If you’ve been diagnosed with a brain aneurysm that requires intervention, read on to understand what you need to know about life after treatment.
While a large number of aneurysms may only require observation, many will require treatment to prevent a life-threatening rupture. It’s important to know, though, that if your aneurysm does require a procedure, you’ll likely have options regarding the course of treatment.
There are two categories of aneurysm treatment, explained Natalie Hall, NP, assistant in Neurological Surgery at Vanderbilt University Medical Center. The least invasive treatments are endovascular procedures, meaning that the aneurysm is treated via a catheter inserted in the artery. The more invasive option is a microsurgical clipping procedure, which requires open surgery. Some patients may be good candidates for either. Your provider will help explain which option(s) would be best for you and your aneurysm. Here, Hall helps us understand how treatment decisions are made, and what each treatment could entail in the years post-procedure.
Pursuing aneurysm treatment
To determine which course your treatment should take, your providers will first perform a cerebral angiogram, which is done in the operating room under conscious sedation (meaning you’re awake, but relaxed). The procedure is similar to endovascular treatments — a catheter will be inserted into the leg or the wrist and an X-ray using contrast dye will allow your providers to very clearly understand the anatomy of the blood vessels and the aneurysm itself. “This imaging study is the gold standard for aneurysm evaluation,” said Hall. “From there we’ll determine which treatment option would be best for that aneurysm.”
The aneurysm treatment plan depends on several different factors — namely, the aneurysm location and its anatomy. But the patient’s overall health factors in as well. Endovascular procedures are easier to recover from, and may carry less risk.
What to expect after treatment
Immediately following an endovascular treatment procedure, you can expect to spend a day or two in the hospital, Hall said. “After that it’s pretty easy to recover from,” she said, noting that you may need to take anti-platelet medications such as aspirin after several types of endovascular treatment — and that this medication may continue lifelong.
Though a microsurgical procedure is more definitive, it’s also more invasive, as there’s an actual incision in the head. Part of skull is removed and a metal clip is placed across the aneurysm in order to block it from your circulation. This requires a hospital stay — usually two to four days. After this type of treatment, you may have a headache, incisional soreness, and fatigue – all of which improves as you recover.
Following an endovascular procedure, you can expect to have a repeat cerebral angiogram between six months to one year after treatment, and may have another at 18 months. After that, less-invasive imaging such as magnetic resonance angiography (MRA) scans can be done for observation to ensure that further treatment isn’t needed. A microsurgical treatment may or not require an angiogram at one year — you can expect periodic computed tomography angiography (CTA) thereafter.
How to prepare for your aneursym treatment consultation
“Having an open mind is important,” said Hall, who also encourages patients to bring someone along who can offer another set of ears during that first appointment. “It’s also important for us to look at the actual imaging, not just the paper report.” It’s also a good idea to talk to family members to evaluate whether there’s a family history of aneurysm. Hall also encourages patients to bring a list of questions to the appointment, to be sure they are all addressed during your visit.
The Cerebrovascular Disease Program at Vanderbilt University Medical Center offers comprehensive care for a wide range of vascular conditions of the brain and spinal cord, including aneurysms, arteriovenous malformations and stroke.