It is stressful to get this diagnosis, and people often feel like they have a “ticking time bomb” when they get this news.
Fortunately, this is not always the case, and the best thing is to speak to a neurosurgeon with cerebrovascular experience to discuss your options further.
Brain aneurysms are not common, but about 3-5% of the population is thought to have one. This incidence can be higher in certain populations such as Finnish or Japanese people.
Aneurysm can occur at any age of life, but generally it is thought that you are not born with an aneurysm, rather that if forms at some point in your life.
Does brain aneurysm show symptoms?
Most of the time the brain aneurysm will not cause any symptoms, and so most people with aneurysms do not even know that they have them. Sometimes your doctor may order a scan of your brain for a completely unrelated reason, and the radiologist who is looking at your scan and providing a report my find an aneurysm by chance. This is called an incidental aneurysm.
Aneurysms will generally not cause you any symptoms unless they bleed. Not all aneurysms will bleed and so the reason for seeing an expert is to discuss the chances that your aneurysm will bleed at some point in your lifetime.
It is not currently possible to predict with absolute certainty if a specific aneurysm will bleed, however after many years of studying aneurysms there are recognised factors that suggest that some aneurysms are at higher risk of bleeding than others.
Your specialist will ask you some questions related to risk factors that are inherent to who you are. Some of the factors that you are likely to be asked about include your habits such as smoking or consuming alcohol. There are some people who have an inherited risk of forming aneurysms, so your specialist is likely to ask you about your family history. Your specialist will tell you, after discussing your specific situation, if you are likely to have an inherited tendency to aneurysm formation. There are also other diseases and medical conditions such as hypertension that may play a role in aneurysm formation and risk of bleeding.
Your specialist will also look at the scans that you have had to see what your aneurysm looks like and where in the brain it is located. The reason for studying this closely, is that certain locations, sized and shapes are at higher risk of bleeding than others.
In some instances, the scans that you have already had may not provide sufficient information to make a recommendation to you about how to manage your specific aneurysm. In this case your specialist may request some other scans to get a better look at your aneurysm. The gold standard for view an aneurysm is called a digital subtraction angiogram (DSA). This is an invasive test, because one of the blood vessels in your groin or arm is used to access the blood vessels of your brain. A special dye is injected to be able to take high resolution images of your brain blood vessels. This test carries a small risk of a stroke and is not required for every single patient with a diagnosis of an aneurysm these days. The reason for this is that non-invasive tests such as MR angiogram and CT angiogram have become increasingly sensitive and are often good enough to provide high resolution images of your aneurysm.
Once your specialist has assessed and discussed the risks of bleeding for you, they will make a recommendation regarding the best way to treat your aneurysm. For many patients this will mean monitoring the aneurysm with serial images to see if it changes in shape and size.
If your specialist thinks your aneurysm requires treatment, they will explain to you the reasons that they think this is best. They will also discuss the options of treatment from inside the vessel versus open brain surgery to treat the aneurysm. While the mechanism to treat aneurysms from inside the blood vessels are newer, they are established and continue to improve. These days most patients with brain aneurysms are treated from inside the blood vessel, rather than with open surgery.
The main advantage of an incidentally diagnosed aneurysm is that you have time to discuss the implications and treatment options in-depth with your brain aneurysm specialist and carefully consider your options. While this remains a serious condition, the treatment methods are well established and in the elective setting where treatment is carefully planned, treatment can be provided safely with a relatively low risk profile.