Brain Aneurysm Treatments
The goal of all brain aneurysm treatments is to stop the risk of having a bleeding event in your lifetime.
Surgical Clipping is a tried and tested treatment of brain aneurysms. It involves a skin incision behind the hair line, a craniotomy in which a window of bone is removed from the skull using a special medical drill, then using a surgical microscope to maneuever in between the bone and brain to pinch off the aneurysm with a surgical clip. For certain location aneurysms which are easy to access surgically and certain shaped aneurysms with wide opening surgical clipping remains an excellent treatment option. Rarely an additional component to clipping is the need for bypass surgery.
- Durable immediate cure with little risk for recurrence
- Less long term follow up required
- More invasive with longer recovery times
- More pain with recovery
Endovascular coiling involves using a long plastic tube called a microcatheter to travel from the artery in your leg or wrist into the artery in the brain and to block off the aneurysm by filling the aneurysm with platinum wires called coils. Coiling is a very safe and effective treatment for brain aneurysms particularly for aneurysms with narrow openings or necks, and wide waists or domes. This approach is often safer for aneurysms located in the vertebrobasilar system or posterior circulation. 15% of the time aneurysms treated with way can change over time or have some regrowth therefore more follow up is needed.
- Minimally invasive and safe
- Rapid recovery time
- Longer follow up is needed to confirm cure
- Limited based on the shape of aneurysm
ADVANCED COILING TECHNIQUES
For aneurysms with wider openings or necks there are more complex approaches to supporting coils to treat brain aneurysms. These 2 options are balloon assisted coiling and stent assisted coiling. A stent is a permanent scaffold to support coils, and a balloon is a temporary one. If a stent is required then you will need to take 2 additional medications that block platelet function for 3 to 6 months after the procedure. These medications are not required if just a balloon is used.
- A minimally invasive option for aneurysms that can't be coiled alone
- Rapid recovery time
- Longer follow up is required to confirm cure
-Aneurysms with wider openings have higher chance of regrowth
- Requires dual anti-platelet medication a kind of blood thinner
FLOW DIVERTER STENTS
Flow diverter stenting is an extremely effective treatment using a finely woven stent which acts as a treatment for brain aneurysms without manipulating the aneurysm at all. The stent works best for aneurysms off of the internal carotid artery and requires patients to take 2 additional medications to block platelet function for 6 months. There are currently 4 different flow diverter stents that are FDA approved in the United States of America. They differ slightly in their sizes, lengths, outward force and stiffness. The decision on which stent is best for you requires expertise and experience in using them all. These stents have higher cure rates than coiling approaching 90% at 1 year, and 95% 3 years after the procedure.
- A minimally invasive approach for aneurysms that can't be coiled
- Higher long term cure rates than coils
- Treatment of choice for fusiform and many wide necked side-wall aneurysms
- Not FDA approved for aneurysms past the internal carotid artery
- Requires 6 months of dual anti-platelet blood thinner medication
- Aneurysm is not immediately cured
ENDOSACCULAR FLOW DISRUPTION (WEB DEVICE)
Currently there is 1 endovascular flow disruptor device available in the United States of America called the WEB device. This device was approved in 2019. The WEB is a finely woven basket shaped device that is designed to treat wide opening or necked bifurcation brain aneurysms. The WEB acts like a flow diverter but is placed inside the aneurysm. This innovative device is useful as it is designed to treat aneurysms past the internal carotid artery and also does not require the need for dual anti-platelet blood thinner medication.
- Minimally invasive approach for aneurysms with shapes that can't be coiled
- Does not require dual anti-platelet blood thinner medication
- Aneurysm recurrence rate can be as high as 25%
- It can take some time for aneurysm to be cured