New treatments for brain aneurysms are giving hope to patients who have been told that their aneurysms are inoperable or to those whose aneurysms have been treated and have recurred.
A brain aneurysm occurs as a weakness in the blood vessels that supply blood to the brain. The weakness will frequently "balloon outward," creating pressure on nearby brain structures that can cause a range of symptoms.
Unfortunately, aneurysms usually occur without symptoms, with the first sign of trouble being the unexpected rupture of the blood vessel. This causes catastrophic brain hemorrhage, killing up to 60 percent of its victims. Those who live through such an event might be left with severe disability.
For 60 years, the gold standard of treatment for aneurysms has been brain surgery to place a clip at the base of the aneurysm. The clip protects the aneurysm from high pressure that can cause rupture.
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In the 1990s, treatments called aneurysm coiling had the advantage of being performed through a catheter placed in the patient's groin rather than requiring brain surgery. Through this catheter, many tiny coils are placed in the aneurysm until it is full. The blood among those coils then clots and walls off the aneurysm.
The disadvantage of coiling is that aneurysm recurrence happens slightly more often than with clipping. With coiling, the aneurysm still exists and occupies excess space in the brain and can produce ongoing symptoms.
A more recent advance in aneurysm treatment uses minimally invasive surgical techniques and involves a gluelike substance called Onyx, which fills the aneurysm. The advantage of Onyx is that it fills the aneurysm completely, giving it better durability than coiling.
The most recent treatment for large and complicated aneurysms is the pipeline embolization device, the first of a new class of FDA-approved devices known as flow diverters. This novel, stentlike device is braided into a flexible mesh tube that is then implanted across the opening to the aneurysm, diverting flow into the normal blood vessel.
This flow diversion shields the aneurysm from the high pressures inside of the aneurysm, allowing a blood clot to form at the base of the aneurysm to permanently prevent bleeding and encourage normal vessel healing. The aneurysm shrinks over time so it can no longer occupy brain space or cause troublesome symptoms.