We understand that learning you have a brain aneurysm can be unsettling. You can be assured that our specialists at the Cerebrovascular Center at UF Health Jacksonville are not only leading experts in their field, but are also committed to providing compassionate care and supporting you throughout the treatment process.

Brain aneurysm: What you need to know

• A brain aneurysm, also called a cerebral aneurysm or intracranial aneurysm, is an abnormal bulge or ballooning of the arterial wall. This dilation can grow over time and may rupture, spilling blood around the brain, which can be life threatening.

• A brain aneurysm can occur at any age. Some brain aneurysms are associated with certain inherited disorders including certain types of genetic connective tissue disorders and polycystic kidney disease. Some brain aneurysms are found in families generally affecting first-degree family members (child, sibling or parent).

• Some of the risk factors for developing a brain aneurysm or causing an aneurysm to increase in size and susceptibility for rupture include untreated high blood pressure, cigarette smoking and drug use.

• Brain aneurysms are frequently detected on imaging during a medical evaluation for another condition. The most common imaging study to identify a brain aneurysm is a CT angiography or MR angiography. These studies are used to look specifically at the vessels.

• You may need a procedure called a cerebral angiogram, also known as digital subtraction angiography (DSA), to further evaluate you and help determine the type of treatment. This minimally invasive sterile procedure is performed using fluoroscopy (live X-ray). A small tube called a catheter is used to access the femoral artery located in the groin. The catheter is advanced over a guidewire to select vessels through which contrast is injected to obtain images.

Brain aneurysm: Symptoms

Unruptured aneurysm

Brain aneurysms typically do not have any symptoms unless they rupture or are large enough to press on tissues or nerves. If an aneurysm causes symptoms from size and location typical symptoms experienced may include eye symptoms such as a dilated pupil, trouble with eye movement, bulging of the eye, redness and irritation of the eye or vision changes. Some large aneurysms can cause numbness, weakness or facial paralysis.

Ruptured aneurysm

A ruptured brain aneurysm will cause a severe headache. This headache is often described as the worst headache of one’s life. Additional symptoms include possible loss of consciousness, seizures, nausea/vomiting. A ruptured aneurysm is a life threatening emergency requiring immediate medical attention.

Brain aneurysm: Treatments

• Treatment for an unruptured brain aneurysm is decided by multiple factors based on relevant research. Many unruptured aneurysms do not require treatment and can be monitored with serial imaging and close follow up.

• Aneurysms that require treatment are typically larger in size, have an irregular shape or are located in a higher risk vessel. The patient’s age, overall health and risk of treatment are also taken into consideration.

• Treatment options for your brain aneurysm will be discussed during your visit. Most brain aneurysms are treated using endovascular treatment techniques however open surgery may also be discussed as a preferred option.

Endovascular treatment

Endovascular treatments are performed from within the vessel, typically accessed at the femoral artery located at the groin or radial artery at the wrist from which catheters are advanced over a small wire to the aneurysm. This method of treatment will require follow up procedures to ensure the aneurysm has no further blood flow.

Methods of endovascular aneurysm treatment include:

• Coil embolization - Tiny spirals of platinum wire are placed into the aneurysm blocking the flow of blood to the aneurysm.
• Flow diversion devices - A special stent like device is placed within the parent vessel across the neck of the aneurysm. The stent diverts the flow of blood away from the aneurysm. Over time the aneurysm will form a blood clot inside effectively eliminating all blood flow to the aneurysm.

Surgical treatment

An open surgery may be the treatment of choice for your aneurysm depending on the size, location and position of normal blood vessels in relation to the aneurysm.

• Microvascular clipping - This procedure requires a craniotomy — opening of the skull followed by careful microsurgical dissection using microscope along the brain tissue, finding the aneurysm and placing a titanium clip at the base of the aneurysm to separate it from parent vessel and blood supply. This method has typically longer hospital stay and recovery time but is usually more permanent treatment compared to endovascular methods.