Not all cerebral aneurysms burst. If your child is diagnosed with very small aneurysms, they may be monitored to detect any growth or onset of symptoms and to ensure aggressive treatment of coexisting medical problems and risk factors.
It is important to note that, like your child, each case is unique, and considerations for treating an unruptured aneurysm include the type, size, and location of the aneurysm; risk of rupture; the age and health of your child, as well as any recent head injuries, diseases or disorders, personal and family medical history and, of course, risk of treatment. Your neurology team will discuss all options and risks with you prior to treatment.
Two surgical options are available for treating cerebral aneurysms and when it comes to performing them, you can trust that our specialists are among the best in the nation. However it is important to note that any surgery, and especially brain surgery, can carry some risk to your child (such as possible damage to other blood vessels, the potential for aneurysm recurrence and rebleeding, and the risk of post-operative stroke).
- Microvascular clipping involves cutting off the flow of blood to the aneurysm. Under anesthesia, a section of the skull is removed and the aneurysm is located. The neurosurgeon uses a microscope to isolate the blood vessel that feeds the aneurysm and places a small, metal, clothespin-like clip on the aneurysm's neck, halting its blood supply. The clip remains in the person and prevents the risk of future bleeding. The skull section is then replaced and the scalp is closed. Clipping has been shown to be highly effective, depending on the location, shape, and size of the aneurysm. In general, aneurysms that are completely clipped surgically do not return.
- A related procedure is an occlusion, in which the surgeon clamps off (occludes) the entire artery that leads to the aneurysm. This procedure is often performed when the aneurysm has damaged the artery. An occlusion is sometimes accompanied by a bypass, in which a small blood vessel is surgically grafted to the brain artery, rerouting the flow of blood away from the section of the damaged artery.
Endovascular embolization is an alternative to surgery. Once your child has been anesthetized, the doctor inserts a hollow plastic tube (a catheter) into an artery (usually in the groin) and threads it, using angiography, through the body to the site of the aneurysm. Using a guide wire, detachable coils (spirals of platinum wire) are passed through the catheter and released into the aneurysm. The coils fill the aneurysm, block it from circulation, and cause the blood to clot, which effectively destroys the aneurysm. The procedure may need to be performed more than once during your child's lifetime.
After treatment, your child will remain in the medical center until the bleeding stops. In addition, underlying conditions, such as high blood pressure, will be treated. Any other treatments your doctor recommends will be based on your child's symptoms and may include anticonvulsants to prevent seizures and analgesics to treat headache. Vasospasm can be treated with calcium channel-blocking drugs and sedatives may be ordered if your child is restless to help keep him or her as still as possible during the recovery stage.
Several months following the rupture, a shunt may be surgically inserted into a ventricle if the buildup of cerebrospinal fluid is causing harmful pressure on surrounding tissue in your child's brain. Depending on the type and severity of your child's aneurysm, rehabilitative, speech, and occupational therapy may be needed to help him or her regain lost function and learn to cope with any permanent disability. Your neurology team will work with you and your family to determine the best course of action to restore your child's quality of life, now and in the future.