What are brain aneurysms?
At risk of oversimplifying, I often tell my patients to think of brain aneurysms as a plumbing problem.
Brain aneurysms are created when a weak area of a blood vessel wall is subjected to the normal pulsations of the blood vessel and heart, which causes the spot to swell and bulge. Such weak spots often occur at points where blood vessels divide and pressure from blood flow is the highest.
When brain aneurysms get larger, they can rupture, resulting in bleeding and irritation of the brain – also known as a hemorrhagic stroke. When this happens, many patients have said they’ve experienced the “worst headache of my life.” Until then, warning signs of rupture are rare.
Why is this important?
Brain aneurysms can happen to anyone at any age. Between 1.5 to 5 percent of the general population has or will have one, and the occurrences happen twice as often in women compared with men. But if aneurysms are detected and treated before a rupture occurs, some of the strokes caused by brain aneurysms can be prevented.
Brain aneurysms are usually found during evaluations for other medical conditions. In many people, they don’t cause symptoms.
As a neurosurgeon at UT Southwestern, one of my goals is to increase awareness of this condition. It’s important for people to understand the impact aneurysms can have and what options we have for treating them.
Preventing aneurysms by changing blood flow
The best time to treat an aneurysm is before brain bleeding occurs.
A relatively new option for treatment is flow diversion. This is a minimally invasive endovascular technique, meaning we access the treatment area from an artery in the leg, similar to many common cardiac procedures, but in this procedure the goal is to direct blood flow away from the aneurysm – essentially correcting the plumbing problem in the brain to prevent a leak.
Current results with flow diversion show an improved rate of occlusion (or blockage) over time. In fact, when blood flow is redirected, scar tissue may form, and the brain aneurysm may simply shrivel away.
How safe is flow diversion?
At UT Southwestern, we have proven success with this new flow-diversion technique as an option for patients with an unruptured brain aneurysm, including those who have a wide, spindle-shaped (fusiform) aneurysm and those who have a higher than average chance for recurrence.
The placement of a flow-diverting stent requires patients to take blood-thinning medications for three to six months for safety reasons. As a result, individuals with chronic nosebleeds, stomach ulcers, heavy menstrual periods, or other issues that inhibit blood from clotting are not candidates for this or many other endovascular treatments.
It is safest to have this procedure performed in a center like UT Southwestern – where specialists in neurosurgery, neuroradiology, neuroanesthesiology, and neurocritical care work are all part of your team. When treated at an advanced comprehensive stroke center, patients can also explore other treatment alternatives, including coil embolization and surgery.
It is important to emphasize that while endovascular treatments like flow diversion are less invasive, that is not the same as less risky. It is important that all of your options are available and discussed with you.
Aneurysm risk factors
With detection of brain aneurysms and the use of pre-emptive treatments like flow diversion, we are able to decrease the chances of patients having hemorrhagic strokes.
Some of the risk factors for brain aneurysms include:
- Family history of brain aneurysms
- Health problems such as chronic hypertension, bicuspid aortic valve, Marfan’s syndrome, or polycystic kidney disease