurysm so that the blood flow can't get into it, and thus it drastically reduces the chance of having a bleeding event in the future.