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Specific treatment for a brain aneurysm will be determined by your doctor based on:
Depending on your situation, the doctor will make recommendations for the intervention that is appropriate. Whichever intervention is chosen, the main goal is to decrease the risk of subarachnoid hemorrhage, either initially or from a repeated episode of bleeding.
Many factors are considered when making treatment decisions for a brain aneurysm. The size and location of the aneurysm, the presence or absence of symptoms, the patient's age and medical condition, and the presence or absence of other risk factors for aneurysm rupture are considered. In some cases, the aneurysm may not be treated and the patient will be closely followed by a doctor. In other cases, surgical treatment may be indicated.
Large, giant and wide-necked aneurysms can be challenging to treat with traditional methods. The pipeline embolization is a new treatment option for large or giant aneurysms with wide necks. Endovascular coiling and open neurosurgical clipping only repair the aneurysm. They do not treat the actual blood vessel, the walls of which became weak and an aneurysm was formed. Pipeline endovascular reconstruction has revolutionized the way we treat cerebral aneurysms. Only a few centers throughout the country have such technology or have physicians trained and certified to perform this procedure.
Endovascular coiling is a minimally invasive technique, which means an incision in the skull is not required to treat the brain aneurysm. Rather, a catheter is advanced from a blood vessel in the groin up into the blood vessels in the brain. Fluoroscopy (live X-ray) is used to assist in advancing the catheter to the head and into the aneurysm.
Once the catheter is in place, very tiny platinum coils are advanced through the catheter into the aneurysm. These tiny, soft, platinum coils, which are visible on X-ray, conform to the shape of the aneurysm. The coiled aneurysm becomes clotted off (embolization), preventing rupture. This procedure is performed either under general or local anesthesia.
Open craniotomy (surgical clipping). This procedure involves the surgical removal of part of the skull. The physician exposes the aneurysm and places a metal clip across the neck of the aneurysm to prevent blood flow into the aneurysm sac. Once the clipping is completed, the skull is secured back together.
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