3 Ways to Stop Brain Aneurysms From Leaking or Bursting

Aneurysms — balloon-like weakness of the blood vessels — are especially dangerous in the brain. While some pose no threat, others are at risk for bleeding and/or can steadily grow. They balloon out and fill with blood. This may compress nerves and tissues, triggering headaches and facial numbness.

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The worst-case scenario: Aneurysms can hemorrhage or burst, flooding the brain with blood. “This causes a really devastating type of stroke that, for one-third of patients, is potentially life-ending,” says neurosurgeon Peter Rasmussen, MD. Doctors treat aneurysms to prevent stroke in three major ways:

1. Surgical clipping

The most traditional procedure, surgical clipping requires general anesthesia and starts with an incision in your scalp.

“We make an opening, or a window, in the skull,” explains Dr. Rasmussen. “Using a powerful surgical microscope armed with a bright light, we locate the aneurysm, place a small metal spring-clip on it, and pinch it off.” After confirming the repair, surgeons close the wound.

“It may seem like a lot to go through,” he says. “But when you leave the hospital with your aneurysm repaired, you’ll be at exceedingly low — or no — risk of hemorrhage.”

2. Coiling

In the mid-1990s, the technology for treating aneurysms advanced quickly. Guided by fluoroscopy or X-rays, surgeons could gently thread catheters through the body’s blood vessels up to the brain. Today, 70 to 80 percent of aneurysm patients can be treated with coiling or other endovascular techniques.

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Typically, small, soft platinum coils — mounted on a wire sent through the catheter — are deposited in the aneurysm. “A clot forms around them, sealing the aneurysm from within,” says Dr. Rasmussen. For aneurysms with wide openings, stents can be added to keep the coils in place.

“Patients are briefly hospitalized, have minimal pain or discomfort and can return to work within a few days,” says Dr. Rasmussen.

3. Flow diverter

Giant carotid artery aneurysms once meant complex, lengthy, high-risk surgeries. The arrival of a special stent in the early 2010s changed all that.

“We can cover aneurysms with these stents in about 15 minutes,” says neurosurgeon Mark Bain, MD. “There is very little pain and a quick recovery period.” Cleveland Clinic endovascular neurosurgeons were among the first to use the flow diverter to treat giant aneurysms.

They advance the braided metal mesh tube through a catheter into the brain, lay it across the aneurysm opening, and expand it so that it’s flush with the vessel wall.

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“The flow diverter does two things,” says Dr. Bain. “It causes the aneurysm to clot off and keeps an important blood vessel to the brain open.” In about six months, blood flow through the aneurysm ceases, and blood vessel cells grow over the stent to create a permanent seal.

An individual choice

All three procedures have their risks and benefits. And they are equally safe. “Your choice of treatment should be a personal one centered on the type of aneurysm, its location, your medical condition, and what’s right for you as a human being,” says Dr. Rasmussen.

In fact, not all aneurysms require treatment, he points out. Those that pose minimal risk can simply be watched over time.

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