Frequently Asked Questions About Subarachnoid Hemorrhage (Aneurysmal Bleeding)

The exact cause of brain aneurysms is unknown. However, some factors are accepted to contribute to the formation of brain aneurysms. These factors are: 1. high blood pressure 2. smoking 3. genetic predisposition 4. damage to blood vessels

Because the wall of an aneurysm is weaker than a normal vessel wall, it may rupture and bleed. When it bleeds, it may cause stroke and death at a high rate in the patient. It is not possible to ignore these risks. While some aneurysms do not need treatment, some can be occluded angiographically by entering with the method called endovascular treatment. Some, due to their shape and location, cannot be closed by the endovascular method and these are clipped by surgery; when clipped, the risk of bleeding also disappears.

The introduction of microsurgical methods in neurosurgery has made surgical treatment the gold standard in brain aneurysms. Despite this, surgical clipping operations are in the class of major and difficult surgeries. The procedure of closing the aneurysm with a clip is performed through craniotomy (removal of a part of the skull). Through the path opened by craniotomy, the brain and brain vessels are reached and the aneurysm is found. After that, the aneurysm is carefully separated from the surrounding brain tissue. At this stage, a small metal (usually titanium) clip is applied to the neck (base) of the aneurysm. These clips have a spring mechanism, and when they are placed, they cut off the blood flow into the aneurysm. The most valid and most effective method in aneurysm treatment is the open surgical approach performed in this way.

In endovascular treatment, the aim is to eliminate the aneurysm, as in surgical treatment. A soft platinum coil is used for the procedure. This coil is carefully advanced to the brain through one of the large arteries in the groin and placed into the aneurysm in the brain. The coil placed into the aneurysm disrupts the blood flow there. As a result of the slowed blood flow, a large blood clot forms there. The aneurysm blocked by the formed clot closes and cannot rupture and bleed.

Neurosurgeons perform the surgical clipping procedure. Interventional radiologists perform endovascular treatment.

In some cases, they are genetic. For example, if there is polycystic kidney disease in the family or if some members of the family have aneurysms, it would be appropriate for the other family members to be checked with painless MR angiography.

The most dangerous situation that may occur during both surgical and endovascular treatment is rupture of the aneurysm and bleeding into the brain. Although it is not known exactly how often this occurs, a rate of approximately 2-3% can be mentioned for both procedures. When the aneurysm ruptures, bleeding occurs into the brain. This may lead to stroke, coma, or death. Intervention for aneurysm rupture that may occur during both procedures can be performed more easily during open brain surgeries. Because during this procedure, the bleeding site can be seen more easily and it is easier to intervene there to control the bleeding. Strokes that may develop due to reduced blood flow and therefore reduced oxygenation may also occur as another dangerous condition during clipping or coil placement. The extent and distribution of this stroke vary according to the location of the aneurysm. Issues such as how long the procedure will take, what risks may occur, and how long after the procedure one can return to normal life depend on the location of the aneurysm, the size of the bleeding, and the patient's medical condition. Therefore, each person's condition should be handled separately and discussed with their physician.