I am a Neurosurgeon with advanced training in Interventional vascular Neurosurgery(FINR) from Zurich, Switzerland, and FMINS-Fellowship in minimally invasive and Endoscopic Neurosurgery from Germany. I am presently working in Columbia asia hospitals, Bangalore. My areas of interest are Vascular Neurosurgery, Stroke specialist, interventional neuroradiology.

1. Brain aneurysm in general
Dr. Avinash KM
MS, MRCS Ed(UK), Mch (KEM, Mumbai), FINR(Switzerland), FMINS(Germany),
• Interventional & Neurovascular surgeon and Stroke specialist,
• Endoscopic Neuro and Spine surgeon,
• Minimally invasive Neuro and Spine surgeon (FMINS).
mob: 9740866228, E mail: doc_avin@hotmail.com
Consultant Neurosurgeon and Neurointerventionist
Columbia Asia Hospital, Bangalore.

2. What is brain Aneurysm?
A brain aneurysm, also referred to as a cerebral aneurysm or intracranial
aneurysm (IA), is a weak bulging spot on the wall of a brain artery very much
like a thin balloon or weak spot on an inner tube. Over time, the blood flow
within the artery pounds against the thinned portion of the wall and
aneurysms form silently from wear and tear on the arteries. As the artery wall
becomes gradually thinner from the dilation, the blood flow causes the
weakened wall to swell outward. This pressure may cause the aneurysm to
rupture and allow blood to escape into the space around the brain. A
ruptured brain aneurysm commonly requires advanced surgical treatment

3. What are the common locations of aneurysms?

4. What are the types of aneurysm?

5. What are the causes and risk factors for formation of
aneurysms?
• Risk factors that doctors and researchers believe contribute to the formation
of brain aneurysms:
• Smoking
• High blood pressure or hypertension
• Congenital resulting from inborn abnormality in artery wall
• Family history of brain aneurysms
• Age over 40
• Gender, women compared with men have an increased incidence of
aneurysms at a ratio of 3:2
• Other disorders: Ehlers-Danlos Syndrome, Polycystic Kidney Disease,
Marfan Syndrome, and Fibromuscular Dysplasia(FMD)
• Presence of an arteriovenous malformation (AVM)
• Drug use, partiularly cocaine
• Infection
• Tumors
• Traumatic head injury
• Risk factors that doctors and researchers believe contribute to the rupture of
brain aneurysms:
• Smoking
• High blood pressure or hypertension

6. What are the symptoms of aneurysms?
1. Asymptomatic incidentally detected aneurysms
2. Symptomatic unruptured aneurysms
3. Ruptured aneurysms
Most brain aneurysms cause no symptoms and may only be discovered during tests for
another, usually unrelated, condition(Asymptomatic incidentally detected
aneurysms).
In other cases, an unruptured aneurysm will cause problems by pressing on areas in
the brain. When this happens, the person may suffer from severe headaches, blurred
vision, changes in speech, and neck pain, depending on what areas of the brain are
affected and how bad the aneurysm is.
Symptoms of a ruptured brain aneurysm often come on suddenly. A sudden, severe
headache that is different from past headaches.(worst headache of life)
Neck pain.
Nausea and vomiting.
Sensitivity to light.
Fainting or loss of consciousness.
Seizures.

7. How is a brain aneurysm diagnosed?
• Because unruptured brain aneurysms often do not cause any symptoms, many are discovered
in people who are being treated for a different condition.
• If your doctor believes that you have a brain aneurysm, you may have the
following tests:
• Computed tomography (CT) scan. A CT scan can help identify bleeding in the brain.
Sometimes a lumbar puncture may be used if your doctor suspects that you have a ruptured
cerebral aneurysm with a subarachnoid hemorrhage.
• Computed tomography angiogram (CTA) scan. CTA is a more precise method
of evaluating blood vessels than a standard CT scan. CTA uses a combination of CT scanning,
special computer techniques, and contrast material (dye) injected into the blood to produce
images of blood vessels.
• Magnetic resonance angiography (MRA). Similar to a CTA, MRA uses a
magnetic field and pulses of radio wave energy to provide pictures of blood vessels
inside the body. As with CTA and cerebral angiography, a dye is often used during
MRA to make blood vessels show up more clearly.
• Cerebral angiogram. During this X-ray test, a catheter is inserted through a blood
vessel in the groin or arm and moved up through the vessel into the brain. A dye is
then injected into the cerebral artery. As with the above tests, the dye allows any
problems in the artery, including aneurysms, to be seen on the X-ray. Although this
test is more invasive and carries more risk than the above tests, it is the best way to
locate small (less than 5 mm) brain aneurysms.

8. What are the treatments available for treating
aneurysms?
Doctors consider several factors when deciding which treatment option is
best for a particular patient. These include:
• Patient age
• Size of aneurysm
• Location of aneurysm
• Shape of aneurysm
• Neurological condition of patient
• Other medical conditions
• Previous history of SAH or familial aneurysm
For unruptured Aneurysm:
1. either treatment : surgery or endovascular
2. observation.
For ruptured Aneurysms: has to be treated.
1. Open surgery
2. Endovascular approach.
Either is recommended to be performed as early as possible after hemorrhage, to
prevent rebleed of the aneurysm. The goal of either treatment is to prevent
rebleeding by sealing off the aneurysm so that the aneurysm is totally obliterated
with either a clip or coil

9. Surgical treatment:
Watch Clipping videos:
http://www.youtube.com/watch?v=PaTzNaTOoxI,
http://www.youtube.com/watch?v=hJACYm7PPg0.
• Clipping of aneurysm.
• Parent artery occlusion with or without
bypass.

10. Endovascular options for aneurysms:
• Watch coiling videos:
Coiling: http://www.youtube.com/watch?NR=1&feature=endscreen&v=5Ss-IOmFyeA,
Flow diverters: http://www.youtube.com/watch?v=jd5VQTS096E&feature=related.
Stent assisted coiling: http://www.youtube.com/watch?v=MfdPbBZ6ETs&feature=related.
• Coiling of aneurysm:
• Stent assisted coiling:
• Balloon assisted coiling:
• Flow diverters:
Kindly read next presentation about endovascular procedures in
aneurysms

11. What happens if I chose not to treat my aneurysm?
Kindly read unruptured intracranial aneurysms.
If one has aneurysm it doesnot mean that it will rupture. Majority
of people will never have any problem with it. But the risk of
rupture increases as the age advances, and the outcome in
case of rupture worsens as age increases.
It is impossible to predict who will bleed and who will not.
Although studies on unruptured aneurysms (ISUIA-II study)
give some percentages of risk of rupture depending on size,
what remains puzzled is why neurosurgeons see many small
aneurysms, less than 7mm, rupture with SAH and yet the ISUIA
study was telling that they have a very low risk of rupture.
From a recent study, 71.8% of ruptured aneurysms were smaller
than 7 mm, and 87.9% were smaller than 10mm.
keeping all this dilemma, controversy, and the psychological
burden of having aneurysm in mind, aneurysms should be
treated as early as possible.