Brain Aneurysms are abnormal dilatations of the cerebral arteries. The danger of cerebral aneurysms comes from their propensity to rupture, causing subarachnoid hemorrhage. Aneurysms can be safely and successfully treated with endovascular coil embolization, where a catheter is placed from the femoral artery into the brain, and metallic coils are used to obliterate the aneurysm sac from within.
Predisposing factors for aneurysm formation can be familial, congenital, or acquired. Modifiable risk factors for aneurysm formation include hypertension and smoking. Aneurysms are often asymptomatic and found incidentally during the work-up of other conditions. Ideally aneurysms will be found at this point and treated before rupture. The overall rupture rate is approximately 1.5% per year, though this can vary with size. This risk is cumulative. Once an aneurysm ruptures, the mortality and morbidity is very high.
Patients with symptomatic aneurysms typically present with either an acute cranial nerve deficit or subarachnoid hemorrhage (SAH). SAH is classically described by patients as the “worst headache of [their] life.” Ruptured aneurysms should be treated promptly, as there is a very high rate of re-bleeding.
Once an aneurysm is discovered, a patient can expect to have one or more imaging tests, including magnetic resonance angiography (MRA), computed tomography angiography (CTA), or digital subtraction angiography (DSA). Evaluation for treatment should include discussion with an interventional neuroradiologist.
The two major treatment modalities are endovascular embolization or “coiling” and neurosurgical repair or “clipping.” For ruptured aneurysms, the data to date show an improved survival with coiling compared to surgical clipping. Coiling is performed at Maimonides by the Interventional Neuroradiology service. A catheter is placed through the femoral artery into the target artery in the brain. Multiple platinum coils are then positioned into the aneurysm using X-ray guidance, filling it from the inside. Recovery is usually rapid, without the need for extended hospital stay or convalescence.
The best outcomes for ruptured and unruptured aneurysms have been shown to occur in centers that have experienced vascular neurosurgeons and endovascular interventional neuroradiologists. Our center's experience in endovascular treatment of aneurysms is among the largest in the New York Metropolitan area.