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What Are Aneurysm and Aneurysm Surgery?

Manifesting itself with bulge and dilatation in arteries, aneurysm is seen in 2 to 3 % of the population. Although aneurysm can develop at any age, it is more commonly seen at advanced ages. Aneurysms can burst resulting in quite serious problems and there is no medical treatment available, the condition can only be treated with surgery. Advanced medical technology minimize serious complications of surgery through minimally invasive interventional treatments.

What is Aneurysm?

Aneurysm is weakening, dilatation and balloon formation in aortic wall and brain vessels . While aneurysm generally develops in brain vessels and aorta it can also occur in different body parts. Aneurisms may not show any symptoms in many patients are generally not dangerous however, if they aneurisms of brain vessels and aorta rupture, this leads to cerebral hemorrhage and internal bleedings. Ruptures develop proportionally to the size of aneurisms. In this case, emergency intervention is required.

What Causes Aneurysm?

Aneurysm develops when the intravascular muscle layer which ensures vascular integrity of the arterial wall is weakened or under-developed secondary to various congenital  diseases or acquired problems. According to studies the following are risk factors for aneurysm.
•    Genetic factors,
•    Congenital malformations, arterioseptal defects (heart holes)
•     Overweight,
•    Hypertension,
•    Advanced age,
•    Drug, alcohol and cigarette use
•    Tumors,
•    Malnutrition,
•    Atherosclerosis,
•    Heavy stress.

What are the symptoms?

Symptoms of the disease change from person to person depending on certain factors and disorders. Symptoms depend on the location of aneurysm as well as the type of aneurysm. Aneurysm may show no signs when the bulge is small or develops slowly. In this case, vessels can rupture suddenly and leads to serious results.
General symptoms of aneurysm are as follows:
•    Pain at the location of aneurysm,
•    Bleeding due to rupture of aneurism
•    Loss of consciousness,
•    Abnormally high heart rate,
•    Hypotension,
•    Dizziness,
•    Nausea and vomiting,
•    Seizures and epileptic attaks
•    Visual disturbances,
•    Fatigue,
•    Facial numbness or paralysis,
•    Photosensitivity.

None of these signs may be seen if aneurysm does not burst. Some patients show one of these signs while some of them experience all of them. In some cases, only the symptoms of the underlying condition are seen. Severe and frequent recurring headaches are one of the most critical signs of brain aneurysms. Headaches# especially if worse after physical activity such as exercise or after sexual intercourse can also be a  sign of brain aneurysm.

What Are The Types of Aneurysm?

Aneurysms are classified according to the region they develop on vessel wall and development patterns. According to their development patterns, aneurysms are classified as saccular (sac-like) and fusiform (flat dilatation on vessel wall) aneurysms. 
In saccular aneurysm a certain small part of vessel wall weakens. This  weakness tends to develop rapidly and is prone to bleeding, usually in brain  or in the internal organs like spleen and kidney. 
In fusiform aneurysm, whole vessel wall becomes weak symmetrically. This type of aneurysms shows slower development compared to saccular aneurysms. Moreover, bleeding is less likely. Generally, aortic aneurysms are included in this group.
Aneurysms are also classified according to their locations in body:

Brain Aneurysm 

Bubble formation in vessels as a result of damage or weakening in vessels of brain is called brain aneurysm. Brain aneurysm, also known as cerebral aneurysm, is the most dangerous type of aneurysm as the vessels are nondurable and have tendency to rupture.  In some cases where bubble is significantly small, it may be symptom-free. Trauma during a difficult delivery at birth can be the cause of brain aneurysm or it may also develop secondary to traumas and various disorders.

Aortic aneurysm

 Aortic aneurysm is classified in two groups, thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA), and it affects the main vessels of body. Aneurysms in abdomen, legs and thoracic regions develop due to reasons such as atherosclerosis.

Pseudoaneurysm

Psudoaneurysm, also known as false aneurysm, implies the type of aneurysm in which ruptures are seen in spite of non-existence of a bulge on vessel wall. Stent, trauma and various infections are among the most important causes of pseudoaneurysm.

How is it diagnosed?

Aneurysms can be detected using imaging technologies such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CTI). Cerebral angiography is another method which provides more detailed information about the aneurysim.
Ruptured brain aneurysm is diagnosed by analysis of cerebrovascular fluid under microscope. Presence of blood in cerebrospinal fluid is a sign of ruptured aneurysm. 
Treatment is tailor made to each patient based on the diagnosis and careful assesment of the aneurism.

What is Aneurysm Surgery?

Current treatment modality for aneurysms of the aorta and brain vessels is surgery. Aneurysm surgery includes all methods utilized against the risk of rupture as a result of severe dilatation in some cases and against aneurysm bleedings in some cases.

What Are The Surgical Methods?

If aneurysm on cell wall ruptures and starts bleeding surgical intervention is needed urgently. Open surgical interventions as well as laparoscopic surgeries can be considered in treatment of aneurysms. The appropriate surgical method for the patient depends on the location, type and size of aneurysm.

Open Surgery

This method, also known as “aneurysm clipping”, is performed under general anesthesia. The aim of clipping method, which was first used in 1937, is to seal the region where aneurysm is present. A part of skull is removed to access the location of brain aneurysm during the surgery. Similarly, a large incision is made on abdominal region and/or chest wall to access the aortic aneurysm. Next, one or multiple titanium clips are generally placed to the neck of aneurysm to stop the blood flow. Clipping is finished by stitching the meninges and skull.
Open surgery sessions generally last for 2 to 6 hours or longer and they may cause certain complications. In the apsenceof complications, patients are expected to recover within 10 days on average.

Endovascular Method

Endovascular method  (closed surgery) has been popular since the 1970s, and it is performed without a surgical incision to the body. The aneurism is accessed generally through the inguinal area, using a catheter through an inguinal vessel under guidance of imaging devices. The catheter is then used to insert platinum wires into the vessel. These wires are configured in the form of a coil and they enable clot formation in the vessel, , hence blood flow into aneurism is prevented. The clot, induces the clip effect similar to open surgeries. Stent can be placed in this region to prevent the wires placed in aneurysm from reaching to the aorta.
Closed surgery sessions generally lasts for 1 to 2 hours, it is less painful and the complication risk is lower compared to open method. Revovery is usually within a few days. However re-bleeding can be seen after the operation and also complications that may occur during the operation is more difficult to control compared to open surgery.

Frequently Asked Questions

What is the possibility of bleeding in aneurysm?

Possibility of bleeding in aneurysm is not exactly known. It is only possible to prediction whether the aneurism may bleed and the severity of bleeding based on certain data. Assumptions are based on the location, size and shape of aneurisms when predicting the  possibility of bleeding. Generally, bleeding may be seen again in ruptured aneurysms; therefore, patients should be immediately taken under observation.

What is the reason of bleeding in aneurysm?

Both in aortic and brain aneurisms we cannot exactly determine when the aneurism may cause bleeding and the underlying causes of the bleeding. However, there are certain predisposing risk factors which may aggregate bleeding of the aneurisms such as high blood pressure,, severe mood disorders due to stress and nervousness, heavy physical activities through increasing blood pressure, smoking, drug abuse and some drugs such as amphetamine are among the factors that can cause bleeding.

Is it possible to prevent aneurysm?

Aneurysm mostly occurs after the age of 35 and it is generally associated with congenital health problems. However it is possible to prevent rupture and bleeding of aneurisms through lifestyle adjustments. Regular non-strenuous physical activities, avoiding smoking, a healthy and balanced diet, avoiding excessive stress and having regular check-ups are among the precautions that should be taken.

Which surgical method used in treatment of aneurysm is better/more appropriate?

Effect of surgical methods both in aortic and brain aneurysms have been proven to be successful for many years. The choice of treatment modality is determined by the  progression of the aneurism and the condition of the patient. Each method has its advantages and disadvantages. Open surgeriy can lead to quite risky and severe complications. On the other hand, there is a risk of recurrence of aneurysm in minimally invasive operations. Specialists determine the most suitable method according to condition of the patient.

 

Medicana International Samsun, 

Neurosurgeon Assoc. Prof. Enis Kuruoğlu, M.D.

 

 

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