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Treatment

  • The purpose of treatment is to prevent rebleeding. Sometimes, for a patient with an unruptured aneurysm, observation alone may be appropriate. 

    At the hospital, a team of neurosurgeons and interventional neuroradiologists recommend and perform treatment for each patient's unique needs. A number of factors, including the patient's medical condition and age, must be considered carefully in choosing the appropriate treatment. There are two main procedures to treat brain aneurysms.

    Endovascular treatment

    Patients undergo general anesthesia for this procedure, which takes place in a radiology suite. It's performed by an interventional neuroradiologist, a doctor who specializes in radiology interventions (minimally invasive procedures) of the brain, spine and nerves.

    The interventional neuroradiologist inserts a long, narrow catheter to an artery in the groin and, using imaging guidance, guides it to the aneurysm in the brain. Most commonly, the doctor threads small coils through the catheter into the aneurysm. These coils fill the aneurysm and help to prevent it from bleeding again

    • Complications: Risk of stroke and rupture of the aneurysm during the procedure.
    • Advantage: Endovascular treatment avoids open surgery on the brain. 
    • Disadvantage: Some aneurysms treated endovascularly grow back.

    Surgery to clip the aneurysm

    The patient undergoes general anesthesia in the operating room. The neurosurgeon makes an incision to open the skull, then gently lifts the brain to reach the arteries below it.

    Using an operating microscope, the neurosurgeon finds the aneurysm and closes it off with a small metal clip. This prevents the aneurysm from filling with blood and bleeding again.

    • Complications: Infection, bleeding during or after surgery which would create a stroke, permanent or transient brain injury or death. Risks of general anesthesia that are present in any surgery also apply. Complication rates vary with the location of the aneurysm.
    • Advantage: If surgery goes well, it permanently repairs the aneurysm, and the patient should not need further treatment.
    • Disadvantage: The risks of open surgery on the brain.

    Treatment for AVMs

    The purpose of treatment is to prevent rebleeding.

    At the hospital, a team of neurosurgeons and interventional neuroradiologists recommend and perform treatment for each patient's unique needs. A number of factors, including the patient's medical condition and age, must be considered carefully in choosing the appropriate treatment. There are two main procedures to treat brain AVMs.

    Endovascular treatment

    Patients undergo general anesthesia for this procedure, which takes place in a radiology suite. It's performed by an interventional neuroradiologist, a doctor who specializes in radiology interventions (minimally invasive procedures) of the brain, spine and nerves.

    The interventional neuroradiologist inserts a long, narrow catheter to an artery in the groin and, using imaging guidance, guides it to the AVM in the brain. A special type of “glue” is used that stops blood flow to the AVM preventing rebleeding.

    • Complications: Risk of stroke and rupture of the AVM during the procedure.
    • Advantage: Gluing avoids open surgery on the brain. 

    Surgery to remove the AVM

    The patient undergoes general anesthesia in the operating room. The neurosurgeon makes an incision to open the skull. Using an operating microscope, the neurosurgeon finds the AVM and removes it. This prevents the AVM from recurring and bleeding again.

    • Complications: Infection, bleeding during or after surgery which would create a stroke, permanent or transient brain injury or death. Risks of general anesthesia that are present in any surgery also apply. Complication rates vary with the location of the aneurysm.
    • Advantage: If surgery goes well, it permanently repairs the aneurysm, and the patient should not need further treatment.
    • Disadvantage: The risks of open surgery on the brain.