Your healthcare provider will figure out the best treatment for you based on:
- How old you are
- Your overall health and past health
- How sick you are
- How well you can handle specific medicines, procedures, or therapies
- How long the condition is expected to last
- Your opinion or preference
Depending on your situation, the healthcare provider will make recommendations for the intervention that is appropriate. Whichever intervention is chosen, the main goal is to decrease the risk of subarachnoid hemorrhage, either initially or from a repeated episode of bleeding.
Many factors are considered when making treatment decisions for a cerebral aneurysm. The size and location of the aneurysm, the presence or absence of symptoms, the person’s age and medical condition, and the presence or absence of other risk factors for aneurysm rupture are considered. In some cases, the aneurysm may not be treated and the person will be closely followed by a healthcare provider. In other cases, surgical treatment may be indicated.
There are two primary surgical treatments for a cerebral aneurysm:
- Open craniotomy (surgical clipping). This procedure involves the surgical removal of part of the skull. The healthcare provider exposes the aneurysm and places a metal clip across the neck of the aneurysm to prevent blood flow into the aneurysm sac. Once the clipping is completed, the skull is secured back together.
- Endovascular coiling or coil embolization. Endovascular coiling is a minimally invasive technique. This means an incision in the skull is not needed to treat the cerebral aneurysm. Rather, a catheter is advanced from a blood vessel in the groin up into the blood vessels in the brain. Fluoroscopy (live X-ray) will be used to assist in advancing the catheter into the head and into the aneurysm. Once the catheter is in place, very tiny platinum coils are advanced through the catheter into the aneurysm. These tiny, soft, platinum coils, which are visible on X-ray, conform to the shape of the aneurysm. The coiled aneurysm becomes clotted off (embolization), preventing rupture. This procedure is performed either under general or local anesthesia.