Cerebral Aneurysms: Evaluation and All Treatment Options

Overview

A cerebral aneurysm is a weakened area in the wall of an artery in or around the brain that bulges outward, Some aneurysms are discovered after they rupture and cause bleeding, while others may be found incidentally during imaging performed for headaches, dizziness, trauma, or unrelated neurologic concerns.

What is a brain aneurysm?

A brain aneurysm, also called a cerebral or intracranial aneurysm, forms when a portion of an artery wall becomes weak and begins to bulge. Many aneurysms remain stable for years. Others enlarge over time or develop features that increase concern for rupture.

Aneurysms can vary by:

  • Size, from very small to large or giant.
  • Shape, including smooth saccular aneurysms, irregular multilobulated aneurysms, fusiform aneurysms, or blister-like aneurysms.
  • Location, such as the internal carotid artery, middle cerebral artery, anterior communicating artery, posterior communicating artery, basilar artery, vertebral artery, and other intracranial vessels.
  • Clinical presentation, including incidental discovery, cranial nerve symptoms, headache, or rupture with hemorrhage.

Symptoms

When symptoms occur, they may include:

  • Headache.
  • Eye pain or pain around the face.
  • Double vision or changes in vision.
  • Eyelid drooping.
  • Facial numbness.
  • Symptoms related to pressure on nearby nerves or brain structures.

When is it an emergency?

A ruptured aneurysm is a medical emergency. Possible warning signs include:

  • Sudden, severe headache.
  • Sudden loss of consciousness.
  • Nausea and vomiting.
  • Neck stiffness.
  • Sudden weakness, numbness, confusion, or speech difficulty.

If these symptoms occur, call 911 immediately. A ruptured aneurysm can cause subarachnoid hemorrhage, a life-threatening form of bleeding around the brain that requires immediate hospital-level care.

How aneurysms are diagnosed

Brain aneurysms may be identified on:

  • CT or MRI of the brain.
  • CT angiography (CTA).
  • MR angiography (MRA).
  • Diagnostic cerebral angiography.

Endovascular coiling

Endovascular coiling is a minimally invasive treatment in which a catheter is advanced through the blood vessels to the aneurysm and very soft platinum coils are placed inside the aneurysm sac. The coils help slow or stop blood flow into the aneurysm and promote thrombosis within the aneurysm itself.

Balloon-assisted coiling

In balloon-assisted coiling, a temporary balloon is used across the aneurysm neck during coil placement to help keep coils safely inside the aneurysm and protect the parent artery.

The balloon is generally inflated only during key parts of the procedure and then removed at the end. This technique can expand minimally invasive options for aneurysms that might otherwise be more difficult to treat endovascularly.

Stent-assisted coiling

Stent-assisted coiling uses a permanent endovascular stent to help support coil placement across a wider aneurysm neck.

Flow diversion

In this approach, a stent-like device is placed in the parent artery across the aneurysm neck. Rather than filling the aneurysm directly, the device redirects blood flow along the normal artery and away from the aneurysm, allowing the aneurysm to gradually thrombose and the artery wall to remodel over time.

Clipping

Clipping is an open surgical treatment in which a neurosurgeon places a clip across the base, or neck, of the aneurysm to exclude it from circulation. This can require a craniotomy and direct access to the aneurysm.

Parent vessel occlusion with or without bypass

In selected complex aneurysms, treatment may involve intentional closure of the diseased parent artery

Conservative risk-factor treatment and surveillance

For some patients, one plan is continued observation with:

  • Repeat imaging at defined intervals.
  • Blood pressure control.
  • Smoking cessation.
  • Lipid and vascular risk management as appropriate.
  • Review of new symptoms or interval changes.

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