1. Introduction

   A brain aneurysm, also known as a cerebral aneurysm, is a medical term referring to a ballooning that occurs at a weak point in the wall of an artery in the brain. Affecting approximately 3% of all adults and increasing in prevalence with age, this condition can lead to significant health problems. The wall of an aneurysm is thinner and weaker compared to a normal blood vessel wall. Over time, the thinning of this wall can cause it to rupture at its weakest point, leading to bleeding between the membranes of the brain, known as a "subarachnoid hemorrhage." A subarachnoid hemorrhage is a life-threatening condition, and approximately half of the patients who experience an aneurysm rupture die due to the bleeding and complications.

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   Definition and Risk Factors of Brain Aneurysm

   Brain aneurysm is not a congenital disease; it typically occurs in individuals over the age of 30, and its prevalence increases with age. Genetic predisposition may play a role in aneurysm formation, but a common genetic cause has not been identified in all patients. Individuals with a first-degree relative diagnosed with a brain aneurysm may have an increased risk of developing an aneurysm. Especially additional risk factors such as smoking and hypertension can cause this risk to be even higher. It is important for individuals with multiple relatives diagnosed with aneurysms to be monitored periodically with imaging methods.  

   General Risk Factors:

   • Genetic Predisposition: Risk increases in individuals with a family history.
   • Hypertension: High blood pressure can lead to weakening of the blood vessel wall.  
   • Smoking and Alcohol Use: These habits negatively affect vascular health.  
   • Polycystic Kidney Disease, Pheochromocytoma, and Aortic Coarctation: These diseases can also increase the risk of aneurysm.
   • Substances Used: Substances such as epinephrine, amphetamine, and cocaine can cause weakening in the blood vessel wall.

    

3. Mechanism of Aneurysm Formation

   An aneurysm occurs when the blood pumped by the heart creates pressure at a weak point in the blood vessel wall. This pressure leads to ballooning of the vessel wall. Hypertension and factors that cause weakening in the vessel wall can increase the development of brain aneurysms.

   Bleeding Risk and Complications of Aneurysm

   Not all brain aneurysms bleed. According to research, approximately 3% of the population has a brain aneurysm, but the annual aneurysm rupture rate is 1:10,000. This means that approximately 8,000 aneurysm ruptures occur annually in our country. It is known that not all aneurysms rupture and cause a brain hemorrhage, but it is difficult to determine which aneurysm will bleed. The annual bleeding risk of an unruptured aneurysm is approximately 1-3%. As the size of the aneurysm increases, the risk of bleeding also increases. For example, the probability of aneurysms larger than 25 mm bleeding within two years is 70%. Aneurysms that have once ruptured and caused a brain hemorrhage increase the risk of re-bleeding and require emergency treatment.

5. Symptoms and Complaints

   The most common symptoms and complaints seen in patients with a brain aneurysm are as follows:

   • Frequent and Prolonged Headaches: The pressure caused by an aneurysm can lead to headaches. These pains can often be chronic and unbearable.
   • Pain Sensation Behind the Eye: A persistent pain sensation behind the eye can be one of the symptoms of a brain aneurysm.
   • Nausea and Vomiting: An aneurysm can cause nausea and vomiting by creating pressure within the brain.
   • Sudden Drooping of the Eyelid: Sudden eyelid drooping in a person without diabetes is a significant symptom that increases suspicion of an aneurysm.
   • Double Vision: An aneurysm can cause double vision by putting pressure on the eye muscles or nerves.
   • Blurred Vision or Vision Loss: Pressure in the brain can lead to disturbances in the visual field.

   These symptoms may be associated with an aneurysm, as well as being symptoms of other diseases. Therefore, it is important to consult a healthcare professional if symptoms are experienced.

5. How is a Brain Aneurysm Diagnosed?

   The diagnosis of a brain aneurysm is usually made using the following methods:

• Magnetic Resonance Imaging (MRI): This is the first-line test for screening for brain aneurysms. MRI imaging is used to detect the presence of an aneurysm.

• Magnetic Resonance Angiography (MRA): Used in the diagnosis of unruptured brain aneurysms. MRA is performed without the use of contrast dye and usually takes 15-20 minutes. During this time, the patient lies still in the MRI machine.

• Catheter Angiography (Digital Subtraction Angiography - DSA): Considered the "gold standard" for aneurysm diagnosis and treatment planning. This method provides 3-dimensional images of the blood vessels and allows for a detailed evaluation of brain aneurysms. Catheter angiography provides detailed information about the size, shape, and location of the aneurysm. The risk of complications during catheter angiography is very low, and high-resolution images are obtained with modern digital angiography devices. This information plays a critical role in determining the most appropriate treatment method.

6. Treatment Methods

   Brain Aneurysm Treatment: Closed (Endovascular) Methods

   The primary goal of brain aneurysm treatment is to eliminate the risk of brain hemorrhage that may occur if the aneurysm ruptures. Treatment aims to block blood flow by closing off the aneurysm sac. Closed (endovascular) treatment methods are among the preferred first-line options for aneurysm treatment today. These methods are generally considered safer and more effective, and the procedure time usually varies between 1.5 and 4 hours.

   Closed (Endovascular) Treatment Methods

   Closed (endovascular) aneurysm treatments are performed from within the blood vessels without opening the patient's skull. They vary in terms of the techniques used and the materials employed.

1. Treatment with Coil (Coiling)

   Endovascular aneurysm treatment with coils is performed under general anesthesia. The treatment process generally consists of the following steps:

   Catheter Placement: The procedure begins with the insertion of a special catheter, 2 mm in diameter, into the femoral artery in the leg.
   Use of Microcatheter: Through the catheter, a fine and flexible microcatheter with a diameter of 0.5 mm is advanced into the vessel. This microcatheter is guided to the vessel where the aneurysm is located.
   Coil Placement: The tip of the microcatheter is placed into the aneurysm sac, and very thin coils made of platinum are deployed through it. The coils form a bundle inside the aneurysm sac, preventing blood flow.
   Completion of the Procedure: Once the aneurysm is completely filled with coils, the microcatheter is withdrawn, and the procedure is completed.

   Diagnosis of Brain Aneurysm is generally performed using the following methods:

   Magnetic Resonance (MR) Imaging: This is the first-line test used to scan for brain aneurysms. MR imaging is used to detect the presence of an aneurysm.
   Magnetic Resonance Angiography (MR Angiography): Used for diagnosing non-bleeding brain aneurysms. MR angiography is performed without contrast agents and usually takes 15–20 minutes. During this time, the patient lies still in the MR scanner.
   Catheter Angiography (DSA): Considered the “gold standard” for aneurysm diagnosis and treatment planning. This method provides 3D images of the vessels and allows for a detailed assessment of brain aneurysms. Catheter angiography provides detailed information about the size, shape, and location of the aneurysm. The risk of complications during catheter angiography is very low, and modern digital angiography devices provide high-resolution images. This information plays a critical role in determining the most appropriate treatment method.

   Treatment Methods

   Brain Aneurysm Treatment: Endovascular Methods

   The primary goal of brain aneurysm treatment is to eliminate the risk of brain hemorrhage that could occur if the aneurysm ruptures. Treatment aims to block blood flow by sealing the aneurysm sac. Endovascular treatment methods are among the preferred first-line options for aneurysm treatment today. These methods are generally considered safer and more effective, and the procedure duration typically ranges from 1.5 to 4 hours.

   Endovascular Treatment Methods

   Endovascular aneurysm treatments are performed inside the blood vessels, without opening the skull. The techniques used and materials applied vary.

   Treatment with Coil (Coiling)

   Endovascular aneurysm treatment with coils is performed under general anesthesia. The treatment process generally consists of the following steps:

   Catheter Placement: The procedure begins with the insertion of a special catheter, 2 mm in diameter, into the femoral artery in the leg.
   Use of Microcatheter: Through the catheter, a fine and flexible microcatheter with a diameter of 0.5 mm is advanced into the vessel. This microcatheter is guided to the vessel where the aneurysm is located.
   Coil Placement: The tip of the microcatheter is placed into the aneurysm sac, and very thin coils made of platinum are deployed through it. The coils form a bundle inside the aneurysm sac, preventing blood flow.
   Completion of the Procedure: Once the aneurysm is completely filled with coils, the microcatheter is withdrawn, and the procedure is completed.

    

Flow-Diverting Stents
Flow-diverting stents enable the successful treatment of aneurysms that were previously considered difficult or high-risk to treat.

Conclusion
Endovascular aneurysm treatment methods accelerate the recovery process and reduce surgical risks. Each method has specific advantages and indications, and the most appropriate treatment option is determined based on the patient's individual condition. Today, endovascular treatments allow for the effective and safe management of brain aneurysms.

Open Surgical Methods:
Clipping: During open surgery, a metal clip is placed across the neck of the aneurysm to prevent it from filling with blood.

Post-Treatment Care and Follow-up

Post-Endovascular (Closed) Treatment Follow-Up:
Early Follow-Up:

• Hospital Stay: Patients are usually discharged within 2–3 days.
• Recovery: Most patients can return to their normal daily lives within a week after discharge.
• Medication: If a stent was used, patients must take blood-thinning medications. The use and dosage of these drugs are determined by the physician.

Long-Term Follow-Up:

• Follow-Up Angiographies: The first follow-up angiography is usually performed 6–12 months after treatment to evaluate its effectiveness. A second angiography is typically conducted after 2 years.
• MRI Compatibility: The materials used in endovascular treatment (stents, coils) are compatible with MRI scanners. Patients usually need not worry about MRI scans, though these materials may trigger false alarms at metal detectors.
• Symptoms and Complications:
• Groin Area: If pain or swelling in the groin area persists for more than one week after endovascular treatment, patients should consult their doctor.

Post-Open Surgical Treatment Follow-Up:
Early Follow-Up:

• Hospital Stay: The hospital stay usually lasts 7–8 days.
• Angiographic Follow-Up: A control angiography is performed within a week after surgery to confirm complete aneurysm closure.

Long-Term Follow-Up:

• Wound Healing: Full recovery of the surgical site may take 4–6 weeks.
• Follow-Up Angiographies: A second angiography is performed 1–2 years after surgery.

MRI Compatibility:

• Clips: Aneurysm clips made of titanium are MRI-compatible. However, older steel clips are not compatible with MRI, and patients treated with such clips must consult their physician before undergoing MRI scans.

Follow-Up After Treatment of a Ruptured Aneurysm:

Hospital Stay:

• Extended Observation: Hospitalization may last 4–5 weeks and can be extended depending on complications.

Monitoring for Complications:

• Complications: Conditions such as vasospasm (vessel spasm due to brain hemorrhage) and hydrocephalus (accumulation of fluid in the brain) should be monitored. These complications can lead to permanent disabilities and may require treatment.
• Seizures: Some patients may need to take anti-seizure medications after a ruptured aneurysm.

General Recommendations:

• Smoking and Alcohol: Do not smoke and avoid excessive alcohol consumption. These factors can increase the risk of aneurysm recurrence.
• Blood Pressure Control: It is important to keep hypertension under control. Blood pressure should be monitored regularly and medications prescribed by a physician.
• Regular Monitoring: Patients with polycystic kidney disease or those diagnosed with aneurysms at a young age should be monitored regularly with MR angiography.

The post-treatment monitoring process is critical for assessing the patient’s response to treatment, identifying potential complications, and ensuring long-term health. During this process, it is essential for patients to remain in regular contact with their doctors and follow the given instructions.

Risks and Complications
There may be risks and complications during the treatment process. While endovascular treatment generally carries lower risk, the risk of complications in open surgery may vary depending on the size and location of the aneurysm.

Conclusion
A brain aneurysm is a condition that can lead to serious health problems. However, with early diagnosis and appropriate treatment methods, these risks can be effectively managed. Today, endovascular treatment methods offer successful outcomes in aneurysm management. Patients diagnosed with aneurysms should consult experienced healthcare professionals for treatment planning and pay attention to lifestyle changes.

These details are supported by medically verified information from specialist Dr. Ibadat Hasanov and are intended to inform individuals. In all cases, the treatment plan is personalized and carefully evaluated by your doctors.