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Treatment for cerebral aneurysm and subarachnoid hemorrhage

A computed tomograpy (CT or CAT) scan of the brain is used to diagnose the subarachnoid hemorrhage, and a cerebral angiogram is then done to determine the size, location and status of the aneurysm. During an angiogram, a thin flexible tube (catheter) is inserted into an artery in the upper thigh and guided through the blood system to the head. There, a contrast dye is introduced into the brain, which reveals the extent of the hemorrhage when X-rayed.

Patients require treatment for the aneurysm as well as treatment for complications of the hemorrhage. Complications may include vasospasm (constricting of a blood vessel which reduces blood flow and increases pressure) and hydrocephalus (fluid build-up in the brain). 

The traditional surgical treatment for cerebral aneurysm involves a craniotomy. A portion of the skull is removed to allow access to the brain and is then returned to position afterwards. The surgeon locates the aneurysm and a clip is applied to prevent further flow into the aneurysm. The patient will be in the intensive care unit after surgery and will remain in the hospital for at least a week. 

In some cases the aneurysm is better treated with neuroendovascular therapy. Here microcatheters are placed in the arterial system and coils are delivered into the aneurysm. Coiling fills the aneurysm, eliminating blood flow into the aneurysm. The surgeon, based on the type and location of the aneurysm, makes the determination as to whether the aneurysm should be coiled or clipped. 

In some cases, magnetic resonance imaging (MRI) or CAT scan may detect the aneurysm prior to any rupture. The treatment for unruptured aneurysms is much the same, however, these patients are generally more stable and the procedure does not have to be done under emergency conditions.