Aneurysm treatment is done by surgery. The main purpose of aneurysm treatment is to prevent blood entry into the aneurysm. Drug treatment of aneurysm is not possible with today’s medical facilities. Although various studies are being conducted on this subject, no such treatment is currently on the horizon.
There are two main types of surgical methods used in the treatment of aneurysms:
1- Open surgery (clipping):In this surgery performed by neurosurgeons, the skull is opened to reach the aneurysm between the brain folds and a clip is placed on the neck of the aneurysm to prevent blood entry into the aneurysm.
2- Closed treatment (endovascular treatment):In this application performed by neuroradiology specialists, the angiography method is used to reach the inside of the aneurysm or up to the neck of the aneurysm with long and thin tubes called catheters, and blood entry into the aneurysm is prevented.
There are different methods used for this purpose:TO The most commonly used method is to fill the aneurysm with thin wires called coils by braiding a ball. The coils used to fill the aneurysms are very soft memory platinum wires with a diameter of 0.25 – 0.45 mm. In the production of these wires, a varying number of coils with different diameters and movement characteristics are used for each aneurysm, since the diameter and type of bend the catheter will make when it comes out of it is determined.
A tube made of wire, called a stent, is inserted into the vessel on which the aneurysm is located, and blood entry into the aneurysm is prevented.
By placing a stent or balloon on the vein with an aneurysm on it, the blood flow direction or flow type in the vein is changed to prevent blood entry into the aneurysm.
Although these procedures are performed under general anesthesia, there is no incision in the patient’s skull. All treatment is done by entering the vein with the help of a needle, usually in the groin.
Although the success of this method, which has been applied for about 20 years, in the treatment of aneurysms was a matter of debate in the early days, it has now become the preferred method in most aneurysms. As a result of multicenter comparative studies with international participation; This method, called embolization / endovascular treatment, has proven successful in the treatment of aneurysms.
How should it be decided in which way the detected aneurysm should be treated?
The following points are important in making this decision:
1- Are there neurosurgery and neuroradiology teams, which are two different specialties, that can apply these methods in the current conditions?
2- Which method is more suitable for the location, size and structure of the aneurysm?
3- Which of these two different methods can be applied with lower risk?
The ideal way to follow this decision is; neurosurgeon, neuroradiology specialist and patient have a joint meeting to discuss the advantages and disadvantages of the methods together and form a joint decision that takes into account the patient’s preferences.
prof. Dr. Ozenc MINARECI