Cerebral Aneurysm

In the management of a patient with a ruptured aneurysm, the immediate goal is to prevent a second bleed as re-bleeding has a 60-80% risk of death and severe disability. The risk of a re-bleed is approximately 1.5% per day, reaching a cumulative risk of 20% at the end of the first 2 weeks, and 50-60% at the end of 6 months.

The best treatment option is often individualised, depending on the site, shape and location of the aneurysm. The patient’s age and clinical condition are also factors to consider.

• Surgical Therapy or Clipping
  Surgical clipping of a brain aneurysm is performed by a neurosurgeon. Access through the skull is obtained via a craniotomy (opening through the skull, often with a special drill / saw). With the use of a microscope, the neurosurgeon then carefully traces the blood vessel involved to look for the ruptured aneurysm. One or more metal clips (usually made from titanium) are then placed across the base, or neck, of the aneurysm. This secures the aneurysm, preventing blood from entering the aneurysm which would otherwise cause a re-rupture. Angiography is commonly performed after the surgery to visualise the closure of the aneurysm and preserve normal flow of blood in the brain.
• Endovascular Therapy or "Coiling"
  Endovascular coiling is a less invasive procedure which is performed by an endovascular surgeon. A catheter is threaded through an artery in the groin and carefully advanced into the brain. By releasing small coils into the aneurysm from within, the latter is packed such that blood can no longer flow into the aneurysm, preventing a re-rupture.
  
  It is important to understand that surgical clipping or endovascular coiling secures the aneurysm to prevent a second bleed. The damage caused by the original bleed is still not overcome. Treatment of the patient continues medically, to help him recover any possible on-going damage and to prevent further complications that arise. This often entails intensive care management.