Types of disorders
Types of disorders | Aneurysm
An aneurysm is a weak spot in a blood vessel wall. In time, a bulge will appear at this location. One assumes that in most cases this weakness is congenital, which after a while grows into a arterial bulge (aneurysm). An aneurysm is usually an expansion or dilation of the entire blood vessel itself (eg, aneurysm of the abdominal aorta), but in the brain one sees bag-shaped bulges (blebs) located at the junction of blood vessels (see figure). These intracranial aneuysms have an increased risk of bleeding. Such a hemorrhage can have different symptoms, such as sudden severe headache with nausea and vomiting and even death. Also, the aneurysm can grow so large that it creates pressure on nearby brain or nerve tissue leading to neurologic symptoms (eg, speech problems, double vision, paralysis ...).
A cerebral aneurysm can occur at any age and both men and women. It is believed that such an aneurysm grows gradually. In general, an aneurysm is only a few millimeters in size. Usually, a cerebral aneurysm is discovered because someone gets a brain hemorrhage. Such a brain hemorrhage is seen especially in women at age 40 to 60 years old. This is a special type of stroke, called a subarchnoid hemorrhage (SAH). The bleeding is not only at the site of the aneurysm, but spreads in the head around the brain and to the neck. Such a bleeding is very severe with a high mortality and morbidity as a result. In the people who survive the initial bleeding, the cause of bleeding, the aneurysm, needs to be treated as soon as possible, because the chance of a second bleeding out of the aneurysm is very high. Such a rebleed has a very bad outcome.
Sometimes a cerebral aneurysm is discovered by chance on a scanner. In such case, an assessment is made by our team whether the aneurysm should be treated or that a follow-up is appropriate. We discuss this in our consultation.
The diagnosis of a brain subarchnoid hemorrhage is made on a CT scan. Subsequently, an angiography (blood vessel study) is made to detect the aneurysm. The angiography study is described in the chapter endovascular treatments.
The treatment of a bleb cerebral aneurysm consists of closure to prevent further bleeding. This occlusion is done under general anesthesia, by means of an operation. In most cases, an endovascular embolization by the interventional neuroradiologist is done. With this technique, the aneurysm is closed from within the blood vessel using a catheter. The aneurysm is filled with specially developed "coils" (spirals/thin threads), This is also known as aneurysm "coiling".
Sometimes a stent needs to be placed. A stent is a tube with a meshwork that both reinforces the blood vessel wall, reduces the size of the opening ("neck") of the aneurysm, and helps to keep the inserted coils in place.
When an endovascular treatment is not possible, the aneurysm can be treated the “classical” way via the skull by a neurosurgical operation under general anesthesia. Through a limited opening in the skull bone the aneurysm is reached from the outside. The aneurysm is closed by the placement of a clip (small “clothespin”) at the transition from the aneurysm to the normal blood vessel.
For a more detailed description of the different treatments you can look under the chapter treatments.