Cerebral (brain) aneurysms (bubble)

What is a brain aneurysm (bubble)?

Brain aneurysms, also known as brain bubbles, are the extravasation of the cerebral arteries as a result of the deterioration and weakening of the normal wall structure.

What is the prevalence of brain aneurysm (bubble)?

The incidence of brain aneurysms in the population varies between 1-5%. It is slightly more common in women than men. The most common age and bleeding age is between 40-70 years. The larger the aneurysm, the greater the risk of bleeding.

Why are brain aneurysms (bubbles) important?

Brain aneurysms (bubbles) are important because aneurysms can bleed, and when they bleed, they are highly fatal. Even if the patient can be treated, various neurological problems may be permanent.

What are the symptoms of brain aneurysms (bubbles), how often do they occur?

Most aneurysms do not usually cause any symptoms until they bleed. Apart from bleeding, the most common symptom is headache. In those who have long-term headaches, when the headache changes in character, or when there are sudden severe headaches, it should be considered that there may be bubbles in the brain and it should be investigated with appropriate tests.

When bleeding occurs, patients describe the most severe headache they have ever experienced in their lives. There may be neurological changes leading to unconsciousness with bleeding and death in 20-30% of patients. In unconscious patients, various degrees of neurological function loss and persistent headaches can be found. Mild headaches, loss of neurological function due to aneurysm compression or clotting, and epilepsy may be seen in patients who cannot bleed.

The annual bleeding risk of an aneurysm detected from bleeding is between 1-3%. The mortality rate due to aneurysm bleeding and bleeding complications is 50%. The risk of rebleeding from a bleeding aneurysm is higher in the first days, and rebleeding occurs in 50% of patients within 6 months. Therefore, bleeding aneurysms must be treated. Treatment of aneurysm detected from bleeding should be evaluated in the light of the patient’s condition and characteristics of the aneurysm, and necessary treatment should be given.

Who should be investigated for a brain aneurysm (bubble)?

Especially in patients with more than one aneurysm, the probability of having an aneurysm in their first-degree relatives is 3-4 times higher. In this case, aneurysm investigation should be done in family members.

High blood pressure, smoking, alcohol use, arteriosclerosis, high blood fat increase the risk of aneurysm formation and bleeding.

Aneurysms can also be detected incidentally, for another reason, or during brain computed tomography or magnetic resonance imaging performed during an aneurysm investigation. In some cases, the diagnosis of bleeding from the aneurysm can also be made by taking fluid from the waist. Brain angiography should be performed in patients who are planned to be diagnosed and treated.

How are brain aneurysms (bubbles) treated?

Brain aneurysms, ie bubbles, are treated surgically by neurosurgeons or by intravascular interventional neuroradiologists. In the surgical method, the skull is opened and the aneurysms are reached and the aneurysms are closed with metal clamps. In a very small group, there may not be a chance to apply any treatment due to the characteristics of the aneurysm. The development of intravenous treatment methods together with technology is making this group smaller and smaller.

How is the endovascular (through the vein) treatment of brain aneurysms (bubbles) done?

Intravascular, that is, endovascular treatment, is performed under general anesthesia, accompanied by an angiography device, usually by entering the inguinal artery. There is no interruption of the patient. The aneurysm is reached with thin tube and wire-shaped devices called catheters, and the inside of the aneurysm is filled with metal spiral wires, which we call different coils. Metallic stents can also be used while filling the aneurysm. In some cases, the aneurysm can be treated in 20-30 minutes only with special stents without filling. In some cases, the procedure can be performed while the patient is awake.

The aim of both surgical and endovascular treatment is to close the aneurysm and prevent it from bleeding. If it bleeds, it is not correcting the brain damage caused by the bleeding.

While hydrocephalus, also known as progressive enlargement of the brain cavities that may develop due to aneurysm bleeding, is usually treated surgically, shrinkage in the cerebral vessels that may lead to paralysis and death is treated by administering vasodilators directly to the vessels during endovascular treatment of aneurysm.

Endovascular treatment is performed by experienced interventional neuroradiologists in centers with technical equipment, intensive care units and neurosurgery clinics that treat aneurysms.

Since most patients treated endovascularly, there is no surgical incision and there is no need to wait for wound healing, the length of stay in the intensive care unit and hospital is shorter than in patients who underwent surgery. There are no complications that may occur due to surgical incision.

While the hospital stay is 2-3 days in patients treated endovascularly without bleeding, the hospital stay may be longer in patients with bleeding, regardless of the treatment.

In case of multiple aneurysms, they can be treated in a single session, even if they are on different sides.

How is the follow-up of patients treated for brain aneurysms done?

Patients treated endovascularly are controlled with computed tomography, magnetic resonance imaging and especially angiography. The aim is to make sure that the aneurysm does not recur and that the treatment is complete. If necessary, endovascular treatment can be performed again for the complete treatment of the aneurysm.

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