Should unruptured brain aneurysms be treated? 3

Should unruptured brain aneurysms be treated? 3

Should unruptured brain aneurysms be treated? 3

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If somebody has a brain aneurysm or arteriovenous malformation that was discovered before it ruptured, or before it created an emergency situation. Dr. P. Roc Chen, MD. That's a very unfortunate fact that a lot of brain aneurysms discovered when they rupture. And that has a very high mortality, a lot of people die once rupture happens. On the other hand, before the aneurysm ruptures or before there is problem with arteriovenous malformation, patients can go to treatment anywhere in the world. In which situations patients would particularly benefit from your expertise in endovascular methods and open brain surgery, and therefore they can fly anywhere in the world for treatment before it becomes an emergency? You point very clearly - the world is flat these days, I mean, really the treatment, the healthcare changes drastically in the entire world, including the US. Obviously, technically neuroimaging is way more advanced over the past 20 years than before. Therefore, we've seen more and more patients who were found with brain aneurysms or so-called arteriovenous malformations, or anything in the brain that would not be identified previously. And the good part is that whatever is identified, for example, unruptured brain aneurysms, these patients have no symptoms. So they certainly can get treatment anywhere in the world, just like you said. I think that it's quite true, these patients, certainly, if they do want the treatment, they can be treated anywhere where they feel more comfortable, they can be treated here - we do treat a fair amount of international patients, including from Asia, Europe, and the Middle East. The key element in the unruptured brain aneurysm, as an example, - certain aneurysms do carry a higher risk of a rupture, and for some aneurysms we know at the very small size they might not carry as high risk of a rupture. First, we need to assess a brain aneurysm - whether it's beneficial or not to treat it. Ideally at this point we want to have a more objective and meaningful idea to assess [brain aneurysm rupture risk]. However, I would say that some brain aneurysm rupture risk assessment methods are still very controversial. Unfortunately, if brain aneurysms rupture, then treatment is often done locally, because patients with ruptured brain aneurysms cannot travel that far. But for an AVM, it's a different story. [ArterioVenous Malformation] When AVMs rupture, the key risk factor been taken cared of. Often, mortality is not that high from a single AVM rupture. It is the repeat AVM rupture that presents a problem. - Right! So we come down to the question - we know at this point that for unruptured AVM the chances of the first rupture in less known. But for the ruptured AVM, the risk of repeat rupture we know - it's high at this point. I don't there's any question that these patients deserve treatment to prevent re-bleed, because otherwise they continue to re-bleed. This is one big issue. At the same time, the risk of AVM bleeding in short period of time is not that high. These patients certainly can travel once they get over the critical phase of recovery [after first AVM bleeding], they can travel anywhere to to get treated. We treat a lot of patients like this, from different states, local patients, and from different countries. The same is with a carotid disease and similar lesions...

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