The Basics: What is an Aneurysm?
An aneurysm is a balloon off the side of a blood vessel which most commonly occurs at branch points. [cite: 3] This happens because these are areas where the blood vessel wall may be weakest and the stress on the blood vessel wall is greatest. [cite: 4]
Types of Aneurysms
- Saccular (Berry): The most common type of aneurysm is a saccular (also known as berry) aneurysm which arises off the side of a vessel. [cite: 86]
- Fusiform: The second most common type is fusiform, which means the entire 360 degrees of the vessel wall are enlarged. [cite: 88]
- Dissecting (Pseudoaneurysms): Dissecting aneurysms (also known as pseudoaneurysms) actually form due to a tear in the wall of the vessel which results in stretching. [cite: 90]
Stratifying Risk of Rupture
There are many factors which influence your risk. [cite: 14] Some are related to the aneurysm itself, and others to your personal history. [cite: 14] There are however some tools which your neurosurgeon may use to help quantify your risk of bleeding and recommended management. [cite: 95]
Aneurysm Factors
- The size of the aneurysm is perhaps the most important, and most studied risk factor. [cite: 16] Larger aneurysms are well understood to have a higher risk of bleeding. [cite: 17]
- The shape of the aneurysm is another very important risk factor. [cite: 18] The presence of a ‘daughter sac’ or irregular shape is understood to increase the risk of bleeding. [cite: 19]
Personal History
- Smoking (even in the past) and high blood pressure are established risks for bleeding from an aneurysm. [cite: 31]
Treatment Options & Risks
If treatment is recommended to prevent future bleeding then this falls into two categories, microsurgery (approaching from the outside of the aneurysm) or endovascular treatment (approaching from inside of the aneurysm). [cite: 41]
Endovascular Treatment
Endovascular treatment involves entering with a needle through a blood vessel at either the top of your leg or your wrist. [cite: 46] Under x-ray guidance the tube is navigated to your aneurysm and it can be treated either by filling it with a device (such as tiny coils of metal) or placing a pipe within the pipe (a stent or flow diverter) to reduce the blood filling the aneurysm, cause it to clot off and heal. [cite: 50]
Microsurgical Treatment
Microsurgical treatment involves making a small opening in the skull (craniotomy), moving between the folds in the brain with the magnification of an operating microscope and finding the aneurysm. [cite: 51] A ‘clip’ which is like a clothes peg (or clothes pin for the Americans) can be placed across the base of the aneurysm so that it cannot fill with blood. [cite: 52]
Risks of Treatment
- The main risks of both treatments include bleeding from the aneurysm during treatment or blocking a normal blood vessel causing a stroke. [cite: 56]
- There is also a risk of the aneurysm coming back and needing more treatment in the future, particularly if the aneurysm is not completely occluded with the first procedure. [cite: 57]
- Other risks relate to the treatment approach and include pain and bruising at either the surgical site or needle insertion site at wrist or leg. [cite: 58]
- Infection may also occur at any break in the skin. [cite: 59]
Expected Recovery & Returning to Life
The recovery depends on the complexity of your aneurysm, the technique chosen to treat it and varies from person to person. [cite: 68]
| Treatment Type | Hospital Stay | Return to Work | Driving Restrictions |
|---|---|---|---|
| Endovascular | Some endovascular treatments can be provided as a day-stay case. [cite: 69] Others require overnight admission to hospital. [cite: 69] | For uncomplicated procedures it is reasonable to expect to take one month off from work to recover. [cite: 71] | Depending on the technique used to treat your aneurysm and local laws you may not be allowed to drive for some time after your procedure. [cite: 72] |
| Microsurgery | Simple microsurgical approaches only require 1-2 night admissions to hospital, while more complex procedures often require a longer admission. [cite: 70] | For uncomplicated procedures it is reasonable to expect to take one month off from work to recover. [cite: 71] | Depending on the technique used to treat your aneurysm and local laws you may not be allowed to drive for some time after your procedure. [cite: 72] |
Activity and Return to Sport
Maintaining good general health, diet and activity levels is important regardless of whether your aneurysm requires treatment or not. [cite: 75] There is no good evidence to suggest that restricting you from any physical activity will reduce your risk of aneurysm rupture. [cite: 76]