Treatments and drugsBy Mayo Clinic Staff
There are two common treatment options for a ruptured brain aneurysm.
- Surgical clipping is a procedure to close off an aneurysm. The neurosurgeon removes a section of your skull to access the aneurysm and locates the blood vessel that feeds the aneurysm. Then he or she places a tiny metal clip on the neck of the aneurysm to stop blood flow to it.
Endovascular coiling is a less invasive procedure than surgical clipping. The surgeon inserts a hollow plastic tube (catheter) into an artery, usually in your groin, and threads it through your body to the aneurysm.
He or she then uses a guide wire to push a soft platinum wire through the catheter and into the aneurysm. The wire coils up inside the aneurysm, disrupts the blood flow and causes blood to clot. This clotting essentially seals off the aneurysm from the artery.
Both procedures pose risks, particularly bleeding in the brain or loss of blood flow to the brain. The endovascular coil is less invasive and may be initially safer, but it also has a higher risk of subsequent re-bleeding, and additional procedures may be necessary.
There are new treatments available for brain aneurysm, including those called flow diverters. These may be particularly useful in larger aneurysms which cannot be safely treated with other options.
Your neurosurgeon or interventional neuroradiologist, in collaboration with your neurologist, will make a recommendation based on the size, location and overall appearance of the brain aneurysm, your ability to undergo a procedure, and other factors.
Other treatments for ruptured brain aneurysms are aimed at relieving symptoms and managing complications.
- Pain relievers, such as acetaminophen (Tylenol, others), may be used to treat headache pain.
Calcium channel blockers prevent calcium from entering cells of the blood vessel walls. These medications may lessen the erratic narrowing of blood vessels (vasospasm) that may be a complication of a ruptured aneurysm.
One of these medications, nimodipine (Nymalize), has been shown to reduce the risk of delayed brain injury caused by insufficient blood flow after subarachnoid hemorrhage of a ruptured aneurysm.
Interventions to prevent stroke from insufficient blood flow include intravenous injections of a drug called a vasopressor, which elevates blood pressure to overcome the resistance of narrowed blood vessels.
An alternative intervention to prevent stroke is angioplasty. In this procedure, a surgeon uses a catheter to inflate a tiny balloon that expands a narrowed blood vessel in the brain. A catheter may also be used to deliver to the brain a drug called a vasodilator, which causes blood vessels to expand.
- Anti-seizure medications may be used to treat seizures related to a ruptured aneurysm. These medications include levetiracetam (Keppra), phenytoin (Dilantin, Phenytek, others), valproic acid (Depakene) and others.
Ventricular or lumbar draining catheters and shunt surgery can lessen pressure on the brain from excess cerebrospinal fluid (hydrocephalus) associated with a ruptured aneurysm. A catheter may be placed in the spaces filled with fluid inside of the brain (ventricles) or surrounding your brain and spinal cord to drain the excess fluid into an external bag.
Sometimes it may then be necessary to introduce a shunt system — which consists of a flexible silicone rubber tube (shunt) and a valve — that creates a drainage channel starting in your brain and ending in your abdominal cavity.
- Rehabilitative therapy. Damage to the brain from a subarachnoid hemorrhage may result in the need for physical, speech and occupational therapy to relearn skills.
Treating unruptured brain aneurysms
Surgical clipping or endovascular coiling can be used to seal off an unruptured brain aneurysm and help prevent a future rupture. However, in some unruptured aneurysms, the known risks of the procedures may outweigh the potential benefit.
A neurologist, in collaboration with a neurosurgeon or interventional neuroradiologist, can help you determine whether the treatment is appropriate for you.
Factors that they would consider in making a recommendation include:
- The size, location and overall appearance of the aneurysm
- Your age and general health
- Family history of ruptured aneurysms
- Congenital conditions that increase the risk of a ruptured aneurysm
If you have high blood pressure, talk to your doctor about medication to manage the condition. If you have a brain aneurysm, proper control of blood pressure may lower the risk of rupture.
In addition, if you smoke cigarettes, talk with your provider about strategies to stop smoking since cigarette smoking may be a risk factor for formation, growth and rupture of the aneurysm.
Sept. 01, 2015
- Williams LN, et al. Management of unruptured intracranial aneurysms. Neurology Clinical Practice. 2013;3:99.
- Meyers PM, et al. Indications for the performance of intracranial endovascular neurointerventional procedures: A scientific statement from the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research. Circulation. 2009;119:2235.
- Cerebral aneurysm fact sheet. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/cerebral_aneurysm/detail_cerebral_aneurysm.htm. Accessed March 4, 2014.
- Cerebral aneurysm. American Association of Neurological Surgeons. http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Cerebral%20Aneurysm.aspx. Accessed March 4, 2014.
- Daroff RB, et al. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. https://www.clinicalkey.com. Accessed March 4, 2014.
- Singer RJ, et al. Unruptured intracranial aneurysms. http://www.uptodate.com/home. Accessed March 4, 2014.
- Raper DM, et al. Seizures after aneurysmal subarachnoid hemorrhage: A systematic review of outcomes. World Neurosurgery. 2013;79:682.
- Brown RD (expert opinion). Mayo Clinic, Rochester, Minn. March 9, 2014.
- Brown RD, et al. Screening for brain aneurysm in the Familial Intracranial Aneurysm study: Frequency and predictors of lesion detection. Journal of Neurosurgery. 2008;108:1132.
- Hasan DM, et al. Aspirin as a promising agent for decreasing incidence of cerebral aneurysm. Stroke. 2011;42:3156.
- Lanzino G (expert opinion). Mayo Clinic, Rochester, Minn. March 18, 2014.
- Brinjikji W, et al. Endovascular treatment of intracranial aneurysms with flow diverters: A meta-analysis. Stroke. 2013;44:442.
- Brinjikji W, et al. Estimating the proportion of intracranial aneurysms likely to be amenable to treatment with the pipeline embolization device. Journal of Neurointerventional Surgery. 2013;5:45.
- Stryker Neurovascular. Safety and Effectiveness of an Intracranial Aneurysm Embolization System for Treating Large or Giant Wide Neck Aneurysms (SCENT). ClinicalTrials.gov. http://www.clinicaltrials.gov/ct2/show/NCT01716117?term=aneurysm&rank=1. Accessed March 20, 2014.