Brain Aneurysm is a condition that is found in 3 to 5% of the population
Brain aneurysm simply means ballooning of the artery
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
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
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
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
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
MRI angiogram showing also a brain aneurysm
A Diagnostic brain catheter image showing clearly the small aneurysm seen on MRI
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
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
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
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
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
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
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
+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