Monday, October 28, 2019

An Alternative Treatment for Aneurysms


Many aneurysms are very small, but you get the idea here.

           Some years ago, during about a break of about a week in college, one of my friends, developed a severe headache, and before the day was over, had surgery for a bleeding aneurysm, in a community hospital.  As a nursing major, I was flabbergasted that he'd left for the holiday, and almost immediately developed an almost blinding headache while driving, and chosen to go to the ER. From there, a neurosurgeon saw him and off he went for an aneurysm clipping, which is certainly brain surgery. A couple of weeks later, once back in school, he seemed fine, if perhaps a little more outgoing following his near brush with death. He continued to do well afterward.

                      The clipping of an aneurysm, using a metallic clip of some design, is the surgery with which most of us are familiar. An aneurysm is a bubble in the arterial system of the brain, that can either remain small and often undetected for many years. Most aneurysms are in fact detected when a CT or an MRI is done for some other reason entirely.  A bleeding aneurysm can be very dangerous. A bleeding aneurysm carries with it a 40% chance of death and an 80% chance of disability.  In addition to releasing blood in a closed space, a ruptured aneurysm can cause a vasospasm or narrowing of an artery of the brain, and this complication can also be devastating, and this alone may cause death.

                     At one time, the permanent clipping of an aneurysm was the only treatment for it. However, in about 1991, neurosurgeons found that they could treat some aneurysms using a "minimally invasive technique".  In a hospital suite, they found they could insert a lengthy and fairly large catheter into the arteries of the groin and thread them up toward the patient's brain.  Since many aneurysms patient to patient, occur in similar locations, techniques to access them from the inside were mastered.  Neurosurgeons who specialized in this technique found that using fluoroscopy allowed them to track the progress of floating the catheter, and that by depositing very thin platinum wires, either interrupted or continuously, inside the aneurysm itself, they could cause it to clot off, seal and become very unlikely to leak in future.  At first, this allowed a different technique to be used for patients who simply weren't well enough for brain surgery.  The technique was also only used for specially selected or aneurysms, at that time.

                   In the present day, the medical literature still considers the interior embolization of aneurysms to be a slightly less effective modality than clipping the aneurysm from the outside.  However, this may not be true for much longer.  Enough of these types of embolization, coiling or stenting of aneurysms has been done so that data can be studied.  It seems that some neurosurgeons who perform this technique have never had an aneurysm leak or rupture following their platinum wire coiling of it.  In fact, almost all aneurysms may be potentially treated using the minimally invasive method as described under present US medical standards.

                   What can you do to avoid aneurysms ?  The ones that are simply a genetic weakness and error don't give us much of a chance to avoid them. However, the aneurysms that we acquired as adults from untreated or poorly treated hypertension or high blood pressure, could potentially be avoided.

                 A patient who has an embolization may be given general anesthesia. Often though, they are medicated, but are awake and cooperative through the procedure. Please know that even if a patient has an aneurysm embolization that they will still remain in ICU for about a day after the procedure. They will still need follow up.  They should still have a follow up examination every year or more with their neurosurgeon on the timetable he/she recommends.  However, the less invasive procedure should take less time, be safer, cheaper, and should get you or your loved one back to work and functioning again more quickly that brain surgery would.

                  Yes, this is the kind of procedure most survivalists would choose !