Treating Brain Aneurysms: The latest advances and treatment options
Brain
Posted on: Aug 16
Treating Brain Aneurysms
Brain
Posted on: Aug 16
Views19258 Shares0
Tags: neuroscience, brain, aneurysms, surgery, article

Treating Brain Aneurysms: The latest advances and treatment options

An estimated one in 50 Americans has an aneurysm. A ruptured intracranial aneurysm is a life-threatening condition that generally results in a poor outcome. An unruptured intracranial aneurysm, however, can be successfully treated in most cases.

Most unruptured aneurysms do not cause symptoms, and many people discover they have one only when it is detected during testing for an unrelated condition. For example, some patients with an unruptured aneurysm present to a primary care provider, ophthalmologist or neurologist complaining of blurred vision or headache. As a result, referring physicians often play a central role in guiding their patients’ treatment. Understanding the latest advances in aneurysm treatment can help physicians direct patients to the right treatment centers for the best outcomes.

The neurosurgeons and interventional neuroradiologists at IU Health Neuroscience treat a large number of aneurysms each year and provide the latest in aneurysm treatment. “Not all neurosurgery groups treat intracranial aneurysm because it requires both extensive experience and specialized expertise,” explained John A. Scott, MD, an interventional neuroradiologist who practices at IU Health Neuroscience. “IU Health Neuroscience provides physicians more treatment choices for their patients and the reassurance of experience.”

Determining an Appropriate Treatment Approach

There are three basic approaches to treating an intracranial aneurysm: medical, surgical and endovascular. Weighing the risks of treatment versus observation, and deciding between surgical and endovascular treatment are decisions that should be made on a case-by-case basis, taking into consideration the patient’s current health, history, and size, shape and location of the aneurysm.

At IU Health Neuroscience, a collaborative team of neurosurgeons, interventional neuroradiologists and neurologists work together to evaluate each patient and chart the best treatment course. Sophisticated MRI, CT and cerebral angiography imaging allow physicians to pinpoint the exact location, size and shape of an aneurysm. This helps physicians determine the most appropriate treatment, and allows for highly precise and more successful treatment.

Advanced Technology for Better Surgical Outcomes

Surgical clipping is an open procedure that involves cutting off the aneurysm’s blood flow. Neurosurgeons remove a small section of skull and place a tiny clip at the base of the aneurysm. With its blood supply cut off, the aneurysm eventually shrinks. Clipping is a well-established treatment option, but one that requires precision and a deep understanding of the brain’s structure. With the most experienced neurosurgeons in the state, IU Health Neuroscience provides confidence and better outcomes for this procedure.

What’s more, neurosurgeons at IU Health Neuroscience have access to a sophisticated fluorescence technology called INFRARED 800 to improve success rates and minimize risks. INFRARED 800 enables quick visualization of blood flow with the aid of fluorescence technology, which provides neurosurgeons with real-time images during surgery. Any problems can be immediately identified and corrected, allowing neurosurgeons to have a higher degree of certainty with fewer complications.

Endovascular Alternatives

Coil embolization is a less-invasive, interventional procedure that has been widely used for nearly 30 years. In coiling, interventional neuroradiologists thread tiny metal coils through a catheter into the aneurysm. The coils fill the aneurysm, blocking blood supply and causing it to shrink.

In some cases, when the patient’s aneurysm has a broad opening, a stent is used to help keep the coils in place. Stent-assisted coiling provides an alternative to open surgery, but it also poses risks, including thrombosis and stenosis. Additionally, the risk of recurrence rate with coiled broad-neck aneurysm can be as high as 30 percent. 

Now, a new generation of endovascular devices is transforming the treatment of wide-neck aneurysm in the carotid artery, offering some patients a successful alternative to clipping, coiling or stent-assisted coiling.

“This is big,” said Dr. Scott. “It’s a potential game-changer for these types of aneurysms, whereas before there really wasn’t any good treatment, either surgical or endovascular.”

Breakthrough Treatment for Broad-Neck Aneurysms

In the case of wide-neck aneurysms, which are considered the most difficult aneurysms to treat, the opening is less like a balloon and more like a bowler hat, Dr. Scott explained. This makes it nearly impossible to clip and challenging to treat with coiling—even with the aid of a stent. In the past, that meant patients faced few good treatment options and a lifetime risk of rupture.

The new endovascular devices attack the aneurysm by remodeling the parent artery and restoring natural blood flow. The Covidian Pipeline Embolization device is the first-such device to be approved by the FDA, and IU Health Neuroscience is the only program in the state and one of only a select few centers nationwide to offer it.

“What makes this different is it gives us another way of treating these aneurysms that does not involve attacking the aneurysm itself,” Dr. Scott explained. “We’re not putting anything in the aneurysm; rather, we’re putting something across the neck of the aneurysm in the parent vessel. It’s a whole new way of approach aneurysm treatment.”

During an endovascular procedure, a flexible, mesh, stent-like device is placed over the opening of the aneurysm and acts as scaffolding to the parent artery. The device is made up of 48, very tightly braided strands of metal and is less porous than traditional stents. “It’s almost more like a solid tube than a porous stent,” Dr. Scott said. “It diverts blood flow downstream, restores natural blood circulation and allows the aneurysm to thrombose.”

Dr. Scott—along with his colleagues, Andrew Denardo, MD, and Daniel Hsu, MD—perform the procedure at IU Health Neuroscience, and have treated more than 25 patients with the Pipeline device since its approval in late 2011. Follow-up angiograms show that most people treated with the device are completely thrombosed after six months.

That said, the new device is not without risks, according to Dr. Scott, and all patients treated with the Pipeline device are pre-medicated with anti-clotting medication. Patients whose aneurysm is located near a branch vessel may be a candidate for the Pipeline device, although surgeons will try to avoid this placement when anatomically possible. This is due to fears that the device could occlude the vessel or the aneurysm may bleed before being fully thrombosed.

“It may not be a magic bullet,” Dr. Scott said. “But it’s an important advance and cutting-edge therapy for cerebral vascular lesions.”

Dr. John A. Scott, MD

John A. Scott, MD, is an interventional and diagnostic neuroradiologist practicing at Indiana University Health. He is a graduate of the Indiana University School of Medicine. He completed his residency at Indiana University Medical Center and a fellowship in interventional neuroradiology at New York University. Dr. Scott is certified by the American Board of Radiology, and is a member of the American Association of Neurological Surgeons, American Society of Interventional and Therapeutic Neuroradiology, and the American Society of Neuroradiology.

Tags: neuroscience, brain, aneurysms, surgery, article
What do you think of this article?

Treating Brain Aneurysms: The latest advances and treatment options

An estimated one in 50 Americans has an aneurysm. A ruptured intracranial aneurysm is a life-threatening condition that generally results in a poor outcome. An unruptured intracranial aneurysm, however, can be successfully treated in most cases.

Most unruptured aneurysms do not cause symptoms, and many people discover they have one only when it is detected during testing for an unrelated condition. For example, some patients with an unruptured aneurysm present to a primary care provider, ophthalmologist or neurologist complaining of blurred vision or headache. As a result, referring physicians often play a central role in guiding their patients’ treatment. Understanding the latest advances in aneurysm treatment can help physicians direct patients to the right treatment centers for the best outcomes.

The neurosurgeons and interventional neuroradiologists at IU Health Neuroscience treat a large number of aneurysms each year and provide the latest in aneurysm treatment. “Not all neurosurgery groups treat intracranial aneurysm because it requires both extensive experience and specialized expertise,” explained John A. Scott, MD, an interventional neuroradiologist who practices at IU Health Neuroscience. “IU Health Neuroscience provides physicians more treatment choices for their patients and the reassurance of experience.”

Determining an Appropriate Treatment Approach

There are three basic approaches to treating an intracranial aneurysm: medical, surgical and endovascular. Weighing the risks of treatment versus observation, and deciding between surgical and endovascular treatment are decisions that should be made on a case-by-case basis, taking into consideration the patient’s current health, history, and size, shape and location of the aneurysm.

At IU Health Neuroscience, a collaborative team of neurosurgeons, interventional neuroradiologists and neurologists work together to evaluate each patient and chart the best treatment course. Sophisticated MRI, CT and cerebral angiography imaging allow physicians to pinpoint the exact location, size and shape of an aneurysm. This helps physicians determine the most appropriate treatment, and allows for highly precise and more successful treatment.

Advanced Technology for Better Surgical Outcomes

Surgical clipping is an open procedure that involves cutting off the aneurysm’s blood flow. Neurosurgeons remove a small section of skull and place a tiny clip at the base of the aneurysm. With its blood supply cut off, the aneurysm eventually shrinks. Clipping is a well-established treatment option, but one that requires precision and a deep understanding of the brain’s structure. With the most experienced neurosurgeons in the state, IU Health Neuroscience provides confidence and better outcomes for this procedure.

What’s more, neurosurgeons at IU Health Neuroscience have access to a sophisticated fluorescence technology called INFRARED 800 to improve success rates and minimize risks. INFRARED 800 enables quick visualization of blood flow with the aid of fluorescence technology, which provides neurosurgeons with real-time images during surgery. Any problems can be immediately identified and corrected, allowing neurosurgeons to have a higher degree of certainty with fewer complications.

Endovascular Alternatives

Coil embolization is a less-invasive, interventional procedure that has been widely used for nearly 30 years. In coiling, interventional neuroradiologists thread tiny metal coils through a catheter into the aneurysm. The coils fill the aneurysm, blocking blood supply and causing it to shrink.

In some cases, when the patient’s aneurysm has a broad opening, a stent is used to help keep the coils in place. Stent-assisted coiling provides an alternative to open surgery, but it also poses risks, including thrombosis and stenosis. Additionally, the risk of recurrence rate with coiled broad-neck aneurysm can be as high as 30 percent. 

Now, a new generation of endovascular devices is transforming the treatment of wide-neck aneurysm in the carotid artery, offering some patients a successful alternative to clipping, coiling or stent-assisted coiling.

“This is big,” said Dr. Scott. “It’s a potential game-changer for these types of aneurysms, whereas before there really wasn’t any good treatment, either surgical or endovascular.”

Breakthrough Treatment for Broad-Neck Aneurysms

In the case of wide-neck aneurysms, which are considered the most difficult aneurysms to treat, the opening is less like a balloon and more like a bowler hat, Dr. Scott explained. This makes it nearly impossible to clip and challenging to treat with coiling—even with the aid of a stent. In the past, that meant patients faced few good treatment options and a lifetime risk of rupture.

The new endovascular devices attack the aneurysm by remodeling the parent artery and restoring natural blood flow. The Covidian Pipeline Embolization device is the first-such device to be approved by the FDA, and IU Health Neuroscience is the only program in the state and one of only a select few centers nationwide to offer it.

“What makes this different is it gives us another way of treating these aneurysms that does not involve attacking the aneurysm itself,” Dr. Scott explained. “We’re not putting anything in the aneurysm; rather, we’re putting something across the neck of the aneurysm in the parent vessel. It’s a whole new way of approach aneurysm treatment.”

During an endovascular procedure, a flexible, mesh, stent-like device is placed over the opening of the aneurysm and acts as scaffolding to the parent artery. The device is made up of 48, very tightly braided strands of metal and is less porous than traditional stents. “It’s almost more like a solid tube than a porous stent,” Dr. Scott said. “It diverts blood flow downstream, restores natural blood circulation and allows the aneurysm to thrombose.”

Dr. Scott—along with his colleagues, Andrew Denardo, MD, and Daniel Hsu, MD—perform the procedure at IU Health Neuroscience, and have treated more than 25 patients with the Pipeline device since its approval in late 2011. Follow-up angiograms show that most people treated with the device are completely thrombosed after six months.

That said, the new device is not without risks, according to Dr. Scott, and all patients treated with the Pipeline device are pre-medicated with anti-clotting medication. Patients whose aneurysm is located near a branch vessel may be a candidate for the Pipeline device, although surgeons will try to avoid this placement when anatomically possible. This is due to fears that the device could occlude the vessel or the aneurysm may bleed before being fully thrombosed.

“It may not be a magic bullet,” Dr. Scott said. “But it’s an important advance and cutting-edge therapy for cerebral vascular lesions.”

Dr. John A. Scott, MD

John A. Scott, MD, is an interventional and diagnostic neuroradiologist practicing at Indiana University Health. He is a graduate of the Indiana University School of Medicine. He completed his residency at Indiana University Medical Center and a fellowship in interventional neuroradiology at New York University. Dr. Scott is certified by the American Board of Radiology, and is a member of the American Association of Neurological Surgeons, American Society of Interventional and Therapeutic Neuroradiology, and the American Society of Neuroradiology.

What do you think of this article? print