Vascular Neurosurgery

Aneurysms of blood vessels in the brain are a fairly common problem. In fact, approximately ten percent of people may have aneurysms that do not cause any symptoms at all. However, an aneurysm can rupture and cause bleeding in the brain. Once discovered, an aneurysm usually is treated to prevent further bleeding over time. The aneurysm is a small area on a blood vessel where there has been a weakening that slowly enlarges over time and can rupture. 

For most aneurysms, the treatment of choice is surgery to expose the aneurysm and place a small metallic clip across the base of the aneurysm to completely occlude it. This prevents further risk of bleeding. The patient is in the hospital for aggressive postoperative treatment if they have had an aneurysm rupture. This is designed to prevent any further problems such as spasm of blood vessels which can occur after bleeding has taken place. 

Here at St. Francis Hospital we have a very high level of sophistication in treating patients both surgically and postoperatively when an aneurysm has ruptured. Certain patients, because of extremes of age or poor medical condition, may not be good surgical candidates. In this situation, patients may potentially benefit from endovascular placement of coils into the aneurysm to obliterate it. This is done in the angiography department by the neuroradiologist. Small metal coils are placed inside the aneurysm via the feeding blood vessel through a small catheter. The coils then allow blood to clot inside the aneurysm, protecting it from bleeding. Although this procedure is relatively new, it does show good promise for the treatment of patients who are not good surgical candidates. This procedure is offered only at very few centers throughout the country. 

Finally, the neurosurgeon is occasionally faced with treatment of an arteriovenous malformation in the brain. This is a small tangle of blood vessels which are leaky because of their abnormal development. This is a congenital problem which can present with bleeding in the brain. 

Some arteriovenous malformations are treated with surgery to remove them which can be accomplished safely if they are in a safe location in the brain. Other arteriovenous malformations can potentially be treated with radiation therapy, depending on their size and location.