What Is An Aneurism?
A Stroke is the ultimate “Brain Attack.” It can strike the young, healthy, productive head of a household during a soft, shared moment with a spouse — anytime. Nothing is more frightening.
One might hear: “I’m having the worst headache of my life!” Or, “Oh, my neck is so stiff!” Then the victim might vomit, perhaps have a convulsion that leaves them comatose and all bystanders truly frightened.
There is lots to be done, and in a very short time frame. Backtracking a bit, it is important to get an instant education on the “Brain Attack.”
The blood vessels at the base of the brain have the capability to control and even commandeer blood to supply the brain as conditions demand. When we lie down, these vessels constrict automatically to prevent the brain from being flooded with an oversupply. When we jump up, these vessels make sure that the heart not only pumps harder, but also that the other blood vessels open up enough to handle the increased volume required by the brain. Thus, these blood vessels have three things that are needed for survival:
People who grow aneurysms have an inborn problem with the elasticity part of these blood vessels. The elastic layer is not formed properly. This weaker part of the blood vessel begins to bulge and balloon over the years.
It is this bulge that is actually called the “aneurysm.” It develops in places where the pressure is greatest — usually where the vessels divide into multiple routes. It enlarges and enlarges, and enlarges further still. Eventually, the chance of “popping” like an over inflated balloon becomes real. When the local blood pressure exceeds the strength of that vessel’s weak point, the danger of rupture is at hand.
The aneurysm can be seen by a number of techniques, the most reliable and accurate of which is an ANGIOGRAM. A catheter is passed into the vessels at the base of the brain and a radio-opaque dye (called contrast) is injected while X-Rays are taken. This study sets up the road map of the blood supply to the brain, and brings the anatomy of the aneurysm to light. Other, less invasive ways to do angiography include MRI scanning (MRAngiography) and the Spiral CT Scan using intravenous rather than intra-arterial contrast. These studies give a 3-D character to the images, making them particularly helpful to the surgeon.
Aneurysms can also be cured by other techniques in selected cases. A revolution (some call it a rapidly expanding evolution) is occurring in the technology of “interventional radiology,” allowing doctors to fill aneurysms with metal coils, glue, balloons, and even stents.
The treatment decision for observation, surgical clipping or bypass, or endovascular coiling largely depends on the aneurysm’s size, location, and neck geometry. The less invasive nature of coiling is likely to be favored in patients who are older, are in poor health, have serious medical conditions, or have aneurysms in certain locations. In patients younger than 40 years of age, the difference in the safety between coiling versus clipping is small. Therefore, the better long-term protection from bleeding may give patients with clipped aneurysms an advantage in life expectancy.
At Salus our surgeons perform the following surgical procedures to treat Unruptured Aneurisms: