Which are the symptoms?
In 90% of cases, it appears as a cerebral hemorrhage: the aneurysm wall is very thin and can burst, resulting in a subarachnoid hemorrhage (SAH).
In 7% of cases, it manifests itself in the form of a neurological deficit caused by compression of nerve structures by the aneurysm.
And, finally, in 3% of cases it is detected accidentally during examinations performed for other reasons.
In order to diagnose an aneurysm before it manifests itself, it is necessary to perform a cerebral angiography, i.e. a study in which the cerebral arterial vessels are examined in detail, or a magnetic resonance angiography (less effective than the first study).
How is it treated?
Two types of treatment are possible: surgical and endovascular.
Both procedures may have risks, even if they are secondary to the risk of not being treated.
The type of intervention is determined jointly by neurosurgeons and neuroradiologists, based on the characteristics and location of the aneurysm.
- Surgical treatment
Treatment performed by microsurgery allows the base of the aneurysm to be closed with special metal clips.
The advantages are numerous, namely, performing a codified procedure, ensuring complete closure of the aneurysm, and the ability to control possible bleeding during the intervention.
But among the risks, there is the danger of rupture during surgery on the aneurysm before this risk is eliminated, leading to hemorrhage, which may require emergency action such as arterial closure.
- Endovascular treatment.
The aneurysm is closed from the inside by inserting metal filaments into the aneurysm sac during angiography that help coagulate the blood.
The goal is to make it harder for blood to circulate inside the aneurysm.
Among the advantages are less trauma compared to surgical intervention and the possibility of treating even aneurysms located in surgically inaccessible areas.
However, endovascular treatment cannot be used for all aneurysms, but only for those that have a specific shape. Another disadvantage is the inability to control possible bleeding during the procedure and the possibility of causing involuntary closure of the cerebral artery.
Angiography is a necessary examination before any treatment can be initiated. Magnetic resonance imaging, magnetic resonance angiography, and angio-CT allow some characteristics of the aneurysm to be evaluated, but they are currently insufficient for the correct planning of therapeutic treatment.