Summer 2005 Issue

Endovascular Coiling Offers Minimally Invasive Option For Treating Unruptured Brain Aneurysms

It is estimated that up to one in 15 people in the United States will develop a brain aneurysm during their lifetime. When an unruptured aneurysm is detected, it can be treated, thus preventing a rupture and possible stroke, brain damage or death.

A minimally invasive treatment option available through Carolina Neurosurgery & Spine Associates is endovascular coiling. This procedure accesses the treatment area from within the blood vessel. The practice is the only neurosurgery group in the region, and one of only three in the Carolinas, performing the aneurysm coiling procedure.
Coils conform to the shape of the aneurysm to prevent a rupture.

“Coiling, or embolization, is not appropriate in every situation,” explained neuroendovascular surgeon Joe Bernard, M.D. “This treatment is effective in treating aneurysms with certain geometric shapes.”

Endovascular coiling of brain aneurysms involves insertion of a catheter into the femoral artery in the patient's leg. Using fluoroscopy, the catheter is navigated through the vascular system to the aneurysm, where soft, tiny, platinum coils are then threaded into it. The softness of the platinum allows the coils to conform to the often irregular shape of an aneurysm sac. The purpose is to fill the aneurysm with coils, thus blocking blood flow into it and preventing rupture.

Several coils are required to completely pack an aneurysm. When in position, a very low voltage current causes the coil to detach from the pusher wire.

“We use this procedure with about 30% of the aneurysm cases we treat. That percentage is growing every year as the technology improves,” said Dr. Bernard. “Due to its minimally invasive nature, patient recovery is much faster than with a surgical approach. Patients usually return home the day after coiling and can recover in days as opposed to the weeks of recovery associated with surgery.”

Surgical treatment of an aneurysm requires a craniotomy. Once the aneurysm is located, it is closed off with a metal clip to prevent the flow of blood into it. Neither surgery nor coiling can repair areas of the brain already injured, and not all aneurysms are treatable by either procedure. Consultation with a neurovascular specialist is needed to determine if a patient is a candidate for either treatment.

Diagnosis
Because the symptoms of brain aneurysms can also be associated with other medical conditions, diagnostic imaging is regularly used to identify both ruptured and unruptured brain aneurysms. Before an aneurysm ruptures, patients often experience no symptoms. Unruptured aneurysms are usually discovered when a patient is undergoing imaging for another condition. Cerebral angiography or CT angiography is used to determine the exact location, size and shape of an aneurysm.


Ruptured Cerebral Aneurysm Symptoms
• Intense headache
• Pain above and behind the eye
• Nausea and vomiting

• Dilated pupils
• Stiff neck or neck pain
• Sensitivity to light
• Blurred or double vision

• Loss of sensation
Note: Before an aneurysm ruptures, patients often experience no symptoms.

For more information about endovascular coiling or any other endovascular services offered by our practice, call 704-376-1605.



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