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Hello, I’m Dr. John Whyte, Chief Medical Expert for Discovery Channel. We know that a ruptured aneurysm is life threatening. But what about an unruptured aneurysm? These are aneurysms that are found by chance and are completely asymptomatic. It is important for patients diagnosed with an unruptured aneurysm to receive complete information along with a thorough neurological evaluation from an experienced neurosurgeon to discuss the likelihood of rupture, and based on that information, make a decision on how to proceed. Dr. Robert Friedlander of UPMC tells us about the factors that should be considered when counseling a patient diagnosed with an unruptured aneurysm.
The danger of an unruptured aneurysm is that it might rupture. And that’s the whole problem with it. Once it ruptures, about 50 percent of the people die within the first 30 days. So it’s critical to try to detect aneurysms before they rupture and then understand what you can do with them. A lot of them are found by chance. For example, the patient has a headache and they get an MRI. The MRI shows an unruptured aneurysm. And so, for the most part, it’s an accidental finding. What is key, once we meet a patient with a newly identified aneurysm, which is asymptomatic and was found by chance, is to really understand the natural history.
And what is key in the treatment is that if we’re going to intervene in that aneurysm, the risk of the intervention has to be lower than the natural history. However, we don’t understand the natural history perfectly. We don’t know each patient. Are you the one that aneurysm is going to rupture? Or is it another person’s aneurysm? It’s one percent a year. So when a patient deals with numbers, we have to put it into context of risk of treatment. It’s critical for the patients to understand the different options for the treatment of aneurysms. Aneurysms can be clipped or coiled. Clipping is an operation where we do a craniotomy.
And using a microscope, we go down to the aneurysm, dissect the aneurysm, all the important branches, and place a titanium clip along the neck of the aneurysm so it doesn’t fill anymore. And then the aneurysm is cured. The other type of treatment is intervascular coiling where intervascular radiologists or neuroradiologists or neurosurgeons go and treat the aneurysm from the inside.
They place the catheter through the femoral artery, thread it all the way up to the origin of the aneurysm, place coils into it, and then that can be cured as well. The key is understanding that there are some aneurysms that are better treated with clipping, and some aneurysms that are better treated with coiling. And it’s key for a patient to be at a center like UPMC where we’re able to provide both treatment options for the patient. One of the keys of managing an aneurysm and minimizing the risks for the patient is that the whole team needs to have a level of expertise in management of the patient. From the anesthesiologist in the operating room, the angiographer performing the angiography, to the nurses, to the surgeon—it’s a whole team approach. When you’re at UPMC, we’re able to provide this 360 whole team approach in order to minimize complications and maximize the best outcomes.
Unruptured aneurysms can be treated in a variety of ways. The correct treatment plan would be easy if we knew which aneurysms would rupture. But we don’t. Instead, neurosurgeons must consider a variety of factors. And after weighing the options, having meaningful discussions with the patient, develop a treatment plan best suited to the patient’s needs.
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