November 13, 2017

Brain Aneurysm

Brain Aneurysm is a condition that is found in 3 to 5% of the population

Brain aneurysm simply means ballooning of the artery
Brain Aneurysm

Shapes of Brain Aneurysms

This ballooning occurs due to weakness of the wall of the artery

Brain aneurysms may blow up and cause a brain hemorrhage

And in turn brain hemorrhage is a very serious condition that can cause coma and death

If you’ve ever seen ballooning of a car tire this is exactly what brain aneurysms are

Brain Aneurysm

Most of the Times brain aneurysms do not cause any symptoms before they rupture

And therefore they are discovered incidentally during brain imaging by CT or MRI due to a different cause like for instance a headache that doesn’t go away

Brain Aneurysm

The white circle in the middle on the Brain CT image is an accidentally discovered Brain Aneurysm

In order to study brain aneurysms accurately certain radiological examination is required called CT angiography

CT angiography display an image of the brain vascular tree

The exact side of the brain aneurysm can dust be detected accurately

Also the shape and anatomical structure of the aneurysm can be studied carefully

Brain Aneurysm

CT Angiogram showing a small Brain Aneurysm

In order to study the shape of the brain aneurysm a step further a minor procedure called diagnostic brain catheter is required

Diagnostic brain catheter is performed by inserting a small tube called a catheter through the artery in the groin

The catheter is navigated under the guidance of an x-ray machine to reach the arteries of the neck

Brain Aneurysm

A Brain catheter is introduced in the human body from the artery in the groin and navigated to the arteries of the neck and brain

Once in proper place medical dye is injected through the catheter and images are obtained

Brain Aneurysm

MRI angiogram showing also a brain aneurysm

Brain Aneurysm

A Diagnostic brain catheter image showing clearly the small aneurysm seen on MRI

Brain Aneurysm

The same Aneurysm seen very clearly on brain catheter angiogram , the images are courtousy of Dr. Mostafa Farid

These images help us remarkably understand the anatomy of the Aneurysm to direct the proper treatment

Brain Aneurysm and it’s treatment

Since the year 2001, the treatment of Brain Aneurysms shifted from surgery to Endovascular, meaning by Brain catheters

As we mentioned above brain catheters are minor procedures done from the groin artery

The aim of treating a Brain Aneurysm is sealing it to prevent it’s rupture

This is done by placing a small catheter, called a Microcatheter in the Aneurysm sac and packing the sac with whirly metal devices called coils, that are introduced through the Microcatheter

Brain Aneurysm

Packing the Aneurysm sac by coils

Packing an aneurysm with coils is like packing a suit case with clothes

Coils thus have to be placed with extreme order and care to ensure they all fit properly inside the Aneurysm sac, and don’t rupture the sac, or kick out in the parent artery harbouring the Aneurysm

Coils are placed in the Aneurysm sac in order from larger to smaller, Russian dolls style

Barin Aneurysm sacs have different shapes, and the width of the Aneurysm sac is a very important determinant of the treatment technique

As the Aneurysm neck, or opening from the main artery, gets wide, the treatment is more challenging, as coils will kick out from the sac to occlude the main artery

Brain Aneurysm

First Aneurysm shows a narrow neck, the second Aneurysm shows a wide neck to sac diameter

Thus a balloon is used to seal the Brain Aneurysm sac during coiling, and when coiling has reached it’s end, the balloon is deflated and the mass of coils will remain in the Aneurysm sac

Brain Aneurysm

The balloon is used to seal the wide Aneurysm neck during coiling to prevent the coils from protruding into the parent artery

Sometimes a stent is used when the balloon fails, the stent acts as a scaffold to keep the coils in place in the Aneurysm sac and preventing them from re-entering the main artery

Brain Aneurysm

A stent scaffolds the Artery containing the Aneurysm preventing the coils from protruding in the parent vessel

Newer devices to treat Brain Aneurysms now are Flow Divertors, or Flow Diverting stents

With a Flow Divertor, the Aneurysm sac doesn’t need to be packed with coils

The Flow Diverting stent as it’s name imply will divert the blood flow from the Aneurysm sac to be just in the main artery

Brain Aneurysm

The flow Diverting stent prevents blood from entering the Aneurysm sac

Although treatment of Brain Aneurysms is becoming safer day after day, yet risk is always there

In the end, it’s still a Brain operation

Complications although less than 5% but can range from blocking arteries and Stroke, to artery perforation and death

But this risk is justified, because when a Brain Aneurysm ruptures the risk of death before reaching the hospital is 20% and for the survivors 60% aquire disabilities

A ruptured brain aneurysm is described by patients as an explosion, and by the worst headache in their lives

Brain Aneurysm

At this stage, when a person presents with a ruptured brain Aneurysm is in the ER, treatment is an emergency

As the risk of Aneurysm rebleeding is very high and is usually followed by death

If you which to ask more questions about brain aneurysms

Please feel free to contact us

+201066224292

+‎201098988641
These are our clinic’s office hotline

Or you can send me an email on

dr.mostafafarid@med.asu.edu.eg

Regards,
Dr. Mostafa Farid, MD, EDiNR
Interventional Neuroradiology Consultant
Faculty of Medicine
Ainshams University Hospital
Cairo, Egypt