An aneurysm is an abnormal bubble or ballooning of the wall of a blood vessel that occurs when part of the vessel wall becomes weak and expands outwards. The vast majority of aneurysms do not present any symptoms, and they are often picked up when a patient has a scan for another reason, like persistent headaches or a recent head injury.
Aneurysms can develop on any blood vessel, but they are most commonly found on arteries rather than veins. An aneurysm in itself isn’t dangerous but left untreated it has the potential to be life threatening. An untreated aneurysm can rupture or burst, potentially leading to a bleed on the brain which can result in a threat to life and/or a stroke.
Consultant neurosurgeon Miss Mary Murphy explains the risk factors for developing an aneurysm and how an aneurysm can be treated.
“There are several risk factors that can increase your chance of developing an aneurysm including smoking or high blood pressure. There is also an increased risk if you have certain medical conditions like sickle cell disease or adult polycystic kidney disease.
Occasionally, there can be a genetic deficiency of the arterial muscle wall which means the patient is vulnerable to developing an aneurysm. Aneurysms are more common in people of Finnish or Japanese descent and occur most commonly in people aged 30 or older.
A range of treatment options
If you are diagnosed with an aneurysm, there are three main options.
The first option is not to treat the aneurysm but to take a “watch and see” approach. Some patients will have an aneurysm that does not grow and does not cause any significant impact on their daily lives. This is only appropriate for lower risk aneurysms. Your neurosurgeon will know whether this is suitable for your aneurysm. It is important to keep even small aneurysms under review in case they change, but in many cases it may be better to leave an aneurysm alone rather than go through a surgical procedure which in itself has risk. Patients will be invited back for regular scans to assess any progress, and treatment will only be suggested if or when the need arises.
If there is a decision to treat the aneurysm, then this would involve either blocking or reinforcing the weak part of the vessel wall, or to clipping it y so it no longer poses the risk of bursting.
To block or reinforce the weak part of the vessel there is an option known as endovascular treatment. This is a minimally invasive procedure where the aneurysm can be treated from inside the blood vessels using thin tubes (catheters). A radiologist will insert a catheter in the blood vessels usually in the groin, or by the wrist.
Endovascular treatment techniques include the coiling of an aneurysm. Coiling is where little platinum wires are placed inside the aneurysm to cause it to clot off. Alternatively, “stenting” the vessel that the aneurysm arises from can be a good option. This is where a small mesh tube is inserted which keeps the blood flowing through the body; like the treatment offered in heart surgery.
Recovery from endovascular treatment tends to be quicker than for open surgery and has fewer post-surgical complications, but it is not a suitable option for all aneurysms. However, there is a slightly higher risk of your aneurysm reoccurring after endovascular treatment, so regular scans would still be recommended. You would also possibly need to remain on blood-thinning medication after endovascular surgery. There is a small risk to life and small risk of stroke and that applies to endovascular treatments as well as surgery.
The final option is open surgery, which involves placing a clip across the opening of the aneurysm (a bit like tying off a balloon). Surgery takes place through a window the surgeon makes in the skull and from the outside of the artery a permanent metal clip is applied to the outside of the neck of the aneurysm. It is unlikely that any further surgical treatment would be required after open surgery, but it is also not without risk and like with endovascular treatments there is around a five per cent chance of a complication such as a stroke occurring.
At UCLH Private Healthcare, our team of neurovascular surgeons and interventional neuroradiologists are among the most renowned neurosurgeons in the UK and have been working together for decades.
Recovering from neurosurgery
Initial recovery from open neurosurgery can be difficult. Although your body will be working well in general, you are likely to feel exhausted and your stamina will be significantly reduced for some time. Most patients are advised to take two months off work after aneurysm surgery.
You should give yourself plenty of time to rest and take regular naps. If you are planning to go out, make sure you plan your rests around it so that you are not over-exerting yourself.
There shouldn’t be anything that you specifically cannot do after you have recovered from aneurysm surgery, but you might find things that require extended periods of concentration or prolonged periods of physical exertion are more difficult.
If you would like to contact us about any neurological problem, please contact the team at uclh.
