Brain Aneurysm
Brain aneurysm is the bulging or ballooning of a blood vessel supplying the brain. Brain aneurysms are present in 1 to 2% of population. The commonest age group affected is 40-60 years.
Brain aneurysms can cause non-specific neurological symptoms such as headaches, double vision, etc. The most serious complication is bursting or rupture of the aneurysm that leads to severe sudden episode of headache and immediate death in up to 20% of affected patients. In the remaining affected population, it leads to serious haemorrhagic stroke that is potentially debilitating.
What are the risk factors of getting an aneurysm?
Some of the known risk factors include:
Family history, Smoking, Hypertension, Polycystic kidney disease, Age over 50 years.
How do we diagnose a brain aneurysm?
A simple CT scan with dye is injected in the arm or an MRI scan without dye injection in the arm is all that is needed to diagnose a brain aneurysm and plan treatment.
Treatment options
Brain aneurysm is a treatable condition. The best time to treat is before it ruptures. Traditional treatment method of open surgery called clipping is largely replaced in majority of patients with minimally invasive endovascular technique called coiling. This technique involves a 5 mm incision in the groin to get into a blood vessel. Through this, multiple small tubes called catheters and wires are advanced into the brain and the aneurysm is completely blocked from inside. No open surgery to skull is required with quicker treatment and recovery.
Latest developments in treating brain aneurysms
- Majority of patients are able to walk home within 1-2 days of treatment of an elective un-ruptured brain aneurysm.
- There are newer technologies available for treating brain aneurysms. These now enable us to treat almost all types of brain aneurysms using interventional techniques without resorting to open surgery. These include advanced techniques of balloon assisted coiling and stent assisted coiling.
- Flow diverters: these are stent type devices that are placed across the neck of the aneurysm enabling gradual occlusion of the aneurysms while preserving flow in normal branches to the brain. These devices are extremely useful in treating all types of aneurysms including those with complex and challenging anatomy.
Carotid Stenting
Carotid artery is the artery in the neck supplying blood to the brain from the heart. Atherosclerosis of the carotid artery is responsible for causing stroke in about 20% of all patients with stroke worldwide.
Atheromatous deposits and plaques cause blockage of blood supply to the brain in high risk individuals. These high risk individuals include smokers, those with high cholesterol, diabetes, hypertension. Eventually, these deposits become critical and cause stroke by either small pieces breaking off to the brain or by completely blocking blood supply to the brain.
Carotid artery blockage can be treated with open surgery or by placing stent within the artery. Carotid stenting is the minimally invasive option of treating these patients without resorting to open surgery and incision in the neck. No general anaesthesia is required with most patients discharged from hospital within 1-2 days. Newer devices and techniques have made the technique extremely safe and effective for patients.
Stroke and Stroke Screening
Stroke is one of the leading causes of death worldwide. It is also the leading cause of long term disability with debilitating and devastating consequences for both patients and family. One of the most recognisable outcomes of stroke is paralysis affecting a part or half of the body.
Stroke is caused by blockage of blood flow to brain cells causing cell death. There are two main types of stroke. More commonly it is due to a clot blocking the blood supply to the brain causing cell death. Less commonly it can be due to bleeding in the brain causing blockage of blood supply to the brain cells. There are limited treatment options once stroke occurs fully. The best way is to prevent stroke and its devastating consequences.
Stroke screening is best suited for individuals with risk factors for stroke. These include those with known family history and cardiovascular disease. High blood pressure, high cholesterol, diabetes, obesity, smoking, excessive alcohol consumption is well recognized as risk factors for stroke.