We just found out that my son-in-law has a cerebral aneurysm that is 3 x 3 mm with a 2 mm neck in his right bafilar artery. He had an MRA this morning,and then went back to work...can you beleive that! He is like a son to me, so needless to say it scares me to death. He's scheduled for a spinal tap in the morning, and possible surgery. He's had a severe headache for the past 11 days and 3 days ago he went to emergency room, but they sent him home after a CT scan , saying it looked like blocked sinuses, with oxycodone to stop the pain, Told him to see his primary DR. Well he did today, and guess the sinus diagionsis was wrong. He is 41 yrs old, doesn't smoke, drink or do drugs, but has a family history of heart problems, and his Mom died of a cerebral aneurysm. My question is, .... because of the location, should he have surgery or the endovascular embolization?
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.
I can not make specific treatment recommendations. However I will try to provide you with some useful information.
When an aneurysm is seen on MRA, a more confirmatory test such as CT angiogram or sometimes more useful a conventional angiogram is needed to better assess the aneruysm; sometimes the appearance of vessels on MRA can be distorted, leading to over- or under- estimation of a lesion. In addition, additional small aneurysms not apparent on MRA may show up on CT angiogram or conventional angiogram.
As you mention, the options for aneurysm treatment are clipping and coiling. Clipping is a surgical procedure in which the aneurysm is surgically ligated (removed); with coiling, small pieces of material are inserted into the aneurysm and it seals off on its own. Sometimes, with coiling, a stent needs to be inserted into the artery to wall of the coiled aneurysm from the rest of the artery. Each procedure has its own risks and limitations.
Which procedure is done really depends on several factors including what the symptoms are (did the aneurysm bleed or not), the size and shape of the aneurysm, and the exact location. If a bleed has occurred (what is termed subarachnoid hemorrhage), emergent management of the aneurysm and treatment in an intensive care unit is mandatory.
Again I can not advise you on which type of treatment is most appropriate, however it is of importance that whatever procedure is done it be at a high volume center where there is a extensive experience with the procedure to be done.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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