[KoK! Health] Brain Time Bomb 'Cerebral Aneurysm'... Differences Between Procedure and Surgery?

Cerebral aneurysms are called the "time bombs" inside the head. It is a vascular disease in which a part of a cerebral artery bulges like a sac, and if the weakened aneurysm ruptures, it can lead to cerebral hemorrhage and even death. However, there are often no symptoms until it ruptures, so many people are unaware of it. It is reported that about 20% of patients with ruptured cerebral aneurysms die before arriving at the hospital.

Therefore, early diagnosis of cerebral aneurysms is crucial, and after diagnosis, it is necessary to decide whether to treat or to monitor the condition. Professor Nam Taekgyun of the Department of Neurosurgery at Chung-Ang University Hospital Cerebrovascular Center said, "Not all diagnosed cerebral aneurysms require immediate treatment; the decision to perform coil embolization or clip ligation depends on factors such as the size, location, shape of the aneurysm, and the patient's age."

The treatment methods for cerebral aneurysms are generally divided into 'aneurysm clipping surgery,' which involves craniotomy corresponding to brain surgery, and 'coil embolization,' which is an endovascular treatment or interventional procedure accessing through blood vessels. Clipping surgery is a long-established method for treating cerebral aneurysms and has technically reached its peak. It involves making an incision in the scalp, opening a small part of the skull, exposing the cerebral aneurysm under a surgical microscope, and blocking blood flow by clipping the neck (opening) of the aneurysm.

The Cerebrovascular Center at Chung-Ang University Hospital is performing coil embolization.
[Photo by Chung-Ang University Hospital]

Coil embolization is a minimally invasive procedure that treats the aneurysm without opening the skull. It involves accessing the cerebral artery through the femoral artery in the thigh (groin, inguinal region) using multiple catheters in stages, then filling the cerebral aneurysm with platinum coils to block blood flow and prevent rupture. If the aneurysm neck is wide, stents or balloons can be used to support the opening during coil embolization.

Professor Nam said, "Coil embolization is a minimally invasive treatment method that can be performed without craniotomy, with a relatively short procedure time of under 3 hours, and patients can be discharged within 1 to 2 days after treatment to resume normal life," but also noted, "coil embolization has a relatively higher chance of recurrence compared to clip ligation, and statistically, 1 in 10 patients may require retreatment, which means more frequent follow-up examinations are necessary after the procedure compared to clipping surgery."

Comparison of cerebral aneurysm clipping and coil embolization. [Image source=Korea Disease Control and Prevention Agency National Health Information Portal]

After receiving coil embolization for a cerebral aneurysm, follow-up examinations should be conducted at 6 months, 1 year 6 months, 3 years 6 months, and 5 years 6 months. If coil embolization was performed with stent assistance, patients must take antiplatelet agents for at least 6 months to 1-2 years, which can be inconvenient. Professor Kwon Jungtaek of the Department of Neurosurgery at Chung-Ang University Hospital Cerebrovascular Center emphasized, "Not all diagnosed cerebral aneurysms rupture; the risk varies depending on location, shape, size, patient age, and health status. There is no absolute superiority between craniotomy and coil embolization. It is most important to accurately diagnose the patient's condition, find a specialist at a hospital capable of both treatments, and promptly choose a safe and precise treatment method."

This content was produced with the assistance of AI translation services.