Brain Aneurysm Diagnosis and Treatment
The OHSU Brain Institute is a national leader in diagnosing and treating brain aneurysms.
- A team of cerebrovascular specialists who work together to tailor treatment to your needs.
- Specialists trained in both neurosurgery and neurointervention (treatment of blood vessels in the brain and spine).
- State-of-the-art imaging.
- One of the most active centers in the U.S. for brain aneurysm embolization.
- The most experience on the West Coast in treating wide-neck aneurysms with pipeline embolization devices.
Diagnosing a brain aneurysm
Tests to check for a brain aneurysm include:
Computed tomography (CT) scan: This scan uses X-rays to produce cross-sectional images, quickly showing any bleeding in the brain.
Cerebrospinal fluid test: This is also called a spinal tap or lumbar puncture. A doctor uses a needle to withdraw cerebrospinal fluid (clear liquid that bathes the brain and spinal cord) from the spine. Blood in the fluid can signal a rupture.
Angiogram: This produces detailed images of blood vessels and blood flow in the brain. Angiograms are used to find aneurysms and to see their size and shape.
- CT angiogram (CTA): This takes 3D X-rays, often after an injection of dye to highlight blood vessels.
- An MR angiogram (MRA): This uses magnetic fields and radio waves to produce detailed computer images of the brain. It can be done with or without dye.
- Cerebral angiogram: This uses advanced X-ray imaging to guide a catheter (thin plastic tube) through a leg artery to the brain. A dye highlights blood vessels and blood flow. Doctors can see the size, shape and location of the aneurysm. This is the definitive way to diagnose aneurysms. Your care team can also use the catheter to insert tiny tools to treat the aneurysm.
Your care team will customize your treatment based on factors such as:
- Your age and general health
- Whether your aneurysm has ruptured
- Your aneurysm’s size, shape and location
Follow-up care: A nurse coordinator will work with you and your primary care provider to coordinate care and monitoring. Our aneurysm surveillance clinic gives you:
- A diagnosis and treatment summary
- Information about your condition
- A clear follow-up plan
- Regular monitoring
The goal is to prevent a second rupture. You might go to:
- Specialized imaging so we can learn more about your aneurysm.
- Neurointerventional care to coil the aneurysm so it doesn’t rupture again.
- To our Neurosciences Intensive Care Unit if you need surgery.
The goal is to prevent rupture.
- For small aneurysms without symptoms, your care team may recommend lifestyle changes. This could include quitting smoking or lowering blood pressure. You also might have regular scans to monitor the aneurysm.
- For larger aneurysms or those with symptoms,clipping or coiling may be recommended.
Brain aneurysm treatments
A neurosurgeon temporarily removes a small section of skull (craniotomy) to reach the aneurysm. Using a small surgical microscope,the surgeon places a tiny metal clip across the neck of the aneurysm to stop blood from flowing into it.Once closed off, the aneurysm shrinks and becomes scar tissue. The clip stays in place to prevent bleeding or rupture.
In this minimally invasive procedure, a doctor fills the aneurysm with tiny platinum coils, sealing it off from the artery. The coils stop blood from entering the aneurysm and putting pressure on its weak walls. This makes the aneurysm less likely to rupture. This treatment is also called coil embolization or endovascular embolization.
The doctor makes a small incision in the groin. Using imaging, the doctor guides a catheter through blood vessels to the aneurysm. The aneurysm’s size, shape and other traits are measured.
A microcatheter with a platinum coil attached is inserted through the initial catheter. The doctor places the coil in the aneurysm. It may take several coils to seal the aneurysm. Once the aneurysm is blocked off (embolized), the catheters are removed.
If the coiling was done for a ruptured aneurysm, you will go to our Neurosciences Intensive Care Unit for recovery and observation. If your aneurysm was not ruptured and your condition is stable, you may go home after a day or two
Pipeline embolization device
If an aneurysm has a wide neck, there’s a risk that coils might slip out into blood vessels and block them. This used to make these aneurysms hard to treat.
OHSU neurointerventionalists were the first on the West Coast to use a pipeline embolization device, or PED, to treat wide-neck aneurysms. This device, also called a blood-flow diverter, directs blood past rather than into the aneurysm. Over time, this helps close off the aneurysm.
- Treatment, Brain Aneurysm Foundation
- “A Patient Guide to Recovery From Brain Aneurysm Treatment,” Brain Aneurysm Foundation
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