Cerebral aneurysms can be a serious disorder. It is estimated that more than 40,000 people in Kentucky harbor an unruptured cerebral aneurysm, a small blister on a blood vessel deep in the brain. Of these so-called "incidental" aneurysms, 300 to 400 will rupture in a year. Because of the sometimes deadly complications of a rupture, the fear surrounding this diagnosis is understandable.
An incidental aneurysm often is found by CT scan or MRI when a doctor is hunting for the cause of something else, sometimes something completely unrelated to the brain such as nasal disease or neck pain.
Regardless of why the aneurysm is found, it is a very stressful event. Most people assume all aneurysms will eventually bleed, causing death or disability, but this may not be the case.
Predicting the future risk of bleeding for a particular patient is important because it helps determine whom we should treat. While current studies can be conflicting regarding which aneurysms will bleed, the major risk factors consistently shown to predict bleeding are patient age, smoking history, history of personal rupture, and size, location and shape of the aneurysm. Smoking cessation and blood pressure control seem to be the only lifestyle changes that can reduce the future risk of rupture.
While treatments for aneurysms have become increasingly safe, there are still significant risks. Because of these factors the decision to treat is sometimes very clear. Younger patients with a large, irregular-shaped aneurysm that has low surgical complexity almost always will be treated. Conversely, a tiny aneurysm in an older patient with high surgical risk should be observed. Unfortunately, most patients that we see with asymptomatic aneurysms are in the middle — middle age with middle-sized aneurysms.
Because no treatment path is associated with zero risk, the goal becomes to reduce the risk to the lowest level for that particular patient. Sometimes that will be observation, and other times it may be intervention.
The most important thing in the management of the aneurysm patient is that the treatment is individualized with all surgical options available. At times, the lowest risk to the patient may be no surgery at all.
Dr. Christian N. Ramsey is a neurosurgeon with Neurosurgical Associates at Central Baptist.