Treatment of cerebral aneurysms
- Robert J Singer, MD
Robert J Singer, MD
- Associate Professor of Neurosurgery
- Neurovascular Therapeutics
- Geisel School of Medicine at Dartmouth
- Christopher S Ogilvy, MD
Christopher S Ogilvy, MD
- Professor of Surgery
- Harvard Medical School
- Guy Rordorf, MD
Guy Rordorf, MD
- Associate Professor of Neurology
- Harvard Medical School
Subarachnoid hemorrhage (SAH) is often a devastating event with a high mortality and morbidity. Most subarachnoid hemorrhages (SAH) are caused by ruptured intracranial saccular aneurysms. In most cases, the presence of the aneurysm is unsuspected until SAH occurs. After aneurysmal SAH, the patient is at substantial risk of rebleeding: 3 to 4 percent in the first 24 hours and 1 to 2 percent each day in the first month . Rerupture is associated with a mortality that is estimated to be 70 percent. Aneurysm repair is the only effective treatment to prevent this occurrence .
Unruptured cerebral aneurysms may manifest clinically by their mass effect on adjacent neurologic structures, or they may be discovered incidentally when a patient has a neuroimaging study for another indication. Such aneurysms have a future risk of rupture and SAH that depends in part on their size and location.
The treatment of cerebral aneurysms is discussed in this topic. Other aspects of the clinical features, diagnosis and management of cerebral aneurysms and aneurysmal SAH are discussed separately. (See "Unruptured intracranial aneurysms" and "Treatment of aneurysmal subarachnoid hemorrhage" and "Clinical manifestations and diagnosis of aneurysmal subarachnoid hemorrhage".)
Surgical and endovascular techniques are available for aneurysm treatment. In many cases, anatomic considerations, such as size, location, along with other morphological features determine which treatment is most appropriate for the patient.
Surgery — Surgical management of cerebral aneurysms, in which a clip is placed across the neck of the aneurysm, is an effective and safe procedure with the evolution of microsurgical techniques in the hands of an experienced surgeon (image 1). This applies to patients with unruptured cerebral aneurysms and those with subarachnoid hemorrhage .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Endovascular therapy
- - Coil embolism
- - Newer techniques
- Anatomic considerations
- SUBARACHNOID HEMORRHAGE
- Early rebleeding
- Timing and choice of therapy
- - Good grade subarachnoid hemorrhage
- - Poor grade subarachnoid hemorrhage
- Posttreatment management
- UNRUPTURED ANEURYSMS
- ANEURYSM RECURRENCE AND LATE REBLEEDING
- SUMMARY AND RECOMMENDATIONS