Intracranial Aneurysm – Types And Treatments

An intracranial aneurysm is a bulge in one of the blood vessels of the brain. The most challenging thing about this vascular condition is that it will often be asymptomatic, meaning that there are no clear symptoms of the problem. So little by little, and without the affected person noticing, this area grows which at worst can crack. If you do not act quickly in such a case, the consequences can be life-threatening.

Most of us know someone who has been in this delicate situation. There are people who, thanks to early identification of the problem, have gotten through it with quick intervention. A classic example of such an operation is embolization. People who discover the problem early may be able to continue living normally, without significant consequences. Other patients, on the other hand, have to live with the effects of a ruptured aneurysm.

No matter what case you are in, there is some information you should not forget. This is a condition that tends to occur most frequently in people between the ages of 40 and 65. Yet it can also affect younger people, and even children. Sometimes certain genetic problems or arteriovenous malformations can lead to these dangerous changes in the blood vessels of the brain.

Anyone, regardless of age and gender, can be exposed to an intracranial aneurysm. However, they are more common in people over the age of 40. They also tend to affect more women than men.

What is an intracranial aneurysm?

An intracranial aneurysm is a vascular change that can occur on an artery, or vein, in the brain. The blood flow will accumulate in this area, which thus ends up causing a dilation of the blood vessel. This area then expands in the form of a bubble, or bulge.

A study by the Department of Surgery at the College of Medicine at the University of Oklahoma explains that nearly 85% of all aneurysms are located in the same area of ​​the brain. They are usually located at the bottom of the brain, near the brain stem. This is also where we find Willis’ arterial circle.

Depending on the shape, size, and location, it is common to distinguish between three different types of intracranial aneurysms:

• Secular aneurysm. This form of aneurysm appears on artery walls. They are not congenital, and they will continue to develop and grow through the life of the patient. This is the most common type of aneurysm.

• Fusiform aneurysm. This type is much more difficult to both detect and treat. Instead of being shaped like a bubble, they tend to affect a large part of the cerebral artery, causing thrombosis.
• Dry aneurysm. This typology is less common and affects younger people. They can be caused by hereditary diseases, infections, arthritis, fibromuscular dysplasia, and atherosclerosis, among others.

What are the symptoms of an intracranial aneurysm?

As we mentioned at the beginning of the article, it is common for an intracranial aneurysm to be asymptomatic. That said, however, they will manifest symptoms if they rupture. If this happens, you need to act fast. Remember the following symptoms, they may indicate that you are suffering from a ruptured aneurysm:

• Sudden and severe headache. Many people describe it as the worst migraine they have experienced. It will be intense and paralyzing, causing stiffness in the neck, and can also lead to cracks in an eye, or even paralysis in an eye.

• Similarly, vomiting and dizziness are common.
• Sensitivity to light.
• Problems with coordination and movements.
• Difficulty thinking clearly.
• Speech disorders (aphasia).
• Loss of consciousness.

Diagnosis of an intracranial aneurysm

Physicians have different scales for evaluating the severity of an intracranial aneurysm. The most common are the Glasgow scale (used if the person has lost consciousness) and the Hunt and Hess scale . In line with the latter, the doctor will consider the following:

• Degree of headache and stiffness in the neck.
• Sleepiness and degree of mental confusion.
• Presentation of hemiparesis (paralysis of one side of the face, or at worst one side of the whole body).
• Come on. This is the condition with the highest severity and worst prognosis.

If you have a family history where this condition has been the case, experts recommend that you go for a checkup and have diagnostic tests done. The most common way to identify the presence of an intracranial aneurysm before it ruptures is by performing:

• A CT scan.
• An angiography of the brain.

On the other hand, there is also some good news for people with this condition. There are many people who go through life without ever knowing that they have an aneurysm. In other words, not all of these cerebrovascular changes end up cracking. The probability is not very high. Nevertheless, there is always a certain risk that it will burst.

Treatment

When treating an intracranial aneurysm, there are many factors to consider. The first is to assess whether the aneurysm has already ruptured or not.

Factors at the second level include the size of the aneurysm, the location, the patient’s age and whether the patient has other neurological problems as well. Still, the good news is that once a doctor has detected the aneurysm early, treatments can be very effective. In addition, the surgery required for treatment is usually not very complicated. An endovascular approach is often enough. These are the most common types of treatments:

Endovascular embolization

This procedure consists of inserting a small catheter through the patient’s groin, and then following the artery all the way to the brain. Once the catheter reaches the location, the surgeon can block the aneurysm.

For the blockage itself, the surgeon will use stents, a surgical instrument that can control and channel these pathologies.

Cerebral revascularization (bypass)

Cerebral revascularization (cerebral bypass) requires the patient to stay in the hospital for 3 to 5 days. For this procedure, the intervention is a little more complicated than the embolization. This is because this procedure requires a small craniotomy to administer the treatment. The ultimate goal is for the revascularization to regulate and reduce the abnormal blood flow to the affected artery or blood vessel.

Surgical blocking procedure

Finally, for the most severe cases, the doctor may choose a procedure that involves an incision in the skull. That said, the procedure itself is done quickly, and relatively easy to perform. Titanium instruments are inserted that will channel and treat the aneurysm.

Whatever the case may be, all of these treatments are very effective when the aneurysm has not yet ruptured. At the same time, it is important to remember that not everyone will be equally lucky. Many people will not be aware of the problem until it is too late as the condition will be asymptomatic. Nevertheless, it is important to keep in mind the information about the symptoms that occur once it has ruptured. Your knowledge can be what makes the difference between life and death.