What is an Aneurysm?

A brain aneurysm can be described as a bulge that forms at a weak spot in a blood vessel in the brain, often resembling a balloon. Aneurysms typically do not show symptoms and are often detected incidentally through brain imaging methods. However, as they grow or rupture, they can lead to serious consequences.

The main treatment methods for brain aneurysms are as follows:

Surgical Intervention: This involves reaching the aneurysm by opening the skull (craniotomy) and performing surgery. Surgery is generally preferred if the aneurysm has a high risk of rupture or has reached a certain size.

Endovascular Procedures: In these techniques, guide tubes (catheters) and miniature tools are used to reach the aneurysm through the vascular system. Procedures such as placing metal coils called microcoils into the aneurysm or using stents that can be expanded with a balloon to prevent leakage are performed using this method.

Gamma Knife Radiosurgery: In some cases, stereotactic radiosurgery (Gamma Knife) can be used to treat the aneurysm. In this method, focused radiation beams are used to target the aneurysm for treatment.

Observation: Some small and low-risk aneurysms may not require treatment. In such cases, regular monitoring and observation are preferred.

It is important to have a detailed discussion with a neurosurgeon to evaluate treatment options and determine the most suitable one, as each patient and aneurysm condition is different.

What Causes Aneurysms?

Aneurysms generally form as a result of the weakening or thinning of artery walls. This weakening or thinning can typically be caused by the following factors:

Congenitally Weak Artery Wall: Some people may be born with weak artery walls, which increases the risk of developing an aneurysm.

Atherosclerosis (Vascular Plaques): Atherosclerosis is a condition caused by the buildup of fats, cholesterol, and other substances in the artery walls. These deposits can weaken artery walls and increase the risk of aneurysm formation.

Hypertension (High Blood Pressure): High blood pressure can continuously exert excessive pressure on artery walls. Over time, this can weaken the artery walls and lead to the formation of an aneurysm.

Genetic Factors: Genetic predisposition can play an important role in the formation of aneurysms. People with a family history of aneurysms have a higher risk.

Injuries or Infections: In rare cases, direct damage to the artery wall, such as from an injury or infection, can lead to the formation of an aneurysm.

Smoking: Smoking can introduce substances into the body that damage artery walls and increase the risk of aneurysms.

The mechanism of aneurysm formation can be complex, and in many cases, the interaction of multiple factors plays a role. Each patient and aneurysm condition can be different, so an individualized approach is important for treatment and management.

Treatment

Many people live their lives without being aware of this condition. If the aneurysm is small and has a lower risk of growth and bleeding based on its location, monitoring alone can be a good option. These individuals still have a small annual risk of bleeding. In addition to monitoring, medication treatment can be applied to patients with unruptured aneurysms. Patients under observation should quit smoking and keep their blood pressure under control.

Currently, the standard treatment method widely practiced is surgery. Aneurysm treatment can be performed using open surgery or endovascular methods. Both methods have their advantages and inherent risks. The most suitable method for the patient is determined by considering factors such as the type of aneurysm, the patient’s age, general condition, accompanying brain injury, and the degree of bleeding. Neither method is absolutely superior to the other.

Surgical Treatment: Through a small opening in the skull, the aneurysm is reached with the help of techniques such as microscopy, endoscopy, and fluorescent angiography, and a permanent “clip” resembling a titanium metal clamp is placed at the root of the aneurysm. This eliminates the possibility of the aneurysm bleeding again. In some cases, it may be necessary to place a catheter in the lower back to drain some of the cerebrospinal fluid before this surgery.

Endovascular Treatment (Coiling): This method can be preferred in suitable patients. The aneurysm is reached through angiography from the groin to the brain vessel where the aneurysm is located, and the aneurysm itself or the vessel it is attached to is filled and blocked with various materials. Sometimes, flow diverter tubes are placed to allow the aneurysm to shrink on its own over time. The advantage is that the skull is not opened and the anesthesia risks are lower. The disadvantage is that in case of sudden bleeding or blockage of vital vessels during the procedure, treatment options are often limited.