Brain Aneurysm Surgery May Not Be a One-Time Event

Brain aneurysms repaired by surgery may reappear years later

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Surgeons have made great strides in treating aneurysms in recent years. However, new evidence suggests that aneurysm repairs may not last as long as expected.

A new study found that more patients may have complications years after brain aneurysm surgery than doctors realized.

"This result is of importance since a large proportion of patients in the study were young, with a mean age of 47 years," said lead study author Olivier N. Naggara, MD, PhD, from the Centre Hospitalier Sainte-Anne in Paris, in a press release. "Consequently, demonstration of the [effectiveness] of prevention of rupture more than 10 years after treatment is a crucial point."

Dr. William W. Ashley, Jr., MD, PhD, an assistant professor in the Department of Neurological Surgery of Loyola University Chicago Stritch School of Medicine, told dailyRx News that "... unless an aneurysm is completely treated, it can still bleed and cause major neurological problems or death from a ruptured brain aneurysm. This is especially important in people who have a recent rupture or a history of rupture. They should be aware of a sudden, severe headache that signals a bleeding event."

Dr. Ashley added, "They should have regular follow-up with their neurosurgeon with regular follow-up imaging. I usually get repeat angiography at 3-6 months and 2 years after treatment to make sure there is no recurrence."

A brain aneurysm is a weak spot that can occur in a blood vessel in the brain. The aneurysm causes the vessel to balloon and fill with blood. As a result, the vessel may leak or break.

If this rupture is not treated in a timely manner, the bleeding may be fatal. To fix the leak, surgeons thread coils through a blood vessel in the groin to reach the aneurysm. These coils expand and form a clot in the aneurysm that stops the bleeding.

"[Recurrence] can happen with any aneurysm — especially if it is not packed tightly with coils," Dr. Ashley said. "We often see this with large and giant aneurysms with complex shapes or configurations and/or with wide necks (or openings into the aneurysm)."

Most patients see their doctor again three to five years after this repair. Imaging is used to check the aneurysm at that time.

According the Brain Aneurysm Foundation, brain aneurysm ruptures are relatively rare. In the US, 1 in every 50 people will develop a brain aneurysm, but ruptures only occur in about 30,000 people each year.

Dr. Naggara and team looked at how long these aneurysm repairs lasted.

Researchers followed 129 patients from Sainte-Anne for more than 10 years. Of these patients, 16 (12.4 percent) had blood flow going back into the aneurysm within the 10 years — and required more care.

According to Dr. Naggara and team, the need for treatment again within five years and/or imaging that showed the aneurysm was only partially sealed were among the signs that a patient may have a recurring aneurysm.

Dr. Naggara and team also looked at data from other studies. Researchers found that aneurysms larger than 10mm in size and aneurysms graded as not completely closed were those most likely to leak in the future.

Dr. Naggara and team recommended that all at-risk patients have imaging done at the 10-year mark and beyond after an initial aneurysm repair, instead of only at the three- or five-year mark.

"[Aneurysm repair] is effective 10 years after treatment for prevention of long-term bleeding, but may be followed by recurrences in a clinically relevant percentage of cases," Dr. Naggara said.

Dr. Ashley said patients who have had aneurysms should "Quit smoking if you do smoke, keep blood pressure controlled and have regular follow-up with your neurosurgeon."

This study was published June 9 in the journal Radiology.

The French Radiological Society funded this research. No conflicts of interest were disclosed.

Review Date: 
June 7, 2015
Last Updated:
June 11, 2015