Aneurysm (Brain) (cont.)
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What is the treatment for a brain aneurysm?
Treatment for unruptured intracranial aneurysms is very controversial. Some investigators suggest that aneurysms less than 10 mm be left alone while those larger than that should be considered for treatment in patients less than 50 years old. The controversy lies in the surgical mortality and morbidity of surgically treated aneurysms. The mortality (death) rates can be as high as 3.8% and the morbidity (development of complications) can be as high as 15.7%. Many investigators suggest that aneurysms larger than 10 mm that are not associated with symptoms should be considered for treatment, especially in patients with coexisting medical conditions. Surgical treatment (clipping, in which the surgeon places a clip at the base of the aneurysm) is less likely in patients who have poor health or other serious medical conditions. Endovascular therapy or coiling (in which a small thin platinum wire is coiled into the aneurysm by a catheter in the blood vessel) is another surgical technique that can result in obliteration of the aneurysm. The goal of treatment for unruptured intracranial aneurysms is to prevent bleeding into the brain.
Ongoing bleeding of a brain aneurysm usually requires consultation with a neurosurgeon, interventional radiologist, and/or a neurologist. These individuals decide if surgery or interventional therapies such as coiling will be of benefit to the patient. For example, the neurosurgeon may decide to suction blood out of the area if it's not too large and hasn't caused catastrophic brain damage. Bleeding from a brain aneurysm is a medical emergency. Medical treatments for brain aneurysms that have bled are designed to reduce and/or alleviate symptoms. Nimodipine is used to prevent or relieve abnormal spasms of the arteries within the brain. Anti-epileptic drugs like phenytoin are used to treat and prevent seizures. Antihypertensive medications like labetalol can help reduce pressure on the blood vessel walls in the brain to lessen the chance of bleeding.
What is the survival rate and prognosis for a brain aneurysm?
Researchers estimate that about 6 million people in United States have an unruptured brain aneurysm, and about 10% to 15% of these people will have more than one brain aneurysm. Someone with an unruptured brain aneurysm has about a 1% chance of the aneurysm rupturing per year. Patients with “giant” aneurysms (1 inch or greater in diameter) have a much higher risk of rupture. The survival rate for those with a ruptured brain aneurysm is about 60% (40% die). For those who survive and recover, about 66% have some permanent neurological defect. In summary, patients with small brain aneurysms that do not rupture (about 80%) have a very good prognosis while those who suffer a rupture have a fair to poor prognosis.
Can brain aneurysms be prevented?
Most brain aneurysms cannot be prevented; however, certain types of lifestyle modification -- such as avoiding illicit drugs and overuse of alcohol -- may reduce the risk of a brain aneurysm. Some brain aneurysms may be treated with surgical techniques that reduce the risk of rupture.
Medically reviewed by Joseph Carcione, DO; American board of Psychiatry and Neurology
Medically Reviewed by a Doctor on 10/3/2016
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