Depending on the size and location of your aneurysm — as well as your overall health — you have multiple options when it comes to treatment.
Finding out that you have a brain aneurysm is understandably a nerve-wracking event. But if you’ve been diagnosed with an aneurysm, know these two things: First, there’s a good chance your aneurysm may only require observation — no intervention necessary. And second, if yours does require brain aneurysm treatment, you’ll likely have multiple options.
It all depends on the size and location of your brain aneurysm. “The bigger it is, the higher the risk of rupture,” said Dr. Matthew Fusco, a neurosurgeon with Vanderbilt Neurosurgery. “And different locations have different risk profiles — aneurysms that are either below the lining of the brain or embedded in the skull are extraordinarily unlikely to rupture, while others, such as those at the anterior communicating artery, can rupture even if they are relatively small.”
Your care team will take these factors, as well as your age and overall health, into account to determine the best course forward. From there, one brain aneurysm treatment may stand out as the best approach, or you may have options. Here, Fusco explains the pros and cons of each.
Brain aneurysm treatment option 1: Endovascular procedures
Endovascular procedures are the least invasive treatment for brain aneurysms. There are a few different methods, but all begin by inserting a small tube known as a catheter in the groin or the wrist and then using that tube to access the aneurysm. From there, your provider might use a technique known as “coiling,” during which three-dimensional spheres are inserted to fill the aneurysm, or they might instead put a device called a flow-diverting stent inside the artery to seal off entry to the aneurysm.
A newer option, called intrasaccular flow diversion, is similar to coiling. Instead of the three-dimensional spheres, a singular, square-shaped metal implant called a Woven Endobridge (WEB), is inserted into the aneurysm. Your physician will choose coils or a WEB based on the shape of the aneurysm. “Sometimes a temporary balloon or a permanent stent is needed to ensure the device stays in the aneurysm,” Fusco said.
- PROS: The procedure is less invasive than open surgery with easier recovery. It also puts less stress on the body, so it’s a good choice for a patient with a heart condition or advanced age. Almost all arterial locations can be reached by endovascular devices.
- CONS: Some configurations of aneurysms are more difficult to treat endovascularly. And the recurrence rate is potentially higher. Because of this, more follow-ups are needed post-treatment.
Brain aneurysm treatment option 2: Open microsurgery
Open surgery is more invasive. During the procedure, the surgeon will make an incision behind the hairline, temporarily take off a window of bone and then go beneath the lining of the brain to put a clip across the neck of the aneurysm to prevent rupture.
- PROS: This procedure is more definitive — there’s not as much of a chance of needing further treatment down the line. It can also treat most any configuration of aneurysm.
- CONS: It takes a lot more to recover from open surgery. Where you might be in the hospital overnight for an endovascular procedure, you can expect a longer stay post-surgery. Also, some arterial locations are less approachable by open surgery.
Which brain aneurysm treatment is right for you?
If your provider determines that either option could work for your aneurysm, the conversation then turns to your age, health characteristics, and personal preferences, said Fusco.
“A lot of times, the two options end up being fairly equal in terms of risk for a patient,” he said. “And some people will say, ‘Please don’t cut my head open — whatever you have to do through the groin is fine, even if I have to have more follow-up.’ And other people will say, ‘I’m so anxious about this I just want to know that it’s cured.’ In that case, we’d be more likely to opt for the open surgery.”
Why it’s important to know your options
“A good vascular center will be staffed by surgeons and physicians who are trained and experienced in all of these procedures,” Fusco said, which is key. “If they’re not comfortable with all of the brain aneurysm treatment options, patients may not be offered all of the potential treatment options.”
In order to know you’ll have access to both endovascular and microsurgery options, be sure to ask your providers if their center has experience in each.
The Cerebrovascular Disease Program at Vanderbilt University Medical Center offers comprehensive care for a wide range of vascular conditions of the brain and spinal cord, including aneurysms, arteriovenous malformations and stroke.
