Transcript of video
Two treatment options for brain aneurysms compared by a prominent cerebrovascular neurosurgeon. What causes brain aneurysms? What are symptoms of cerebral aneurysms? How to find out if you have a brain aneurysm? How to avoid death from ruptured brain aneurysm? Should you treat unruptured cerebral aneurysm? Is “clipping” or “coiling” the preferred method of brain aneurysm treatment? Two treatment options for brain aneurysms compared. Dr. Anton Titov, MD. How do you know if you’re having a brain aneurysm? Dr. Arthur L. Day, MD. Sometimes cerebral aneurysms rupture, brain aneurysm survival rate is approximately 50%. Unruptured brain aneurysm treatment should be considered after careful assessment and medical second opinion from several specialists. Medical second opinion is also required to treat ruptured brain aneurysm. Dr. Arthur L. Day, MD. Often open brain surgery and clipping is preferred for definitive treatment of ruptured brain aneurysms. Brain aneurysm treatment without surgery is possible by endovascular coiling. Endovascular aneurysm coiling has small morbidity. Treatment for Brain Aneurysms requires medical second opinion in all situations. Brain Aneurysms: To Operate or Not to Operate? You need medical second opinion to decide. Ruptured Brain Aneurysms can be treated by Aneurysm Clipping. This is a preferred method to treat ruptured brain aneurysms if patient can tolerate the surgery. Video interview with leading expert in cerebrovascular neurosurgery and minimally invasive neurosurgery. Medical second opinion confirms that cerebral aneurysm diagnosis is correct and complete. Dr. Anton Titov, MD. Medical second opinion also confirms that brain aneurysm angiography is required. Medical second opinion helps to choose the best treatment for intracranial aneurysm. Get medical second opinion on brain aneurysm and be confident that your treatment is the best. Dr. Arthur L. Day, MD. Brain aneurysms and cerebral arteriovenous malformations are common problems. Dr. Anton Titov, MD. Can you briefly describe what is a brain aneurysm? Dr. Arthur L. Day, MD. The term aneurysm refers to a dilated blood vessel. Most brain aneurysms arise from arteries because arteries are under pressure. Arteries develop a weak spot that starts to expand. It starts to balloon or to bubble. That balloon increases in size and it eventually may rupture and cause a catastrophic bleeding into the head. Brain arteriovenous malformations are other cerebrovascular problems. Cerebral arteriovenous malformations have a congenitally malformed area. The arteries and veins in this area connect in an abnormal way. This can lead to problems. One problem is a formation of brain aneurysms. Another problem is bleeding into the brain. Dr. Arthur L. Day, MD. . Many people do not know that they have an aneurysm or arteriovenous malformation in the brain. Then an emergency happens. What is the natural course of brain aneurysms and cerebral arteriovenous malformations? Dr. Arthur L. Day, MD. Most brain aneurysms develop in later life. Brain aneurysms more typically develop in women in their forties or fifties. Brain aneurysms can develop earlier. There may be a strong genetic history of cerebral aneurysms. There may be a presence of unusual circumstances. Brain aneurysms form because there is a weakness in the artery. The course of time and the pressure from heart beats and the pumping of blood from the heart cause this arterial weakness to grow. This brain artery weakness (a brain aneurysm) starts to show up. It is like a car tire that is getting weak. This weakness starts to balloon out. Weak tire eventually causes a flat tire. There are usually no warnings that aneurysm exists in the brain. Dr. Arthur L. Day, MD. Sometimes brain aneurysm grows bigger near a nerve or near some other brain anatomical structure. Then patient can have warning symptoms that cerebral aneurysm is getting ready to rupture. Usually the first time patients learn about a brain aneurysm is when brain aneurysm ruptures. Sometimes brain aneurysm ruptures. Then it causes severe headache and often death. Sometimes a patient does not die from rupture of brain aneurysm. Then neurosurgeons can treat aneurysm to make sure cerebral aneurysm rupture does not happen again. Brain MRI and CT scans are now done more often for some other reason. For example, MRI and CT is done after a car accident. Such brain scans can show that the person has a brain aneurysm. Such cerebral aneurysm discovery is called incidental discovery. In these patients we can treat brain aneurysms before they rupture and cause bleeding into the brain. Accidental discovery of unruptured brain aneurysms happens more often. This situation is happening more often now. People have more brain MRIs and CTs done for other medical problems. Sometimes we discover an unruptured brain aneurysm. Dr. Arthur L. Day, MD. Let’s imagine a person who developed a bad headache. They have a focal neurological deficit on neurological examination in an emergency room. There is loss of speech or loss of ability to move, or other sign of malfunction of nervous system, or loss of consciousness. This person will be brought to the hospital. Sometimes doctors discover that this patient has bleeding into the brain. They will ask a neurosurgeon to see this patient. Dr. Anton Titov, MD. What will neurosurgeon do with this patient to diagnose the cause of bleeding into the brain? How to treat a cerebral aneurysm? Is there other cerebrovascular problem in this patient? Dr. Arthur L. Day, MD. We first must find the cause of bleeding into the brain. Head CT scan (“cat scan”) is the first diagnostic test to do. Head CT scan can easily show blood in the brain. Location and pattern of blood in the brain can help neurosurgeons to identify a cause of bleeding. For example, a head trauma or rupture of brain aneurysm is a cause of head bleeding. We can see a bleeding from cerebral arteriovenous malformation. Head CT scan may hint that bleeding is caused by a structural vascular abnormality. For example, ruptured brain aneurysms, cerebral arteriovenous malformation can cause bleeding into the brain. We can then do a more detailed diagnostic test that shows us arteries and veins of the brain. This test is called arteriogram (angiography). One way to do brain angiography is invasive. It involves puncture of artery in arm or leg and injecting X-ray contrast dye into the brain vessels to see the arteries and veins. Another method to see brain arteries and veins is a variation of brain MRI scan or brain CT scan. It is MRI angiography or CT angiography. This method is not invasive. It does not allow us to see brain arteries and veins as good as in an invasive classical angiogram. But MRI angiography or CT angiography usually provides enough details. We can understand that there is something wrong in the brain. It could be a brain aneurysm or brain arteriovenous malformation. Dr. Arthur L. Day, MD. Sometimes ruptured brain aneurysm is indeed the cause of brain hemorrhage. Then two treatment methods can help such patient. One is open brain surgery. This is called “brain aneurysm clipping”. Neurosurgeon opens the skull and finds the brain aneurysm. Dr. Anton Titov, MD. Neurosurgeron then places a special metal clip across the neck of the brain aneurysm. Another treatment method is called “brain aneurysm coiling”. This is endovascular neurosurgery method. Endovascular neurosurgeon puts a wire into artery of the patient. The wire reaches brain aneurysm from inside the artery. Neurosurgeon puts small coils this plug the aneurysm. These coils let the blood inside brain aneurysm to coagulate. How to choose the best method of treatment of ruptured brain aneurysm? How to compare open brain surgery? There is “aneurysm clipping” and brain aneurysm “coiling”. Endovascular neurosurgeon does coiling of brain aneurysm. Dr. Anton Titov, MD. Which one of these two methods is better? Dr. Arthur L. Day, MD. Obviously, the best method of treatment of ruptured brain aneurysm is to have a team of experts. Experts should understand both open brain surgery and endovascular neurosurgery. Such team of experts can choose the best treatment for each patient. Sometimes if you only know how to do one method of treatment, you treat all brain aneurysms the same way. Sometimes a doctor knows how to use only one method of treatment. This doctor will treat all patients in the same way. But the ideal situation is to consider both open brain surgery method and endovascular neurosurgery method for each patient. Then team should pick the best method of treatment for that particular patient. Open surgical treatment of recently ruptured brain aneurysm cures the patient for the rest of patient’s life. Surgical treatment (called “brain aneurysm clipping”) is the best treatment in a young person who is in good physical shape. He is in a good state of health. “Brain aneurysm coiling” by endovascular method has a small but real probability that aneurysm will form again after many years. So open brain surgery to treat brain aneurysm is the best method. It ensures that the brain aneurysm is gone forever. For younger patients we often do open brain surgery to cure them of aneurysm. Sometimes a blood clot from ruptured brain aneurysm puts a pressure on a nerve in the brain. Or sometimes blood clot creates another neurologic deficit. Sometimes we do open brain surgery to clip the brain aneurysm. We can also drain the blood clot. This is formed in the brain after aneurysm rupture. Dr. Arthur L. Day, MD. This removes the pressure from the brain. It helps to treat neurologic deficit. Therefore, neurosurgical operation offers the best chance to a patient to recover from a neurologic deficit. You cannot do that with endovascular method of treatment of ruptured brain aneurysm. “Brain aneurysm coiling” cannot clean up blood clot in the brain. Endovascular treatment also cannot remove pressure from the brain. Putting coils into the brain aneurysm leaves its size the same. Or it makes brain aneurysm bigger than it was before endovascular treatment. Choosing the best treatment method for ruptured brain aneurysm depends on several factors. (1) age of patient, (2) skills of neurosurgeon, (3) the severity of patient’s clinical condition, and (4) what symptoms does ruptured brain aneurysm cause. All this is in addition to brain aneurysm existence. Two treatment options for brain aneurysms compared. Dr. Anton Titov, MD. Brain aneurysms: how they form? Who is at risk? To operate or not to operate unruptured brain aneurysm?