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 examine the vessels specifically.

• 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, due to its size and location, an aneurysm may cause 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, and nausea/vomiting. A ruptured aneurysm is a life-threatening emergency requiring immediate medical attention.

Brain aneurysm: Treatments

• Physicians take multiple factors into account when suggesting treatment for an unruptured brain aneurysm. Many 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. 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 in the groin or the 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 - A physician places tiny spirals of platinum wire into the aneurysm, blocking the flow of blood to it.
• Flow diversion devices - A special stent-like device is placed within the parent vessel across the neck of the aneurysm. The stent diverts blood flow 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 a microscope along the brain tissue, finding the aneurysm, and placing a titanium clip at the base of the aneurysm to separate it from the parent vessel and blood supply. This method often requires a longer hospital stay and recovery time, but it is usually a more permanent treatment than endovascular methods.