What is a brain aneurysm?
A brain aneurysm is a balloon-like swelling that results from a weakness in the wall of one of the blood vessels supplying blood to the brain. There is a risk that the aneurysm will rupture (burst suddenly) and cause a haemorrhage (bleed).
What is coiling?
In the 1990s, coiling was introduced as a way of treating ruptured and unruptured brain aneurysms without the need for a craniotomy (an operation that opens the skull to expose the brain). (You may wish to see our fact sheet, Craniotomy, for further information.) Coiling involves approaching the aneurysm from inside the blood vessel, so that there is no need to open the skull. Small metal coils are inserted into the aneurysm through the arteries that run from the groin to the brain. The coils remain in the aneurysm; they are not removed. They stop blood flowing into the aneurysm and therefore reduce the risk of a bleed or a re-bleed.
Who gets brain aneurysms?
You’re more likely to develop a brain aneurysm if you:
- Are female.
- Are 40 to 60 years old.
- Have a family history of aneurysms
- Have a rare blood-vessel disorder like arterial dissection, fibromuscular dysplasia or cerebral arteritis.
- Have a genetic disorder that affects connective tissue such as Ehlers-Danlos syndrome, Marfan syndrome, neurofibromatosis type 1 or Loeys-Dietz syndrome.
- Have polycystic kidney disease.
- Are born with brain aneurysm as a birth defect.
What causes brain aneurysms?
It’s not clear why a brain aneurysm forms. Researchers believe these factors irritate and weaken blood vessels:
- Smoking.
- Blood infection.
- High blood pressure (hypertension).
- Amphetamine and cocaine use.
- Traumatic brain injury (often caused by car crashes).
- Atherosclerosis (fatty buildup on blood-vessel walls).
What are the symptoms of an unruptured brain aneurysm?
The most common signs of an intact aneurysm are headaches. Other signs may include:
- Vision changes.
- Enlarged (dilated) pupil, the black part of the eye.
- Seizures.
- Numbness or tingling on the head or face.
- Pain above and behind the eye.
- Neck pain.
- Nausea and vomiting.
What are the symptoms of a ruptured brain aneurysm?
A brain aneurysm that is leaking or has burst open is life-threatening. It requires emergency medical treatment. People with a ruptured brain aneurysm often say the headache is the worst headache of their lives. The severe headache comes on suddenly and lasts for hours to days.
Besides a severe headache, you may have some of the same symptoms of an unruptured aneurysm (see list above). You might also have:
- Stiff neck.
- Drowsiness or even coma.
- Mental confusion.
- Dizziness or problems with your balance.
- Difficulty speaking.
- Weakness or no feeling in an arm or leg.
- Heart attack.
How is a brain aneurysm detected?
To find out if you have a brain aneurysm, your healthcare provider will order an imaging test. These tests show the size, shape and location of brain aneurysms:
- MRI (magnetic resonance imaging)
- CT (computed tomography)
- Diagnostic cerebral angiogram
- MRA (magnetic resonance angiography)
- CTA (computed tomography angiography)
Occasionally, a ruptured aneurysm may not show on the initial imaging test. If your symptoms point to a ruptured aneurysm, your doctor may order a lumbar puncture (spinal tap). This test shows whether there’s blood in the fluid surrounding your brain.
How are brain aneurysms treated?
Surgery and/or endovascular therapy are the treatment for brain aneurysms, whether they are ruptured or unruptured.
1. Open surgical (microvascular) clipping.
During this procedure, your surgeon cuts a small opening in your skull to access the aneurysm. Using a tiny microscope and instruments, your surgeon attaches a small metal clip at the base of the aneurysm to pinch it off. This blocks blood from flowing into the aneurysm. The surgery can stop a brain bleed or keep an intact aneurysm from breaking open. Recovery time is different for ruptured (several weeks to months) and unruptured (usually two to four weeks) aneurysms. This procedure is considered to be durable with a low recurrence rate.
2. Endovascular therapy (coil embolization, stenting, balloon remodeling, flow diversion, intraluminal web device)
For this procedure, your surgeon doesn’t need to create an opening in your skull. Instead, a doctor inserts a catheter (a flexible tube) in a blood vessel, usually in the groin or wrist, and threads it to your brain.
Through the catheter, your doctor places a ball of wires (it looks like a tiny ball of yarn), most often made of platinum, in the aneurysm, sometimes with the help of small stents or balloons. Recently another small device (called Web), which looks like a mesh ball, made of nickel titanium, also became available, and works in a similar fashion as coils. Both methods result in blood clot formation around and inside the wire ball or web device, and block blood flow into the aneurysm, reducing or eliminating the risk of rupture.
Another technique, called ‘flow diversion’ also involves weaving a catheter up a blood vessel from the groin or wrist to the brain. Then your doctor uses the catheter to place a mesh tube in the part of the blood vessel that contains the aneurysm. The mesh encourages or diverts the blood to flow over instead of into the aneurysm.
Just like with open surgery, recovery time can be several weeks to months for ruptured aneurysms. However, a much shorter recovery, only a few days, is expected for unruptured aneurysms treated with endovascular therapy. Depending on the specific endovascular method, some may have a low risk of aneurysm recurrence. 
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