The appointment
was scheduled for Monday 2-Jan-06 and based on his findings he recommended yet another test - one said to be on the "Gold Standard"
T
his was to be an Angeogram.  This was scheduled for Wednesday, 4-Jan-06.  The Right-side Artery in the groin area was cut half way in to and a tube was inserted.  This was pushed through me, through
my heart and into my brain.  At various places they would inject a dye and snap a picture.  All in all they took about 20 photos.  The dye gave me the "mother of all headaches" and I was in recovery about 6 hours allowing my artery to begin to grow back together and some of the "killer dye" effects to ware off.

I was scheduled for an office visit on Friday 6-Jan-06.  At the O.V. I learned that YES, I had two aneurysms - one on the Right - about 9 mm long and one on the Left - about 5 mm long.  Neither were considered to be initially life threatening.  BUT - he recommended surgical removal of the one on the Right side with the possibility of getting the Left-side at the same time IF we Got Lucky.  He also recommended that I do 4 things :
1.  Loose 20 - 30 lbs weight
2.  Get in better physical shape to tolerate a 5 - 6 hr operation
3.  Get my Cholesterol under 200
4.  Seek & get a second opinion

I've begun working on the fab-four and hope to have more info soon.

Contact me if I can help you.
Bill Swearingen bswear@hal-pc.org  1-10-06

5   Cerebral Aneurysms

John Pile-Spellman, M.D.
Director of Interventional Neuroradiology
Professor of Radiology and Neurosurgery
Columbia Univesity College of Physicians and Surgeons
New York, New York
T:212-305-6515
F:212-305-5476
EMail: jp59@cunixf.cc.columbia.edu

Contents:

• What is an Aneurysm?
• How do they develop?
• What are the dangers?
• How is an aneurysm diagnosed ?
• Why should it be treated?
• What are the treatment options?
• Additional Information

Other useful links:

• 3-D Visualization of Brain Aneurysms by University of Iowa
•  

What is an Aneurysm? An Aneurysm is a bulge in the blood vessel. They are relatively common and affect the larger arteries throughout the body. They can effect the blood vessels of the brain. Note the dissecting of the aneurysm away from the blood vessel.Click on pictures for a larger view.

Click on pictures for a larger view.

• How do they develop? It is not clear why a person develops a cerebral aneurysm. They are very uncommon in patients below 20 years of age and are increasingly common in older patients. In people over 65, they may be found in as high a 5% of the population. It appears they are related to an absence of a muscular layer that makes up part of the blood vessels that over time stretches and thins and creates the aneurysm. Smoking appears to markedly increase the chance that one will develop a cerebral aneurysm.    Click on pictures for a larger view.

  Click on pictures for a larger view.

• What are the dangers?

  Aneurysms can break open and bleed into the brain causing a stroke or even death. This is called a hemorrhage, or rupture. These are usually quite serious. It is estimated that approximately 30,000 people in the United States suffer an aneurysm rupture. The results from these bleeds are quite bad. It has been estimated that if 5 people suffer a bleed today, in one year, only one person will be alive and well. One person will be disabled and three will be dead. Aneurysms, once they bleed, have a high incidence of recurrent bleeding in the days following. There are also delayed problems of water on the brain, (hydrocephalus), and narrowing of the blood vessels because of the irritation of the blood on the blood vessels known as Vasospasm. Rebleeding, hydrocephalus, and vasospasm can happen days to weeks after the initial bleed. Aneurysms can and do grow. If they reach a certain size, usually over 25 mm, (one inch), they can start putting pressure on the surrounding brain and cause progressive problems. These are called Giant aneurysms.

  Taken together, all aneurysms appear to bleed at about a 4 % per year rate, or a 1/25 chance of bleeding. It should be noted that most small aneurysms under 6 mm (1/4 inch) are very unlikely to bleed.

  How is an aneurysm diagnosed?

  If an aneurysm bleeds, the patient almost always has a severe headache that prompts the patient to seek medical attention. A CT scan of the brain or a Lumbar puncture usually identifies the blood outside the blood vessel and is called a Subarachnoid Hemorrhage (SAH). An angiogram is usually performed to identify the exact blood vessel that has bled and the detailed anatomy of the aneurysm.

  Occasionally, aneurysms grow and press on the surrounding area around the brain and cause other symptoms such as headache or double vision. This may prompt an MRI / MRA that may identify an aneurysm that has not bled.

  Why should it be treated?

  Treatment of the aneurysms can be used to

  • (1) keep them from rebleeding
  • (2) treating the hydrocephalus
  • (3) treating the vasospasm.

  The major danger is from rebleeding in the days to weeks following the initial bleed.

  What are the treatment options?

  To avoid rebleeding, aneurysms can be treated with Direct Surgery or Embolization (Endovascular). Direct surgery is usually the preferred method of treatment since it is highly effective and relatively safe. Under general anesthesia, surgery is performed to open the skull and identify the neck of the aneurysm. This is the junction between the good strong blood vessel and the weakened ballooned aneurysm. A clip is put across this area. In those patients where direct surgery is believed to have a higher risk, or be less effective, embolization may be offered.

  Endovascular surgery is performed by navigating a small tube or catheter into the aneurysm from the blood vessel in the leg artery under X-Ray guidance. Tiny platinum coils or tiny latex or Silicone balloons are used to fill the aneurysm. The materials that are used to treat aneurysms are new and considered investigational, and require a special consent. Patient selection is based on the individual patient and aneurysm anatomy. Occasionally, a number of operations must be performed to safely obliterate the aneurysm.

   

  Additional Information

  A group of patients and family members who have much knowledge and experience with aneurysm have formed an Aneurysm support group nationally with regional chapters. Any member of our team would be glad to answer any questions you might have. Below is a list of phone numbers that may be of use for your reference.