Neuroscience Institute Swedish Cerebrovascular Center
Brain aneurysms are not always treated immediately. Sometimes, if the aneurysm is very small and is not leaking, your doctor may prefer to monitor it for awhile, especially if there are other medical conditions that need to be managed.
Your doctor may recommend imaging every year or on a regular basis, to observe the aneurysm and determine if it is growing.
When it is time to treat the aneurysm, there are four main options:
The brain aneurysm team at Swedish has many years of experience in all of these treatment options, and in protecting patients from the risk of stroke following treatment.
Clipping: This procedure requires the neurosurgeon to enter the brain to place a small clothes-pin-like clip around the base of the aneurysm where it protrudes from the blood vessel. The clip blocks the blood flow to the aneurysm so there is no more pressure applied to the weakened wall of the blood vessel. The blood that remains in the aneurysm clots, and there is no longer a threat the aneurysm will burst and bleed into the skull.
Parent vessel occlusion: Sometimes an aneurysm has damaged the blood vessel so much that the neurosurgeon must clamp off the entire artery. This is a more complicated surgery that may also require a bypass to re-route the blood around the clamped section of the vessel. The choice of treatment is primarily determined by the size, shape and location of the aneurysm, as well as your medical condition, overall health and family history.
Coiling: Coiling is a minimally invasive procedure used to repair the aneurysm from inside the blood vessel. An interventional neuroradiologist threads a very thin, hollow tube (micro catheter) through the blood vessel to the location of the aneurysm. This tube is used to transport a tiny, tightly coiled bundle of platinum fibers to the aneurysm.
While viewing the procedure on a monitor, the surgeon inserts the coil into the aneurysm to protect the weakened wall of the blood vessel from the pressure of the blood flow. Sometimes a tiny splint-like sheath (stent) is inserted into the blood vessel to help strengthen that section of the vessel and to help keep the coil in place.
Pipeline: Pipeline is an endovascular procedure that can be used to treat large or giant wide-neck brain aneurysms in adults.
The Pipeline® Device restores original, natural blood circulation while providing permanent long-term occlusion. During the procedure, the device (a braided cylindrical mesh) is implanted across the aneurysm neck. This slows the flow of blood into the aneurysm, which allows the diseased vessel to heal.