Ongoing Management of Aneurysms

What do you do when a small aneurysm is to be watched?

Although very small aneurysms have a low rate of rupture they do need to be monitored for change in shape or size. If this occurs then re-consideration of treatment needs to be made. Because of the low risk of rupture for these patients the investigative procedure needs to be of low risk. Two methods of monitoring that do not require admission to hospital that are of low risk are CTA and MRA. The frequency with which these monitoring investigations are performed vary from case to case (for eg. Elderly patients with a very small aneurysm may need no further monitoring as the remaining life-time benefit from treatment would be very low). Other steps that need to occur that might reduce the chance of aneurysm growth and rupture are maintaining normal blood pressure (therefore, careful monitoring by your GP) and ceasing smoking.

What is the chance of a new aneurysm forming?

As many as 20% of people with one aneurysm will develop a second. Therefore, surveillance and monitoring are necessary even after an aneurysm has been treated. The benefits for treating asymptomatic unruptured aneurysms at an age greater than 65 are likely to be small and monitoring is usually only necessary until this age. It may be that cessation of smoking and maintaining a normal blood pressure reduces the chance for new aneurysm formation.

What risk for other family members developing an aneurysm?

There is an increased risk for first degree relatives (brothers, sisters, children) developing an aneurysm. This genetic risk is a predisposition to forming aneurysms during life. It does not mean that the aneurysms are present at birth or childhood. When 2 or more first degree relatives have an aneurysm the risk is even greater with a 10 to 20% chance of other first degree relatives developing an aneurysm. A good way to detect aneurysms is either by CTA or MRA. Because aneurysms, even when inherited, are rare before adulthood the initial testing can normally be delayed until early adulthood unless symptoms occur.

Guidelines for the managment of intracranial aneurysms at Dalcross Private Hospital

This area is intended for the use of Nursing staff and Medical staff of Dalcross Private Hospital in Sydney.

Clipping versus coiling of unruptured aneurysms

Surgery is considered the first choice for:

-Middle cerebral artery location.

-Size greater than 14 mm.

-Multiple aneurysms where a single exposure can allow all aneurysms to be repaired.

-Aneurysms downstream from occluded artery.

-Patient age less than 55 years.

-Need for ongoing antiplatelet or anticoagulant therapy.

-If diagnositic DSA is unnecessary or undesirable.

GDC coiling is considered the first choice for:

-Patient age greater than 65 years and the aneurysm is less than 15 mm in size with a neck-to-fundus ration of 1:2 and the neck is less than 4 mm in size.

-Heavily calcified neck identified on CT scan.

-Posteriorly projecting basilar and posteriorly projecting ACoA aneurysms.