Brain aneurysms are a potentially life-threatening medical condition that occurs when a weak spot on a blood vessel in the brain bulges and fills with blood.

If left untreated, these aneurysms can rupture, leading to a brain hemorrhage, stroke, or even death. Fortunately, there are several surgical and endovascular options available to treat brain aneurysms, each with its own benefits and considerations.

1. Clipping

Clipping is a traditional surgical procedure performed to treat brain aneurysms.

During this procedure, a neurosurgeon makes an incision in the scalp, removes a small portion of the skull, and places a metal clip around the neck of the aneurysm to stop the blood flow. Clipping offers a more permanent solution as the aneurysm is isolated from the blood circulation. However, it requires open surgery and may involve longer recovery time and potential risks associated with anesthesia.

2. Coiling

Endovascular coiling, also known as coil embolization, is a minimally invasive procedure used to treat brain aneurysms.

Instead of opening the skull, a catheter is inserted into an artery, typically in the groin, and navigated through the blood vessels to the site of the aneurysm. Tiny platinum coils are then inserted into the aneurysm, causing it to clot and preventing further blood flow. Coiling offers a shorter recovery time, reduced risk of complications, and avoids the need for open surgery.

However, it may not be suitable for all types of aneurysms and may require repeat procedures if the coils shift or the aneurysms regrow.

3. Flow Diversion

Flow diversion is a relatively new endovascular technique used to treat wide-necked or complex brain aneurysms. In this procedure, a stent-like device, known as a flow diverter, is inserted into the blood vessel leading to the aneurysm.

The flow diverter diverts blood flow away from the aneurysm, promoting the formation of a clot inside the aneurysm. Flow diversion is particularly useful for large or difficult-to-treat aneurysms and offers a less invasive treatment option compared to traditional surgery.

However, it requires careful patient selection and monitoring due to the potential risk of complications such as blood clots or vessel rupture.

4. Balloon-Assisted Coiling

Balloon-assisted coiling is a technique that combines features of both surgical clipping and endovascular coiling.

A small balloon is inflated inside the aneurysm to temporarily block blood flow, allowing the insertion of coils to prevent further bleeding. The balloon is then deflated and removed. Balloon-assisted coiling can be a useful option for wide-necked aneurysms that are not amenable to standard coiling.

However, it still carries the risks associated with endovascular procedures, such as vessel injury or coil migration.

5. Bypass Surgery

In certain cases where the aneurysm is located near critical blood vessels, bypass surgery may be necessary. During this procedure, a neurosurgeon creates a new pathway for blood to flow around the aneurysm, bypassing the weakened blood vessel.

Bypass surgery requires a highly skilled surgical team and carries the inherent risks associated with invasive procedures. It is typically reserved for complex aneurysms that cannot be treated with other methods.

6. Pipeline Embolization Device

The pipeline embolization device is a type of flow diverter that offers a minimally invasive option for treating certain types of brain aneurysms.

Similar to other flow diverters, it promotes the formation of a clot inside the aneurysm, effectively sealing it off from blood circulation. This device is particularly useful for wide-necked aneurysms and offers the advantage of a rapid recovery compared to traditional surgical interventions.

However, not all aneurysms are suitable for pipeline embolization, and careful patient selection is necessary to ensure optimal outcomes.

7. Neurovascular Clipping

Neurovascular clipping is a specialized technique used to treat brain aneurysms located deep within the brain.

In this procedure, a neurosurgeon uses a microscope and delicate instruments to isolate and clip off the aneurysm from the surrounding blood vessels. Neurovascular clipping is a highly precise procedure that requires advanced surgical skills.

It may be the preferred option for aneurysms in challenging locations, but it carries the risks associated with brain surgery and requires a longer recovery period.

8. Stent-Assisted Coiling

Stent-assisted coiling is a technique where a stent is deployed across the neck of the aneurysm to create a scaffold for the coils. This helps to maintain the position of the coils within the aneurysm and prevents their displacement.

Stent-assisted coiling can be used for wide-necked or complex aneurysms that would otherwise be difficult to treat with standard coiling alone. It offers an effective solution to prevent aneurysm rupture and promotes healing. However, it may require prolonged antiplatelet medication to reduce the risk of blood clots.

9. Stereotactic Radiosurgery

Stereotactic radiosurgery is a non-invasive treatment option for brain aneurysms that uses highly focused radiation beams to target and obliterate the aneurysm.

This technique avoids any incisions or invasive procedures, making it suitable for patients who are not ideal candidates for surgery. However, its effectiveness may be limited for larger aneurysms, and the full benefits may not be seen for several years after treatment.

10. Watchful Waiting

Watchful waiting, also known as observation or conservative management, is an option for brain aneurysms that are small, asymptomatic, and have a low risk of rupture.

In such cases, regular monitoring with imaging studies such as magnetic resonance angiography (MRA) or computed tomography angiography (CTA) is recommended to assess any changes in the aneurysm size or morphology. If there is evidence of growth or an increased risk of rupture, intervention may be necessary.