Cerebral Aneurysm

Treatment

Treatment of a cerebral aneurysm at Mayo Clinic involves a team of specialists from Neurology, Neurosurgery and Neuroradiology. Generally, a neurologist will serve as the "quarterback" of the care team, coordinating the care and serving as the main contact for the patient.

Preventing future hemorrhage is the goal of treatment. This goal is accomplished in two main ways: clipping the aneurysm in surgery and coiling the aneurysm with endovascular surgery. Mayo Clinic physicians have extensive experience with both methods. The treatment team and the patient determine the best treatment option, based on aneurysm location and configuration and the patient's neurological and medical status.

Surgery

During the surgery, done 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 its neck to prevent rupture. Advanced microsurgical techniques have greatly reduced the risks of this surgery. Risks depend on the aneurysm's size and location and the patient's age. The possibility of an aneurysm recurring after surgery is quite low.

Aneurysm coiling

Enlarge

Endovascular Therapy

In endovascular therapy, a neuroradiologist or neurosurgeon passes a catheter through an artery and deposits detachable platinum coils in the aneurysm. The procedure is called aneurysm coiling. The coils fill the aneurysm, which reduces blood flow into the aneurysm sac and lowers the risk of bleeding. Endovascular therapy is gaining increased acceptance in the treatment of both ruptured and unruptured aneurysms and offers an alternative to surgery in many cases.

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

Monitoring

In aneurysms with a low risk of rupture, periodic monitoring is often recommended as the best approach.

A long-term study of more than 4,000 patients, led by Mayo Clinic and sponsored by the National Institutes of Health, provided physicians with 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. 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 larger aneurysms, and those who had aneurysms on arteries 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.

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 on arteries in the front portion of the brain.

At Mayo Clinic, neurologists, neurosurgeons and neuroradiologists 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.