Cerebral Aneurysm

Treatment

The goal of treatment is to prevent future hemorrhage. There are two main ways this can be accomplished.

Surgery

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The most common treatment for cerebral aneurysms is open surgery under general anesthesia. The neurosurgeon makes an incision in the scalp, creates a window in the skull, locates the aneurysm and places a metal clip across the neck of the aneurysm to prevent rupture. Advanced microsurgical techniques have greatly reduced the risks of surgery; however, the outcome is associated with the aneurysm's size, location and shape.

Endovascular Therapy

In endovascular therapy, a neuroradiologist passes a catheter through an artery and deposits detachable platinum coils in the aneurysm. These devices prevent bleeding and protect against subarachnoid hemorrhage. Gaining acceptance in the treatment of both ruptured and unruptured aneurysms, endovascular therapy offers a less invasive alternative to surgery for some patients with difficult-to-reach aneurysms.

Physicians at Mayo Clinic have extensive experience with this technique. The procedure is usually done under general anesthesia to keep the head still during placement of the coils.

Monitoring

Some aneurysms have such a low risk of rupture that periodic monitoring offers a preferable approach to treatment.

A long-term study of more than 5,000 patients led by Mayo Clinic and sponsored by the National Institutes of Health has given physicians new insight into when or when not to intervene. The study found a strong link between an aneurysm's size and location and its risk of rupture. According to the study, patients with relatively small aneurysms — under ¼ inch in diameter — located in the front portion of the brain had the lowest risk of subarachnoid hemorrhage. Patients with aneurysms ½ inch or more in diameter in the back part of the brain had the highest risk. Patients with a history of subarachnoid hemorrhage from a previous aneurysm also had a higher risk of subarachnoid hemorrhage.

As a result of this study, many neurologists and neurosurgeons now recommend a more conservative approach instead of surgery for patients without a history of subarachnoid hemorrhage who have small aneurysms located in the front portion of the brain.

At Mayo Clinic, neurologists and neurosurgeons agree that the decision to treat or to monitor a cerebral aneurysm has to be individualized for each patient, after a thorough discussion of all the options and known risk factors.