Brain Aneurysm Repair

• What is a brain aneurysm?
• What are the warning signs I may be having a brain aneurysm?
• Are there risk factors involved with the development of brain aneurysms?
• What are the possible ways in which a brain aneurysm can be repaired?
• Is there any risk of a brain aneurysm repair?
• How should I prepare for a brain aneurysm repair?
• What can I expect after undergoing a brain aneurysm repair?

What is a brain aneurysm?

When we want to know what are the possible ways of repairing a brain aneurysm, it is important to understand what exactly it is, so that we can get a clear picture of how it needs to be managed. A brain aneurysm, also called cerebral aneurysm, occurs as a result of a weak spot on the walls of the blood vessels which supply the brain, causing this area to balloon out and bulge. With time the wall of the vessel in this region become thinner and weaker as the blood flows through it continuously. And when the pressure is too much to handle the aneurysm will rupture, resulting in bleeding into the brain tissue, which is a medical emergency and requires immediate and advanced surgical intervention.

What are the warning signs I may be having a brain aneurysm?

The symptoms that patients experience might be due to either merely the presence of an aneurysm or because the aneurysm has ruptured. Symptoms which may warn you about the presence of an aneurysm include:

• Localized headaches worsening with time
• Impaired vision with blurring and double vision
• Retro-orbital pain
• Impaired speech such as slurring of speech
• Gradual onset numbness and weakness in any part of the body

When the aneurysm has ruptured, the symptoms you may experience will be more pronounced, such as:

• Sudden onset severe headache which you will consider as the worst headache you have ever experienced in your life
• Sudden onset numbness or weakness in any part of the body
• Loss of consciousness
• Blurring or loss of vision, with severe pain behind the eyes
• Development of seizures

When an aneurysm ruptures the bleeding tends to last only for a few minutes, but the damage cause by bleeding to the surrounding tissues can be extensive, and can lead to complications such as:

• Vasospasm – where the bleeding vessel becomes contracted and narrow in order to stem the bleeding, but this results in limitation of blood flow to the brain tissue supplied by that vessel, causing death of brain cells.
• The ruptured vessel can re-bleed after some time
• Hydrocephalus
• Hyponatremia

Although signs and symptoms may give your doctor a clue about the presence of a brain aneurysm, diagnostic investigations include:

• CT/MRI scan
• Lumbar puncture and investigation of cerebrospinal fluid
• Cerebral angiogram — Best Diagnostic Tool

Are there risk factors involved with the development of brain aneurysms?

You may be born with risk factors to developing brain aneurysms, and they include:

• Cerebral ArterioVenous malformation – which is an abnormal connection between the arteries and veins in the brain which leads to abnormal blood flow in these areas
• Polycystic kidney disease – where you have multiple cysts forming in the kidney leading to increased blood pressure
• Connective tissue disorder – which lead to weakening of the walls of the blood vessels making it easier for aneurysm formation such as Ehlers-Danlos syndrome
• Family history of brain aneurysm

For those with a family history of brain aneurysms, screening may help with early detection and management, helping to reduce the complications which can occur. Screening is done via MRI or CT scanning in first degree relatives over the age of 25, which is then followed by scans every 5 or 10 years. 

Even though you may not be having these risk factors at birth, as you age you may become more prone to developing brain aneurysms, and the factors which increase your risk include:

• Cigarette smoking
• Being diagnosed with high blood pressure
• Increasing age
• Increased consumption of alcohol
• Abuse of recreational drugs such as cocaine

What are the possible ways in which a brain aneurysm can be repaired?

There a number of different methods which are used to repair a brain aneurysm. Depending on the type of aneurysm, the exact location of the aneurysm, and patient factors such as the age and general health status, your doctor will decide on one of the following methods:

• Surgical Clipping – is a process by which the surgeon will make an incision on the scalp, remove a part of the skull, in order to access the aneurysm, and then a metal clip is placed on the neck of the aneurysm, cutting off the blood supply to it. Depending on where the aneurysm is located, this procedure is given different names, such as, ACOM repair (Anterior Communicating Artery), MCA (Middle Cerebral Artery), PICA (Posterior Inferior Cerebellar Artery), DACA (Distal Anterior Cerebral Artery) and AICA (Anterior Inferior Cerebellar Artery). The procedure is certainly better than Coiling when done by experienced hands and also costwise lesser.
• Endovascular Repair – which is a procedure done by accessing the aneurysm from the groin. An incision is made in the groin and a catheter is passed through it, and after accessing the aneurysm, a platinum wire is placed inside the aneurysmal sac like a coil, which helps to disrupt the blood flow to the aneurysm and seal it off from the artery. This is a less invasive procedure compared to surgical clipping.
• Flow diverters – is a modern procedure which poses less risk than the two methods mentioned above. Flow diverters are tubular stent like implants which help to divert the blood flow away from the aneurysmal sac, which then promotes the healing of the region and reconstruction of it. This method is useful in managing very large aneurysms which cannot be treated with the other methods.

In the case of rupturedaneurysms, all of the above mentioned methods are used. In the case of unruptured aneurysms also these methods can be used. But whether your doctor opts for surgical management of an unruptured aneurysm will depend on certain factors. Because you have to weigh the risk of potential rupture of the aneurysm against the risk of undergoing surgery, and decide which outweighs the other. Sometimes watchful waiting can be the way out for small aneurysms which have a very low risk of rupture. Other non-surgical methods of management of an unruptured aneurysm include:

• Lowering blood pressure with medication, diet and exercise
• Limiting your intake of caffeine
• Stopping recreational drug abuse
• Quit smoking
• Avoid actions which will increase your blood pressure such as lifting heavy objects, coughing, constipation.

Is there any risk of a brain aneurysm repair?

The repair of a brain aneurysm is considered a major surgery and definitely carries a risk just like other major surgeries. These include:

• Swelling/edema of the brain
• Neurological deficits due to damage to brain tissue such a visual impairments, speech impairments, behavioralabnormalities, and even some weakness in certain areas of the body.
• Infection of the surgical site or the brain tissue itself
• Formation of blood clots which can lead to a stroke
• Development of seizures

You may also be faced with anesthetic risks such as developing an allergic reaction to the anesthetic agents, since a brain aneurysm repair requires general anesthesia.

How should I prepare for a brain aneurysm repair?

If a patient presents with a ruptured aneurysm, it is an emergency and there is very little time to prepare for surgery in this case. But in the case of an unruptured aneurysm, you have some time to prepare yourself for surgery, then you need to do the following:

• Discuss all the medication you are taking with your doctor, for pre-existing conditions such as hypertension and diabetes.
• Stop smoking if you do
• Follow the instructions given by your doctor, such as fasting for a period of 8 hours before the surgery, taking any premedication, undergoing any investigations to assess your level of fitness for surgery as well as avoiding any medication prior to surgery.

When it comes to preparation for the surgery, the most important aspect of it is the cost of the surgery. The exact of surgery is not available because it depends on many factors like, if the aneurysm is ruptured or not, the fitness level of the patient and if they have other associated health issues, and how long the patient takes to recover from the surgery. But in general the clipping procedure is said to be the cheapest, with endovascular coiling costing 1.5-3 times more and flow diversion costing 1.5-4 times more.

What can I expect after undergoing a brain aneurysm repair?

Generally the hospital stay for an aneurysm repair is between 2-7 days, depending on the type of procedure and patient factors. Endovascular coiling has a faster recovery time than the other procedures. Immediately after the surgery you will be admitted to the ICU for close monitoring.

You will have to take things easy for about 4-6 weeks before you return to normal activities, and even then you should not be doing any strenuous activities for at least 3 months after surgery. You will be asked to come for a follow up angiogram to monitor the aneurysm.