Advanced Brain Aneurysm Diagnosis & Treatment
— Safe, Precise & Minimally Invasive Neurointerventional Care
Brain Aneurysm ( Cerebral Aneurysm ) – Symptoms, Causes, Diagnosis & Treatment
A Brain Aneurysm (Cerebral Aneurysm) is a weakened area in a brain blood vessel that bulges like a balloon and may rupture, causing life-threatening brain bleeding (subarachnoid haemorrhage). Early diagnosis using advanced imaging and timely treatment with endovascular coiling, flow diverter stents, or surgical clipping can help prevent serious complications and improve patient outcomes.
What is a Brain Aneurysm?
A Brain Aneurysm is a weak or thin area in a blood vessel of the brain that bulges outward like a balloon. Due to continuous blood flow and pressure, this bulge may gradually increase in size. In some cases, an aneurysm can rupture (burst), leads to subarachnoid haemorrhage (SAH), a type of brain haemorrhage, causing bleeding in the brain.
Many brain aneurysms remain small and may not cause symptoms. However, larger aneurysms or ruptured aneurysms can lead to severe neurological complications and require immediate medical attention.
Why Does a Brain Aneurysm Occur?
A brain aneurysm develops when the wall of a blood vessel becomes weak. Several factors can increase the risk:
- High blood pressure (Hypertension)
- Smoking and tobacco use
- Family history of brain aneurysm
- Increasing age
- Excessive alcohol consumption
- Head injury
- Certain genetic disorders
Symptoms of a Brain Aneurysm ( Unruptured )
Small aneurysms may not cause any symptoms. Larger aneurysms can press on nearby nerves and brain structures, leading to:
- Persistent headaches
- Pain behind or above the eye
- Blurred or double vision
- Drooping eyelid
- Numbness or weakness on one side of the face
Symptoms of a Brain Aneurysm ( Ruptured )
A ruptured aneurysm is a medical emergency and may cause:
- Sudden severe headache ("worst headache of life")
- Nausea and vomiting
- Neck stiffness
- Seizures
- Loss of consciousness or coma
Outcome of SAH or Aneurysm ruptured:
- 10-20% of patients die before they reach the hospital.
- Risk of re-rupture and death are very high if left untreated (40-50% in a month).
- Vasospasm is a common complication that may occur 5 to 10 days after SAH. Irritating blood byproducts cause the walls of an artery to contract and spasm thereby narrows the diameter (lumen) of the artery. It reduces blood flow to that region of the brain, causing a secondary ischemic brain injury. It causes death and permanent disability in upto 20 % of patients.
How is a Brain Aneurysm Diagnosed?
- Cerebral Angiography (DSA) : Digital subtraction angiography (DSA) of brain is the gold standard technique for diagnosis of aneurysm.
- CT or MR angiography.
Brain Aneurysm Treatment Options
Treatment depends on the aneurysm’s size, location, symptoms, and risk of rupture.
- Endovascular Coiling
- Flow Diverter Stent
- Surgical Clipping
How is Endovascular Coiling Performed?
Endovascular coiling is a minimally invasive procedure used to treat brain aneurysms without open brain surgery. The procedure is typically performed in a specialized neurointerventional suite under advanced imaging guidance.
Step 1: Patient Preparation
The patient is given general anaesthesia to ensure comfort during the procedure. The treatment area is cleaned and prepared in a sterile manner.
Step 2: Catheter Insertion
A small puncture is made in an artery, usually in the groin. A thin, flexible tube called a catheter is carefully inserted into the blood vessel.
Step 3: Navigation of Microcatheter to the Aneurysm
Using real-time cerebral angiography guidance, the catheter is gently advanced through the blood vessels to reach the brain aneurysm.
Step 4: Coil Deployment
Tiny soft platinum coils are gradually placed inside the aneurysm through the microcatheter. These coils reduce blood flow into the aneurysm and promote clot formation within it.
Step 5: Additional Support Devices (If Required)
In certain cases, a balloon or stent may be used to help keep the coils securely in place and improve treatment stability.
Step 6: Final Angiographic Assessment
A final cerebral angiogram is performed to confirm successful treatment and ensure that blood flow through the normal arteries remains intact.
Step 7: Catheter Removal and Recovery
The catheter is removed, and the puncture site is closed. The patient is then monitored closely during the recovery period before discharge.
How is Flow Diverter Treatment Performed?
When is Flow divertor preferred?
- Blister aneurysms
- Very small or very large/giant aneurysms
- Wide neck & fusiform aneurysms
- Multiple aneurysms
Surgical Clipping for Brain Aneurysm
What is Surgical Clipping?
Surgical clipping is a traditional treatment option for brain aneurysms. This procedure is performed by a neurosurgeon through open brain surgery.
During the procedure, a portion of the skull is temporarily opened (craniotomy) to access the brain and locate the aneurysm. Once the aneurysm is identified, a small specially designed metallic clip is placed across its neck. This clip blocks blood flow into the aneurysm, preventing it from enlarging or rupturing while preserving normal blood flow through the surrounding arteries.
Advantages of Endovascular Coiling Over Surgical Clipping
Endovascular coiling has become one of the most widely preferred treatment options for brain aneurysms due to its minimally invasive nature and excellent clinical outcomes. Compared with traditional surgical clipping, coiling offers several important advantages for patients.
Key Benefits of Endovascular Coiling
- Minimally Invasive Treatment, no Craniotomy Required
- Lower Risk of Long-Term Seizures
- Faster Recovery
- Suitable for Complex Cases
- Simultaneous Treatment of Vasospasm
- Multiple Aneurysms Can Be Treated Together.
Why is Endovascular Coiling Commonly Preferred?
Due to its proven effectiveness, minimally invasive approach, and favourable patient outcomes, endovascular coiling has become a standard treatment option for most brain aneurysms. It offers a safer option to traditional surgical clipping while avoiding the need for open brain surgery.
In developed countries approximately 80% of aneurysm are treated by endovascular methods (Coiling & Flow diversion).