A brain aneurysm is one of the diseases related to the brain and nerves, which is caused by the formation of multiple bulges in the wall of brain arteries. If the brain aneurysm ruptures, the patient will face several risks; For this reason, before the job is over, you should consider brain aneurysm treatment. Various methods have been considered for aneurysm treatment. The most sensitive of these methods is surgery, but with the help of medicine and embolization, this disease can also be treated. In the following, the best method of aneurysm treatment will be examined.
As long as the cerebral aneurysm is not closed, the risk of re-bleeding threatens the patient, and considering the general condition of the patient and the side risks of anesthesia, it is better to perform definitive treatment and brain aneurysm surgery at the earliest opportunity.
There are two ways to close this compartment full of blood flow:
Open surgery method has been the primary treatment for brain aneurysms in the last few decades and has saved patients’ lives. In this surgery, after opening the skull and the membranes around the brain, under the microscope, cerebral vessels are seen, and then the aneurysm is found, and finally, with a metal device called an “aneurysm clip,” the neck of this balloon is taken to stop the blood flow inside it.
Unlike the older types of clips, in the new clip technology, the alloy used does not interfere with the post-operative MRI that may be necessary for the patient. The requirement for the successful performance of this surgery is the finesse of the hand and sufficient experience of the neurosurgeon in this operation to avoid damage to the natural vessels and brain tissue and ultimately close the aneurysm neck.
Another treatment that has received more attention than before in the last decade is angiographically performed from inside the vein. In this method, the fine angiography tube is inserted inside the leg vein and brought to the cerebral vessels and the aneurysm. Then an excellent wire with a spring state called a “coil” is sent into the aneurysm to fill the aneurysm space with a metal coil. In this way, the blood flow inside the aneurysm is reduced, clot forms, and the risk of bleeding is eliminated.
Many studies have been conducted to compare these two methods, and they are still ongoing, and each has advantages and disadvantages.
Choosing one of these methods depends on the type, location, sizes, and other characteristics of the aneurysm and the patient’s general conditions, such as the simultaneous heart, lung, and kidney diseases, and the available facilities.
Some brain aneurysms are better treated with an open method; in some cases, an intravenous method is necessary, and some can be treated with both methods, the choice of which depends on the opinion of the doctor and the patient.
Open surgery is associated with more risk during the patient’s operation, infection risk, brain damage, and more care afterward. These risks will be generally lower in the closed method. However, on the other hand, studies have shown that with the success of open surgery for the definitive treatment of brain aneurysm In the hands of a neurosurgeon, it is more likely that the aneurysm will enlarge in the following years (in other words, its recurrence).
The risk of re-bleeding from the aneurysm is more significant in the closed method because, in this method, the aneurysm itself is not closed and is filled inside.
Again, the blood flow inside a part of the aneurysm is established, or its size becomes more extensive. In addition, if the aneurysm is treated with a secure method by a doctor other than a neurosurgeon, the control of complications caused by this treatment, such as brain bleeding during surgery, by other non-surgeon specialists (neurology or radiology specialist, who sometimes treat aneurysms by an intravascular method) will be complicated and even impossible.
For example, if the aneurysm ruptures and bleeds while filling the aneurysm with a spring, this treatment will face a severe problem because there is no access to the skull space, and especially a non-surgeon cannot perform an emergency open surgery and control the bleeding.
Opening the skull will make it very difficult to control the bleeding inside the vein.
In summary, open-brain aneurysm surgery is associated with more intraoperative risk but closed intravascular surgery has a greater risk of future recurrence and regrowth of the aneurysm.
One of the methods that can be used to treat a brain aneurysm is a surgical blade. The surgery itself is divided into different categories, and the choice of each method depends on various parameters. Among the necessary parameters, we can mention the size of the aneurysm, its type, and its location. The most common surgical procedures are:
In order to access the brain aneurysm, the specialist surgeon must create a hole called a craniotomy in the skull. Open surgery must be done carefully; the slightest mistake can lead to the most significant events. During surgery, the surgeon places a tiny clamp in the area below the neck of the aneurysm to block the blood flow.
This type of surgery, performed to treat brain aneurysms, is among the minimally invasive methods. In this method, there is no need to open the skull; Because the groin is used to send the catheter into the artery, and then the catheter reaches the brain aneurysm by passing through the blood vessels.
The third surgical method is related to artery blockage. Sometimes open surgery is not possible, or the artery is damaged to a great extent. For this reason, the surgeon completely blocks the vein and will use a side route for the blood flow. Often, the side path consists of a tiny stream, the source of which is the foot.
For each surgical method of cerebral aneurysm treatment, the patient must be admitted to the intensive care unit for at least two weeks. During this period, nurses and specialist doctors must take care of the patient’s condition with great care and investigate signs of bleeding, hydrocephalus, vasospasm and other possible complications.
Another standard method for treating brain aneurysms is the use of medicine. Drug treatment is also widespread and can significantly reduce the pain caused by the disease. The surgeon prescribes various painkillers to relieve the headache of the disease. Also, during the illness, a person may have seizures. Therefore, the prescription of anticonvulsant drugs is mandatory. In order to prevent vasospasm, the surgeon prescribes vasodilator drugs. It should be noted that a person’s skull may experience much pressure and bleeding during a brain aneurysm. Therefore, the surgeon or specialist doctor must keep the patient’s blood pressure low to reduce bleeding and control intracranial pressure.
The newest method to treat cerebral aneurysms is the flow diverter. Diverters are a type of stent. This method is entirely logical and is a safe alternative to open surgery. When using the flow diverter, there is no need to close the neck of the aneurysm or to place small coils inside the aneurysm; Because the blood flow path is entirely away from the aneurysm, which is done with the help of blood flow diverting stents.
In this method, the interbrain aneurysm is gradually coagulated, reducing the risk of bleeding. This method can be used when the aneurysm is not well accessible or large. It should be noted that in this treatment method, there is no need to open the skull anymore, and people will have a shorter recovery period.
It should be noted that embolization itself has different types. Which include:
All embolization methods are non-invasive, and performing them may carry many risks. Also, during any of the existing methods, there is a possibility that the brain aneurysm will rupture. So this should be done with utmost care.
A cerebral aneurysm will cause the rupture of an artery, and various methods can be used to treat it. Surgical, drug, new, and non-invasive methods are placed among the aneurysm treatment methods. A neurologist determines the best way to treat aneurysm. The doctor chooses the best aneurysm treatment method according to parameters such as ruptured or unruptured aneurysm, age of the patient, general condition of the patient, the general appearance of the aneurysm, location of the aneurysm, underlying diseases that increase the risk of rupture, etc. For this reason, the first step is to consult a specialist with sufficient knowledge and experience in aneurysm treatment to determine the treatment method according to the individual’s condition.
Dr. Majid Zohrabi started treating his patients in Dubai in 2022 and continues his activities in private medical centers in the UAE.