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Neurology (Expert Forum)
Do I need surgery?
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
Do I need surgery?
by p1957, Sep 16, 2008 10:32AM
I just wanted to know if I should get surgey I am not sure. I have a anerysm on my left that measure 2.5. I have had it for a year now and I am getting many more headaches then normal. I hve had migraines for 20yrs now. I am 51.
People tell me they think i should get surgery I am confused.
People tell me they think i should get surgery I am confused.
Doctor's Answer
by Lama Chahine, MD, Sep 17, 2008 02:06PM
, Sep 17, 2008 02:06PM
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor,
Without the ability to obtain a history from you and examine you and review your imaging, I can not comment on whether or not you need surgery. However, I will try to provide you with some useful information on intracerebral aneurysms (aneurysms of the brain blood vessels).
The risk of having an aneurysm is that it can rupture and cause a type of hemorrhage in the brain called subarachnoid hemorrhage. Larger aneurysms can also compress on nearby nerves and other brain structures.
Before I continue, let me say, and I can not over-emphasize, that one of the biggest risk factors for aneurysm rupture and bleeding is smoking, so if you smoke it is imperative that you stop. Use of drugs such as cocaine also increases risk. Controlling blood pressure is also important in patients with aneurysms.
Whether or not to have surgery on an aneurysm depends on several things: its size, location, shape, and other factors. Whenever an aneurysm bleeds, it absolutely needs to be operated on.
In general, aneurysms less than 7 mm in size have a relatively lower risk of rupture than larger aneurysms. However, if an aneurysm is smaller than 7 mm but is causing symptoms, treatment is warranted. The location of an aneurysm also affects the risk of rupture. If is located in part of the carotid artery called the cavernous carotid, there is a lower risk of rupture. Those located in the part of the brain circulation that supplies the anterior part of the brain (front part) is somewhat intermediate in risk, and those located in the posterior circulation have the highest rate of rupture. Other factors in location (such as whether the aneurysm is "intra-dural") are important. Finally the shape of the aneurysm also affects the management.
You have mentioned that your aneurysm is 2.5, but you do not specify whether it is 2.5 mm (millimeters) or centimeters (cm), so I can not comment on your aneurysm. If it is 2.5 cm, this is called a giant intracerebral aneurysm. These have a high rate of rupture and it is recommended that they be treated in younger patients but the management again depends on various factors.
It is important to know that there are 2 different procedures that can be done for an aneurysm. One is surgical, it is called clipping. The other is done through an angiogram (a catheter is inserted into a blood vessel and taken to the brain), and the procedure is called a coiling. This is less invasive (an actual surgery is not done) but of course has its complications as well. Which procedure is done depends on the size, shape, and location of the aneurysm. The neurosurgeon and possibly also the neurologist taking care of you will be the ones best fit to determine the type of procedure that is most suitable for you. Either way, the procedure is best done at a high-volume center, one where several of these procedures are done each year, so that the person doing the procedure is expert at doing it and dealing with complications should they arise.
If it is decided that the aneurysm has a low risk of rupture, it must be followed by the neurosurgeon with periodic imaging (either a CT angiogram or a conventional angiogram) to monitor its growth rate.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Without the ability to obtain a history from you and examine you and review your imaging, I can not comment on whether or not you need surgery. However, I will try to provide you with some useful information on intracerebral aneurysms (aneurysms of the brain blood vessels).
The risk of having an aneurysm is that it can rupture and cause a type of hemorrhage in the brain called subarachnoid hemorrhage. Larger aneurysms can also compress on nearby nerves and other brain structures.
Before I continue, let me say, and I can not over-emphasize, that one of the biggest risk factors for aneurysm rupture and bleeding is smoking, so if you smoke it is imperative that you stop. Use of drugs such as cocaine also increases risk. Controlling blood pressure is also important in patients with aneurysms.
Whether or not to have surgery on an aneurysm depends on several things: its size, location, shape, and other factors. Whenever an aneurysm bleeds, it absolutely needs to be operated on.
In general, aneurysms less than 7 mm in size have a relatively lower risk of rupture than larger aneurysms. However, if an aneurysm is smaller than 7 mm but is causing symptoms, treatment is warranted. The location of an aneurysm also affects the risk of rupture. If is located in part of the carotid artery called the cavernous carotid, there is a lower risk of rupture. Those located in the part of the brain circulation that supplies the anterior part of the brain (front part) is somewhat intermediate in risk, and those located in the posterior circulation have the highest rate of rupture. Other factors in location (such as whether the aneurysm is "intra-dural") are important. Finally the shape of the aneurysm also affects the management.
You have mentioned that your aneurysm is 2.5, but you do not specify whether it is 2.5 mm (millimeters) or centimeters (cm), so I can not comment on your aneurysm. If it is 2.5 cm, this is called a giant intracerebral aneurysm. These have a high rate of rupture and it is recommended that they be treated in younger patients but the management again depends on various factors.
It is important to know that there are 2 different procedures that can be done for an aneurysm. One is surgical, it is called clipping. The other is done through an angiogram (a catheter is inserted into a blood vessel and taken to the brain), and the procedure is called a coiling. This is less invasive (an actual surgery is not done) but of course has its complications as well. Which procedure is done depends on the size, shape, and location of the aneurysm. The neurosurgeon and possibly also the neurologist taking care of you will be the ones best fit to determine the type of procedure that is most suitable for you. Either way, the procedure is best done at a high-volume center, one where several of these procedures are done each year, so that the person doing the procedure is expert at doing it and dealing with complications should they arise.
If it is decided that the aneurysm has a low risk of rupture, it must be followed by the neurosurgeon with periodic imaging (either a CT angiogram or a conventional angiogram) to monitor its growth rate.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
