What are brain aneurysms ?
This is an abnormal ballooning of an artery in the brain. These can be caused by multiple factors like :
? Uncontrolled high blood pressure
? Atherosclerosis, deposition of cholesterol in the walls of the arteries of the brain.
? Smoking.
? Heredity
? Females, these are more common in women, than men.
What are the symptoms of Brain Aneurysms ?
Non ruptured aneurysms can be completely symptom free. Some people with non ruptured brain aneurysms can have symptoms like recurring headaches. Depending on the size of the aneurysm, its location and the brain structures that it compresses , it can also cause symptoms like :
? Visual symptoms like double vision or blurry vision.
? Cranial nerve affection.
? Localized headaches.
? Tinnitus, ringing in the ears etc.
Ruptured brain aneurysms cause bleeding in the brain, a subarachnoid haemorrhage. This is a medical emergency and is fatal if left untreated.
Ruptured brain aneurysms can present as :
? Intense headache, the worst headache on one’s life.
? Neck stiffness.
? Brain stroke, depending on the area affected.
? Inability to move limbs, slurring of speech.
? Stupor.
? Unconciousness
How are brain aneurysms detected ?
» CT Scan :
When a ruptured brain aneurysm is suspected, a CT scan is done on an emergency basis. This is the standard test to detect bleeding in the brain. The bleeding can be localized and graded according to its severity. Locating the bleed can also help in estimating the location of the ruptured aneurysm.
» DSA ( Digital Subtraction Angiogram ) :
This is the gold standard test for detecting brain aneurysms. It is done in a Cath-Lab. During this test, a catheter is navigated into the arteries supplying the brain and contrast is injected. This can be seen under X rays and accurate pictures of the aneurysms can be taken. This helps not only in localising the aneurysm but also gives us valuable information regarding its morphology, its angulation, orientation of the aneyurysm neck and helps in deciding the “working angle” . This is the angle of the X ray beam that best shows the neck of the aneurysm and would be best to treat the aneurysm.
MRI and MR Angiograms : MRI can also detect ruptured aneurysms but it takes a longer time than a CT scan and the patient has to remain absolutely still for the entire period.
Treatment options -
Surgical Clipping :
This is an open surgery in which the brain is surgically accessed and a clip is placed across the neck of the aneurysm, thus preventing it from filling.
As this is an open surgery, morbidity related to surgical brain injury can occur. Also, recovery period can be longer.
Endovascular Coiling :
This is a minimally invasive treatment of brain aneurysm. The procedure is carried out from the femoral artery that is accessed from the groin, as for the angiogram.
Tiny detachable platinum coils are navigated up the brain arteries and to the aneurysm. These are then positioned within the aneurysm. Multiple such coils are placed so that the aneurysm is completely filled.
Currently, almost all types of aneurysms, regardless of the width of its neck can be treated by endovascular coiling.
Newer methods like Balloon Assisted and Stent assisted coiling are used to treat aneurysms with wide necks which would otherwise need open surgery.
Recent advances like the Flow Diverter Device, which is a pipeline that redirects blood flow away from the aneurysm are available to treat giant and very wide necked aneurysms.
What is the natural course of Subarachnoid Haemorrhage associated with a Ruptured Aneurysm ?
Subarachnoid haemorrhage causes normal cerebral arteries to come in contact with blood. This causes cerebral vasospasm. This means the blood vessels of the brain contract and become narrow.
This can be prevented by giving the “HHH” therapy, which included Hypertension, Hemodilution and Hypervolemia. This therapy is initiated as soon as the aneurysm is secured so as to prevent the arteries from going into spasm. This is most common during the 5th to 10th days after first onset of bleeding. The degree of haemorrhage and a history of smoking are the factors that can predict onset of vasospasm.
HHH therapy greatly helps in preventing and treating vasospasm. If vasospasm does occur, it is treated by giving an intra-arterial injection of Nimodepine, this is a vasodilator and is injected via a catheter in the brain arteries ( done in the Cath-Lab).
What is the safely and effectiveness of Aneurysm Coiling ?
Aneurysm coiling is a relatively safe procedure, and is as effective as surgical clipping in terms of regrowth of the aneurysm.
