Each case is considered individually and can be dependent upon many factors. The best treatment option is decided in a discussion between clinical staff (surgeon and radiologist) and this is then discussed further with the patient and/or family. Any treatment method carried out on the blood vessels of the brain carries the risk of serious complications including stroke and death. Treatment is only considered if the benefits of the treatment are greater than the risks of the treatment to the patient.
Whilst in hospital, the aim is to promote rest, and control any pain and nausea. Close observation will be necessary of signs such as blood pressure and neurological state. The aim of treatment will be to reduce the chances of another haemorrhage occurring from the same site in the future.
How are aneurysms treated?
There are two main types of treatment available, surgical clipping or coil embolisation. The treatment offered will depend on many factors, including the position and shape of the aneurysm, and will be carried out at a time that is considered best in each individual situation. An operation may be delayed if the doctors feel that the person is too unwell, as this can increase the risks of the surgery.
This involves an operation under general anaesthetic, and is carried out by a Neurosurgeon. A section of the hair may be shaved (commonly at the front), and then a cut will be made in the scalp. A piece of bone will be removed in order to allow the surgeon access to the brain. Once the surgeon has found the aneurysm a metal clip is placed across its neck to seal it off, and prevent the risk of a further bleed from it. The piece of bone is then replaced, and the scalp stitched or clipped (stapled) together again. A large bandage may be placed on the head.
This is the traditional treatment approach but a recent study has shown that the same result can be achieved with the non-invasive procedure of coiling.
During endovascular treatment, the aneurysm is packed with small platinum coils. With the patient under general anaesthetic, a small catheter is introduced at the groin into the major artery and navigated, using x-ray screening into the aneurysm. In this way, coils can then be deposited inside the aneurysm. The aim is to pack the aneurysm with coils so that blood is then unable to enter it. The diagram shows this technique. This procedure was originally developed to treat aneurysms not accessible by surgery and was first performed in the UK in 1992. Occasionally other materials other than coils may be used. The long-term benefits of coiling have yet to be confirmed but it is expected that the benefits will be long lasting. There is usually a follow up scan or angiogram carried out at six months following this treatment method.
Some people have an aneurysm that ruptured to cause SAH but it was left untreated. This is usually because the risks to the patient of treatment were greater than the risk if nothing were done. After six months, the risk of another haemorrhage from a previously ruptured but untreated aneurysm is small. In this case, it is advisable to stop smoking, drink alcohol only in moderation and ensure that blood pressure is kept within normal limits.