Not all cerebral aneurysms burst. Some individuals with very small aneurysms may be monitored to detect any growth or symptoms and aggressively treated for coexisting medical problems and risk factors.
Each case is unique, and many factors must be considered before treating an unruptured aneurysm such as:
- Type, size and location of the aneurysm
- Annual risk of rupture
- Patient’s age, health, personal and family medical history
- Risk of treatment
Two invasive options are available for treating cerebral aneurysms, both of which carry some risk to the individual such as:
- Possible damage to other blood vessels
- Potential for aneurysm recurrence and bleeding
- Post-operative stroke
Microvascular clipping involves cutting off the flow of blood to the aneurysm. Under anesthesia, a section of the skull is removed and the aneurysm is located. The neurosurgeon uses a microscope to isolate the blood vessel that feeds the aneurysm and places a small, metal, clothespin-like clip on the aneurysm’s neck, halting its blood supply. The clip remains in the person and prevents the risk of future bleeding. Clipping has been shown to be highly effective, depending on the location, shape, and size of the aneurysm. In general, aneurysms that are completely clipped surgically do not return.
A related procedure is trapping, in which the surgeon clamps off (occludes) the entire artery that leads to the aneurysm. This procedure is often performed when the aneurysm has damaged the artery. An occlusion is sometimes accompanied by a bypass, in which a small blood vessel is surgically grafted to the brain artery, rerouting the flow of blood away from the section of the damaged artery.
Endovascular embolization is an alternative to surgery. Once the individual has been anesthetized, the doctor inserts a hollow plastic tube (a catheter) into an artery (usually in the groin) and threads it, using fluoroscopic angiography, through the body to the site of the aneurysm. Using a guide wire, detachable coils (spirals of platinum wire) are passed through the catheter and released into the aneurysm. The coils fill the aneurysm, block it from circulation, and cause the blood within the aneurysm sac to clot, which effectively destroys the aneurysm. The procedure may need to be performed more than once during the person’s lifetime.
Treatment of Symptoms
Other treatments associated with the management of cerebral aneurysms that are symptomatic may include:
- Anticonvulsants to prevent seizures
- Analgesics to treat headache
- Calcium channel-blocking drugs to treat vasospasm
- Sedatives may be ordered if the person is restless
A shunt may be surgically inserted into a ventricle at the time of the hemorrhage or up to several months following rupture if the buildup of cerebrospinal fluid is causing harmful pressure on surrounding tissue.
Individuals who have suffered a subarachnoid hemorrhage often need rehabilitative, speech, and occupational therapy to regain lost function and learn to cope with any permanent disability.
An unruptured aneurysm may go unnoticed throughout a person’s lifetime. A burst aneurysm, however, may be fatal or could lead to the following conditions:
- Hemorrhagic stroke
- Vasospasm (the leading cause of disability or death following a burst aneurysm)
- Short-term and/or permanent brain damage
The prognosis for persons whose aneurysm has burst is largely dependent on the age and general health of the individual, other preexisting neurological conditions, location of the aneurysm, extent of bleeding (Hunt and Hess grade), and time between rupture and medical attention.
Individuals who receive treatment for an unruptured aneurysm generally require less rehabilitative therapy and recover more quickly than persons whose aneurysm has burst. Recovery from treatment or rupture may take weeks to months.