Almost all brain aneurysms should be treated to prevent them from rupturing or repair ruptured aneurysms as quickly as possible and strengthen the arteries to prevent future ruptures.
The following are some of the surgical techniques used to treat aneurysms.
3-D Computer Modeling — This technique, first performed by neurosurgeons at UCSF Medical Center, is used for difficult to treat and rare aneurysms. It produces 3-D images of the aneurysm and blood flowing through the arteries to the aneurysm. Dye is injected into arteries to track blood flow. A computer superimposes that information over brain scans to compose a 3-D model of the aneurysm. Using a computer, surgeons can test if different surgical techniques would alter blood flow enough to ease "hot spots" of pressure inside the aneurysm.
Microsurgical Clipping — A majority of aneurysms can be treated with microsurgical clipping. Aneurysms are accessed through an opening in the skull. A surgeon, using high-magnification operating microscopes, spreads apart brain tissue. A small metal clip is placed at the base of the aneurysm to tie off the bulging section of the artery. The clip must be placed without tearing the artery and causing a stroke.
Skull Base Surgery — This surgery is typically used for deep and complex aneurysms located beneath the brain. The aneurysm is accessed through the bone at the base of the skull. A surgeon accesses the aneurysm from underneath or the side of the artery. The shorter pathway causes less disturbance.
Vascular Bypass Grafting — Some aneurysms, such as those that are complex and large, require vascular bypass grafting. A vein is taken from the leg and used to connect an artery in the neck and an artery in the brain to bypass the aneurysm.
A minimally invasive alternative to surgery is endovascular treatment of brain aneurysms, known as endovascular coiling. The procedure does not require an incision in the head. It is performed under general anesthesia or light sedation, and has a shorter recovery time and hospital stay compared to conventional surgery. Endovascular therapy, however, is not recommended for all patients.
The procedure involves placing small, metal coils inside the aneurysm using a catheter or long, flexible tube. The catheter is inserted into an artery in the leg and navigated through the vascular system, into the head and aneurysm.
The coils detach from the catheter and are placed in the aneurysm, where they block blood flow and cause blood to clot, destroying the aneurysm. Coils are made of platinum so they're visible on an X-ray and flexible so they can conform to the shape of the aneurysm.
Reviewed by health care specialists at UCSF Medical Center.