Brain Aneurysms: Know the Facts and Treatment Options

Most people grasp the severity of brain aneurysms, but many don’t know that there are lifesaving treatment options for the estimated 1 in 50 people that carry the unruptured form of the condition.

A brain aneurysm ruptures every 18 minutes. When that happens, they are fatal in about 40 percent of cases.

About two-thirds of those who survive the rupture suffer some permanent neurological impairment.

However, most aneurysms do not necessarily carry such dire consequences.

Even patients who suffer the most fatal form of a hemorrhagic stroke, including a ruptured brain aneurysm, have a 40 percent better chance of survival when treated at a high-volume hospital (one that treats more than 35 cases a year), compared to patients admitted to low-volume centers (those that treat fewer than 10 cases a year), according to a new study.

The study found that the availability of specialized physicians and nurses, along with technology and established protocols, were primary factors. Baptist Hospital physicians treat more than 100 brain aneurysms each year.

An estimated 50 to 80 percent of all aneurysms do not rupture during the course of a person’s lifetime.

A brain aneurysm is an abnormal bulge in a brain artery that develops where the blood vessel wall is weakened.

About 1.5 to 5 percent of the general population has or will develop a cerebral aneurysm. That’s about 3 to 5 million people in the United States, but most don’t show any symptoms. A small percentage may suffer from bleeding.

“However, an aneurysm can produce symptoms as it enlarges, including headaches or localized pain. If an aneurysm gets very large, it may produce pressure on the normal brain tissue or adjacent nerves,” said Jack Klem, M.D., medical director of cerebrovascular surgery at the Baptist Health Neuroscience Center. “This pressure can cause difficulty with vision, numbness or weakness of an arm or leg, difficulty with memory or speech, or seizures.”

Dr. Klem will join Sergio Gonzalez-Arias, M.D., medical director of Baptist Health Neuroscience Center, and Italo Linfante, M.D., the Center’s medical director of interventional neuroradiology, on Thursday, May 23, when they will show viewers of a Baptist Health South Florida webcast how a brain aneurysm is repaired using a minimally invasive technique.

The procedure, endovascular embolization (or coiling), is a newer treatment option for patients who have been diagnosed with a brain aneurysm. The procedure takes about two hours and patients are typically able to go home the following day.

The goal of coiling is to safely seal off the aneurysm and stop further blood from entering the abnormal bulge, which increases the risk of rupture or possible bleeding.

The technique involves inserting a catheter into the patient’s groin and threading it through blood vessels into the brain using x-ray guidance.

Through the catheter, the physician uses another tube to deposit platinum coils to fill the aneurysm, blocking blood flow. This has become a potentially life-saving treatment for aneurysms that were previously considered inoperable. It is the preferred method to treat cerebral aneurysms.

“This option gives great hope to all patients with brain aneurysms, including those who previously may have been told they had inoperable aneurysms,” Dr. Linfante said.

During the webcast, the more traditional and more complex approach of treating cerebral aneurysms will also be discussed. This option requires an incision in the scalp and then removing part of the skull. The artery affected by the aneurysm is located using a microscope.

A neurosurgeon inserts a metal clip at the base of the aneurysm. This serves to cut off blood flow, thereby destroying the aneurysm. The removed part of the skull is replaced and the incision is sewn together.

Neurologists and neurosurgeons consider many factors before making a treatment recommendation, including:

Treatments for ruptured brain aneurysms are aimed at relieving symptoms and managing complications. They include medications and interventions to prevent stroke from insufficient blood flow. There are also procedures to lessen pressure on the brain from excess fluid associated with a ruptured aneurysm.

But treating aneurysms early is vital, so it is important to know the risk factors.

A person may inherit a propensity for aneurysms, or aneurysms may develop because of hardening of the arteries (atherosclerosis) and aging.

Risk factors include a family history of aneurysms, gender, race, hypertension (high blood pressure) and smoking.

There are almost 500,000 deaths worldwide each year caused by brain aneurysms, and half the victims are younger than 50.

“Managing risk factors to prevent future aneurysms may require dietary changes and exercise to control blood pressure, cholesterol levels, and manage overall heart health,” Dr. Klem said.

Read about an engaged couple who survived life-threatening aneurysms.