neurologic disorders
Brain Aneurysms
Treatment of Brain Aneurysms
For smaller, asymptomatic aneurysm, serial imaging For large or symptomatic aneurysms, endovascular therapy Treatment of unruptured aneurysms depends on Type, size, and location of the aneurysm Risk of rupture Patient age and health Personal and family medical history Risks of treatment Risk of rupture versus that of perioperative complications should be discussed frankly with the patient. Control of atherosclerotic risk factors, especially smoking cessation and use of antihypertensive drugs as appropriate, is important. If<7 mm, asymptomatic aneurysms in the anterior circulation rarely rupture and do not warrant the risks of immediate treatment. They can be monitored with serial imaging. If aneurysms are larger, are in the posterior circulation, or cause symptoms due to bleeding or due to compression of neural structures, Treatment (eg, stents, coil embolization), if feasible, can be tried. Sometimes open surgery with placement of a microvascular clip is necessary. Early repair is essential if patients have had aneurysmal bleeding because rebleeding is the most serious early complication with fatality rate up to 70%. Treatment of mycotic aneurysms is aggressive antibiotic therapy directed at the specific pathogen. Usually, mycotic aneurysms must also be surgically repaired. If the aneurysm has ruptured, digital subtraction angiography is used to locate it; then endovascular therapy or open surgery is done to repair it. 