Definition and General Information: Brain aneurysms are the ballooning of the arterial network in the brain, usually at the bifurcation points, and they give a ‘strawberry on the branch’ appearance in the films showing the vascular network (angiography). 5 to 6 out of every 100 people have an aneurysm in their brain, and 10-20 out of every 100,000 people have cerebral hemorrhage due to aneurysm rupture. Aneurysms are more common in Caucasians, women and over the age of 50, and are associated with some diseases (Ehler Danlos, Marfan syndrome, Polycystic kidney disease, etc.). In addition, systemic high blood pressure, smoking and cocaine use accelerate aneurysm formation.
Complaints and Diagnosis:Aneurysms can present in three different ways, depending on their location and size in the brain; By making a mass effect without tearing, by clotting without tearing and causing vascular occlusion, and by tearing and bleeding inside the brain. Especially in aneurysms with a diameter of 10 mm or more, the possibility of rupture is higher. Patients often experience aneurysm rupture during exercise (straining in the toilet, performing work that requires performance, during sexual intercourse) and usually a very severe headache occurs. Nausea, vomiting, instability, weakness in one half of the body, loss of vision, and loss of consciousness often accompany this picture, and approximately 15% of the patients die before they can be taken to the hospital. Brain computed tomography (CT) examination shows bleeding in 95% of cases. In a small number of cases that cannot be diagnosed with CT, cerebral hemorrhage is diagnosed by performing a lumbar puncture (the procedure of taking cerebrospinal fluid from the waist). In order to understand the size and three-dimensional location of the aneurysm, MR examination can also be performed, especially in giant aneurysms (greater than 25 mm). In order to determine the location of the aneurysm in the cerebral vascular network, angiography (DSA) is performed by entering the inguinal vein or CT-angiography, which has been preferred in recent years and has largely replaced DSA.
Treatment: Aneurysm rupture is a medical emergency. In this event, which has a high death and disability rate, patients need urgent surgery after their general medical conditions are regulated. The gold standard treatment is clipping (latching) the neck of the aneurysm using microsurgical methods and thus isolating it from the cerebral artery network. The long-term results of endovascular coiling (filling the aneurysm by entering through the inguinal vein) method, which has been applied for the last 10-15 years, are unknown and it is not possible to remove clot-shaped hemorrhages in the brain with this method. Aneurysm surgery should be performed by an experienced surgical and anesthesia team, and post-operative intensive care support should be provided.
