2016 Top Doctor in 5280 Magazine
There are quite a few different types of brain aneurysms. In order to thoroughly explore all the different types of brain aneurysms, and their possible treatment options one would have to refer to several text books. However, this can serve as a quick review of some of the more common types of aneurysms people can encounter.
The first and most common type of brain aneurysm is the one most people think of when talking about a brain aneurysm. That is the saccular aneurysm. This type of aneurysm is caused by a weakness in the blood vessel wall. It is the type of aneurysm most commonly studies and in fact the rates of hemorrhage quoted for complications, for hemorrhage associated with aneurysms in general are usually referring to this type of aneurysm. This type of aneurysm is usually found at branch points of blood vessels. The treatment for this type of aneurysm have been discussed in another part of this website (Services --> Brain Aneurysms) but basically include either observation, using small coils from the inside of the blood vessel or clips from the outside of the blood vessel to occlude that little pouch and prevent the risk of rupture in the future.
Another type of aneurysm sometimes found in the brain is what some people call the blister aneurysm. This type of aneurysm is frankly difficult to diagnose prior to the onset of symptoms. It’s difficult to know exactly what causes these aneursm. One thought is that they are caused by an injury to the blood vessel which can then progress quickly to a hemorrhage in the brain. These aneurysm are difficult to treat. Various treatment options have been tried to include surgery, coiling, bypass surgeries and even stents to strengthen the actual blood vessel. The bottom line is that these can be quite complicated and during treatment the surgeon in general usually has several plans for treatment in case things don’t go as planned with the last one usually being the sacrifice of the blood vessel either with a bypass or sometimes without.
Another type of aneurysms are the atherosclerotic aneurysms. When I think of these aneurysms the typical example is the aortic aneurysm. While that is not in the brain itself it serves as a good example. The same thing that happens to the aorta can happen in the brain. An area of plaque develops and with many years of high blood pressure, cholesterol and other problems an area of widening develops in the blood vessel itself. For the most part no treatment other then an aspirin a day is required for these aneurysms. However, that said I have seen several cases which required treatment and I can tell you that these are some of the most difficult aneurysm to treat. Partially it’s because usually their location is difficult to get to from a surgical standpoint, the treatment is complicated and sometimes risky, and the patients are usually older and have several other problems like high blood pressure, diabetes and are at a higher risk of complications.
Even another type of aneurysm are the dissecting aneurysms. These aneurysms are ones that again happen sometimes very quickly. They are usually the result of some kind of trauma or accident. The location is typically more commonly in the back of the brain or posterior circulation. The treatment for these is again dependent of their presentation. Typically if there has been no hemorrhage in the brain some doctors would recommend just using blood thinning medications to help the blood vessel heal. In fact in one of the meetings I attended there was a discussion about using blood thinner even in the presence of a brain hemorrhage. I must admit that while in the future that very well may be the preferred treatment method at this time it really makes me nervous. In the past these aneurysm were usually treated surgically but more and more people are moving away from treating these with surgery and relying on endovascular methods such as stents and coils to help treat these aneurysms. The reason for this is from a surgical standpoint when you are faced with this type of aneurysm it can be a daunting sight. Normally the blood vessels in the brain are really thin anyway. Usually you can actually see the blood flow through them during surgery. In these cases the blood vessel is injured and is even thinner and more friable then usual.
So there you go. Four different types of aneurysms in the brain. Obviously this is not an exhaustive list. You can also get an aneurysm in the brain from other reasons such as infection, vasculitis, some tumors and even some other causes. But these are some of the more common ones. As always I think that any kind of aneurysm should be evaluated by a neurosurgeon preferably one that specializes in the treatment of these conditions.
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