Surviving a Brain Aneurysm Hinges on the Right Treatment

SACRAMENTO, Calif. (TheImproper.com)--Many people have family members who have died from a ruptured brain aneurysm. In fact, about 30,000 Americans experience an aneurysm every year. Of these, more than 50 percent die after the rupture. Of the survivors who are able to undergo brain surgery, a minority return to their prior quality of life.

Through advances in brain imaging, we're able to obtain pictures of the insides of people's brains without much difficulty. With them, doctors are able to diagnose the un-ruptured brain aneurysm, or weak point along a blood vessel.

The telltale sign of a ruptured brain aneurysm is the proverbial "worst headache of your life." Some people pass out, become comatose, vomit, have a stiff neck, or become bothered by bright lights. You might be saying to yourself, 'Hey, I've experienced those symptoms." But if you've lived to talk about this experience, it was not an aneurysm.

A diagnosis, which usually includes a CAT scan, will show fresh blood from a ruptured brain aneurysm in most cases. If the CAT scan is negative, then a lumbar puncture is possible. If this is also negative, then you are in the clear. If it's positive, you need to see a neurosurgeon who specializes in treating brain aneurysms.

Ideally a cerebrovascular neurosurgery specialist is the best doctor to see, since it means that this person has received further training beyond the standard residency in neurosurgery. He or she will discuss the various options with you, from doing nothing, to surgery, or something called "coiling" the aneurysm.

Surgery is straightforward. The surgeon opens your skull, works between the brain crevices, finds the aneurysm and secures it with a titanium clip. Then the surgeon confirms that all other normal vessels are open and closes the head. Done properly, the aneurysm problem is erased for good.

"Coiling" is a little more involved. An artery in the groin is punctured and a catheter is fed up to the brain arteries. It's a long stretch, but this is done fairly often. At this point, a platinum "coil" is placed into the sac of the aneurysm. It is supposed to cause the aneurysm sac to clot and remove the threat of a rupture.

So why don't we coil all aneurysms? It seems easier, less risky, and doesn't require opening up the head. The answer is that coiling can result in recurrent aneurysms and can lead to complications similar to open-brain surgery. However, in the game of intuitive appeal, a catheter in the groin seems better than opening up your head. But we are still within the initial maturation phase of the brain aneurysm coiling procedure. It has been around for only 15 years compared with 70-plus years for "craniotomy," the procedure for opening the skull to treat brain aneurysms.

In the heavy industry push for implanting "coil" devices to treat cerebrovascular disease, one element is forgotten - the patient. As surgeons, once we cut someone, we generally have them as patients for life. Chances are your aneurysm will be coiled by an interventional neuroradiologist, who is quite qualified, but not trained to take care of you post-procedure.

You need to think about your brain and your brain aneurysm, and make sure you understand all of the implications for the remainder of your life, prior to agreeing to a particular treatment. When someone does a procedure, you should be able to follow up with that particular physician for all aspects of care relevant to your brain aneurysm.

How would you feel if your neurosurgeon just turned you over to your family doctor for aftercare? Well, that is what happens in many cases of brain aneurysm management. It's sad but true, but that's the influence of industry on the continuity of patient care.

Dongwoo John Chang, MD, FRCS (C) is the Chief of Cerebrovascular Neurosurgery, Chief of Epilepsy Surgery, and Co-Director of the Comprehensive Epilepsy Program of the UC Davis School of Medicine and Medical Center in Sacramento, California. A Stanford University graduate, Chang served his neurosurgery residency at McGill University Faculty of Medicine/Montreal Neurological Institute.

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