There are two common treatment options for a ruptured brain aneurysm.
- Surgical clipping is a procedure to close off an aneurysm. The neurosurgeon removes a section of your skull to access the aneurysm and locates the blood vessel that feeds the aneurysm. Then he or she places a tiny metal clip on the neck of the aneurysm to stop blood flow to it.
Endovascular coiling is a less invasive procedure than surgical clipping. The surgeon inserts a hollow plastic tube (catheter) into an artery, usually in your groin, and threads it through your body to the aneurysm.
He or she then uses a guide wire to push a soft platinum wire through the catheter and into the aneurysm. The wire coils up inside the aneurysm, disrupts the blood flow and causes blood to clot. This clotting essentially seals off the aneurysm from the artery.
Both procedures pose risks, particularly bleeding in the brain or loss of blood flow to the brain. The endovascular coil is less invasive and may be initially safer, but it also has a higher risk of subsequent re-bleeding, and additional procedures may be necessary.
There are new treatments available for brain aneurysm, including those called flow diverters. These may be particularly useful in larger aneurysms which cannot be safely treated with other options.
Your neurosurgeon or interventional neuroradiologist, in collaboration with your neurologist, will make a recommendation based on the size, location and overall appearance of the brain aneurysm, your ability to undergo a procedure, and other factors.
Other treatments for ruptured brain aneurysms are aimed at relieving symptoms and managing complications.
- Pain relievers, such as acetaminophen (Tylenol, others), may be used to treat headache pain.
Calcium channel blockers prevent calcium from entering cells of the blood vessel walls. These medications may lessen the erratic narrowing of blood vessels (vasospasm) that may be a complication of a ruptured aneurysm.
One of these medications, nimodipine (Nymalize), has been shown to reduce the risk of delayed brain injury caused by insufficient blood flow after subarachnoid hemorrhage of a ruptured aneurysm.
Interventions to prevent stroke from insufficient blood flow include intravenous injections of a drug called a vasopressor, which elevates blood pressure to overcome the resistance of narrowed blood vessels.
An alternative intervention to prevent stroke is angioplasty. In this procedure, a surgeon uses a catheter to inflate a tiny balloon that expands a narrowed blood vessel in the brain. A catheter may also be used to deliver to the brain a drug called a vasodilator, which causes blood vessels to expand.
- Anti-seizure medications may be used to treat seizures related to a ruptured aneurysm. These medications include levetiracetam (Keppra), phenytoin (Dilantin, Phenytek, others), valproic acid (Depakene) and others.
Ventricular or lumbar draining catheters and shunt surgery can lessen pressure on the brain from excess cerebrospinal fluid (hydrocephalus) associated with a ruptured aneurysm. A catheter may be placed in the spaces filled with fluid inside of the brain (ventricles) or surrounding your brain and spinal cord to drain the excess fluid into an external bag.
Sometimes it may then be necessary to introduce a shunt system — which consists of a flexible silicone rubber tube (shunt) and a valve — that creates a drainage channel starting in your brain and ending in your abdominal cavity.
- Rehabilitative therapy. Damage to the brain from a subarachnoid hemorrhage may result in the need for physical, speech and occupational therapy to relearn skills.
Treating unruptured brain aneurysms
Surgical clipping or endovascular coiling can be used to seal off an unruptured brain aneurysm and help prevent a future rupture. However, in some unruptured aneurysms, the known risks of the procedures may outweigh the potential benefit.
A neurologist, in collaboration with a neurosurgeon or interventional neuroradiologist, can help you determine whether the treatment is appropriate for you.
Factors that they would consider in making a recommendation include:
- The size, location and overall appearance of the aneurysm
- Your age and general health
- Family history of ruptured aneurysms
- Congenital conditions that increase the risk of a ruptured aneurysm
If you have high blood pressure, talk to your doctor about medication to manage the condition. If you have a brain aneurysm, proper control of blood pressure may lower the risk of rupture.
In addition, if you smoke cigarettes, talk with your provider about strategies to stop smoking since cigarette smoking may be a risk factor for formation, growth and rupture of the aneurysm.