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Several Treatments Available for Intracranial Aneurysms

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Several Treatments Available for Intracranial Aneurysms

August 11, 2000

By Sheila Dwyer, Veins1 Staff

What feels like a mild headache turns out to be a brain aneurysm in one percent of the general population. Without intervention, an aneurysm can burst and result in stroke or even death, depending on its severity. There are several options available to people afflicted with aneurysms, from a fairly non-invasive procedure to highly invasive cranial surgery. Taking into account the medical needs of the patient and the location of the aneurysm, a doctor will decide on a course of treatment shortly after detection.

Aneurysms, bubble-like defects in blood vessel walls, can hemorrhage and cause major medical complications. More than 112,000 people will be diagnosed with a brain aneurysm this year. In the worst case, the aneurysm will burst and cause life-threatening complications. Ten to 15 percent of hemorrhage patients die instantly. Others will survive with an aneurysm long enough for a doctor to intervene before permanent damage is done; still others will suffer a stroke. Ideally, a doctor will catch an aneurysm before it bleeds into the brain’s subarachnoid space and does permanent damage.

Traditional treatment for a brain hemorrhage and detection of an aneurysm has been an open craniotomy. During a craniotomy, a portion of the skull is removed while doctors surgically repair the aneurysm by blocking it off with a surgical clip. Until recently, doctors waited up to several weeks for the brain to recover from an initial hemorrhage before putting the patient through the trauma of open brain surgery. However, it turns out that repairing the brain immediately does not cause the negative neurological side effects once feared. Immediately performing surgery prevents a second hemorrhage. This type of surgical repair usually results in a long hospital stay, rehabilitation, and complications.

Dr. Guido Guglielmi, a neuroradiologist at UCLA and the University of Rome Medical School, developed a nonsurgical alternative to open craniotomy. Endovascular therapy is beneficial for treating aneurysms that are not accessible surgically due to their position in the brain. A device known as a Guglielmi Detachable Coil (GDC) is made of an extremely fine platinum wire and fashioned to the end of a longer stainless steel wire. Via a puncture in the thigh, doctors insert the coils through a catheter in the patient’s blood vessels. Once the coils reach their destination, they are detached from the wire and left to block the aneurysm from normal blood circulation in the brain. A patient’s recovery usually lasts less than three days. The only lasting scar is the puncture wound on the thigh.

Boston Scientific/Target, the company responsible for the development and manufacture of GDC coils, has also filed for U.S. Food and Drug Administration clearance to introduce a new product to the United States. Their GDC Tri-Span Coil, which has passed European standards testing, acts as a scaffold at the opening of the aneurysm to contain subsequent coils. Once approved here, it will be used to treat oddly shaped aneurysms that were previously deemed untreatable by surgery and less invasive techniques.

GDC coils also have the power to stave off hemorrhaging in an aneurysm. If a physician locates an aneurysm during a magnetic resonance imaging (MRI) test, he or she can perform endovascular surgery, preventing permanent damage.

Often it is not possible to discover an aneurysm in time to stop the hemorrhaging. Once the burst occurs, there is a finite amount of time available to react to the situation. Advances in aneurysm treatments have increased patient survival rates and allowed doctors to perform procedures never before feasible.



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