Endovascular Neurosurgery

Since the early 1990s, endovascular surgery has been widely used to treat patients with an aneurysm or weakening of a blood vessel wall. Endovascular surgery is done from within the affected blood vessel, as opposed to open surgery that repairs vessels from the outside through an incision and opening in the bone.

The primary use of endovascular surgery is to prevent and treat the rupture of a cerebral aneurysm. A cerebral aneurysm is caused by a weakness in the wall of an artery. An aneurysm can enlarge with time and may rupture, causing bleeding in the brain. It is estimated that up to 1 in 15 people will develop a cerebral aneurysm in their lifetime. Approximately 40,000 people suffer a bleed from a cerebral aneurysm annually.

Risk Factors

Individuals at a greater risk for developing a brain aneurysm include women, African Americans, smokers, and patients with uncontrolled high blood pressure. Patients with a prior history of a ruptured aneurysm are at a slightly increased risk for developing or bleeding from a separate aneurysm. Patients with two first-degree relatives with a history of bleeding into the brain from an aneurysm are at greater risk for developing a cerebral aneurysm and should therefore be screened at around 35 or 40 years of age.

Symptoms

The majority of cerebral aneurysms are not discovered until they rupture. A small minority can present with symptoms related to local pressure in the brain. An increasing number of aneurysms are being discovered through symptoms unrelated to the aneurysm.

Symptoms of Ruptured Cerebral Aneurysm

Severe headache (usually characterized as the "worst headache of your life")
Nausea and vomiting
Stiff neck or neck pain
Fainting or loss of consciousness
Seizures
Sensitivity to light

Detection and Diagnosis

Cerebral aneurysms are identified using imaging techniques, such as CT scan, MRI, MR angiogram, and catheter angiogram. Ruptured aneurysms are commonly diagnosed via a CT scan, which is very sensitive for detecting blood inside the brain. Cerebral angiography or computed tomographic angiography is used to find the exact location, size and shape of an aneurysm. Both of these techniques utilize injected contrast dye and X-rays to visualize the aneurysm. A catheter angiogram is the gold standard test for evaluating the blood vessels of the neck and brain. Rapid identification and treatment of cerebral aneurysms is crucial because of the risk for a potentially catastrophic rebleeding episode. When an aneurysm has ruptured, the highest risk of rebleeding is within the first 24 to 48 hours.

Treatment Options

Endovascular Surgery is performed from within the blood vessels and has become a widely accepted treatment option. The procedure requires local or regional anesthesia to numb the area around the femoral artery at the top of the right leg. A catheter, or plastic tube, is placed in the femoral artery. The physician then uses X-ray imaging to advance a separate catheter to the blood vessel supplying the aneurysm. From here, multiple X-ray pictures are obtained which allow for determination of the optimal treatment option, clipping or coiling.

When repairing an aneurysm, a flexible catheter is inserted into the femoral artery and advanced directly within the aneurysm itself. Detachable coils and stents can be inserted to block the flow of blood into the aneurysm and cause it to become clotted. Real-time X-ray technology, known as fluoroscopic imaging, is used to visualize the patient's blood vessels and as the coils are placed within the aneurysm, progressive blockage of the aneurysm can be seen.

Although it is a fairly recent technology, endovascular surgery has become widely used in the last 10 years because of the following advantages that it provides to patients:

Less discomfort
Less invasiveness
Smaller incision
Less stress on the patient's heart and lungs
Reduced need for blood products
Fewer risks for older patients with multiple medical problems (e.g. Coronary heart disease or lung disorders)
Shorter recovery time

If you or someone you know is faced with a cerebral aneurysm or other disorders of the blood vessels in the brain, ask your doctor if endovascular surgery is an appropriate treatment option.

Contact Information

To contact GW Neurosurgery call (202) 741-2750.

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