Dr. Li-Mei Lin

Brain (Cerebral) Aneurysms

Background

• A brain aneurysm is an abnormal ballooning from a weakened part of an artery wall in the brain

• A brain aneurysm has a risk of bursting open and spilling blood into the brain space causing life threatening hemorrhage called subarachnoid hemorrhage.  This is a type of hemorrhagic (bleeding) stroke.  Brain Aneurysm Video

• Aneurysms are categorized into small (<10mm), large (10mm – 25mm), or giant (>25mm).
  • Aneurysms of ANY size can rupture, the average size of ruptured aneurysm is 4.5mm

 

Symptoms

• Most brain aneurysms don’t cause any symptoms until they burst open and rupture blood into the brain (subarachnoid hemorrhage)

• When an aneurysm ruptures, it can cause
  • worst headache of your life
  • loss of consciousness
  • seizures
  • nausea and vomiting
  • weakness or paralysis

Click here to read more about subarachnoid hemorrhage (SAH)

• Some brain aneurysms can cause symptoms when they have grown to a large enough size causing pressure in the brain or pushing on surrounding nerves.  Symptoms may include:
  • headache
  • blurred vision
  • double vision
  • seizures

 

Diagnosis

• Brain aneurysms are found only with special tests that look at the blood vessels in the brain called angiography.
  • Non-invasive angiography include CT angiography and MR angiography
  • Best form of angiography is a conventional catheter-based diagnostic cerebral angiogram.
    • This is an invasive test similar to a heart catheterization that uses fluoroscopy and contrast dye to provide a map of the blood vessels in the brain
    • The quality and resolution of the images obtained are less than 1mm.

Click here to read more about cerebral angiography

 

 

Treatment

Neurosurgeon versus neurologist versus radiologist versus neurointerventionalist…what does all of this mean?  Which one of these specialist is the best for treating brain aneurysms?

• A neurologist does not perform surgeries and most are not neurointerventionalists, which means they cannot treat brain aneurysms.
• A radiologist may be a neurointerventionalist and can offer some brain aneurysm treatments but not all.
• A neurointervenionalist may be a radiologist, a neurosurgeon or a neurologist depending on his/her training background and can offer some brain aneurysm treatments but not all.
• A neurosurgeon who is a cerebrovascular (blood vessels in the brain) specialist and has training in minimally invasive neurointerventional techniques is the best specialist who can offer all the options available for brain aneurysm treatments, BOTH surgical and neurointerventional.

Options

• Open Surgical Aneurysm Clipping
  • Video                  

• Minimally Invasive Neuroendovascular Treatments
  • Aneurysm Coiling
    • Stent-assisted Aneurysm Coiling
    • Balloon-assisted Aneurysm Coiling
  • Flow Diversion Stents (click here to read more about aneurysm flow diversion treatment)