The Brain's Time Bomb: Managing Cerebral Aneurysms Before They Rupture

Prevention and Treatment Insights from Professor Han Hyunjin of Severance Hospital
Most Cases Are Asymptomatic and Often Discovered Incidentally During Health Screenings
Blood Pressure Control and Smoking Cessation Are Essential... Brain Examinations Recommended for Those Over 40

One of the diseases to be particularly cautious of during sudden drops in temperature, as is the case with the current weather, is a cerebral aneurysm. Most people live without any noticeable symptoms, but if an aneurysm suddenly ruptures and causes cerebral hemorrhage, it can become life-threatening. On the other hand, if a cerebral aneurysm is detected in advance through a health screening, it can be prevented with appropriate treatments such as surgical clipping, coil embolization, or a flow-diverting stent procedure. On October 31, we spoke with Professor Han Hyunjin of the Department of Neurosurgery (Stroke Center) at Severance Hospital to learn about the symptoms and treatment methods of cerebral aneurysms.

Professor Han Hyunjin of the Department of Neurosurgery at Severance Hospital is explaining the symptoms and treatment methods of cerebral aneurysms. Photo by Kim Hyunmin

A cerebral aneurysm refers to a condition in which a weakened area of a cerebral blood vessel bulges asymmetrically due to blood flow pressure. Because of its shape, it is commonly referred to as a "berry" on the cerebral blood vessel. If detected while it is bulging, it is classified as an "unruptured cerebral aneurysm," while if it has ruptured and caused cerebral hemorrhage, it is classified as a "ruptured cerebral aneurysm." In South Korea, 150,000 to 200,000 people are diagnosed with cerebral aneurysms each year, and among them, about 15,000 to 20,000 have already experienced a rupture or are at risk of rupture and are receiving hospital treatment. It is known that 25% to 50% of patients who experience subarachnoid hemorrhage due to a ruptured cerebral aneurysm die, making it important to receive preventive treatment before rupture occurs.

The problem is that most cerebral aneurysms only show symptoms after they have ruptured. Except for very rare cases where paralysis of the cranial nerves causes one eyelid to droop or where a very large giant aneurysm directly stimulates brain tissue, most people do not experience any noticeable symptoms. Professor Han explained, "The brain itself does not feel pain, so having a cerebral aneurysm does not cause pain by itself. Pain occurs when blood from the aneurysm irritates the surrounding meninges or when the blood vessel itself is under strong pressure." If you suddenly experience an intense and unprecedented headache, as if someone has struck your head hard, or if you develop nausea, vomiting, and decreased consciousness, you should seek medical attention immediately. Professor Han added, "In such cases, it is necessary to locate and block the site of the ruptured aneurysm and then provide intensive treatment for one to three months until the brain recovers without rebleeding."

It is common for cerebral aneurysms to be discovered incidentally while searching for the cause of chronic migraines or during a CT or MRI scan performed for a health checkup. Even in these cases, not all patients require immediate treatment. If the size, location, and shape of the aneurysm indicate a low risk of rupture, close monitoring may be sufficient. For example, Professor Han advises that a small aneurysm occurring near the ophthalmic segment of the internal carotid artery has a very low chance of rupturing, so periodic follow-up as instructed by a physician is sufficient.

Professor Han Hyunjin of the Department of Neurosurgery at Severance Hospital is explaining the symptoms and treatment methods of cerebral aneurysms. Photo by Kim Hyunmin

However, for cerebral aneurysms with a high risk of rupture, treatments such as surgical clipping, which involves tying off the vessel with a micro-clip, or embolization procedures using coils or stents are necessary to prevent rupture. The oldest treatment, surgical clipping, is a procedure in which the skull is opened and the neck of the balloon-like aneurysm is tightly clipped. Coil embolization involves inserting a microcatheter into the blood vessel, positioning it within the aneurysm, and then filling the aneurysm with a very soft metal coil to block blood flow into the aneurysm. For large, fusiform, or dissecting aneurysms, a special type of stent called a "flow diverter" may be used, or a "flow disruptor" may be used if the aneurysm has a wide neck. Professor Han emphasized, "The shape and location of cerebral aneurysms differ for each patient, and in elderly patients, the risks of surgery must also be considered. Each treatment method has its own advantages and disadvantages, so the choice of treatment depends on the individual case of the patient's cerebral aneurysm."

For patients diagnosed with unruptured cerebral aneurysms who are under observation, the most important factors are blood pressure control and smoking cessation. In particular, patients with hypertension should take their prescribed medication on time and consistently monitor their blood pressure to prevent it from rising. Professor Han stated, "The incidence of cerebral aneurysms is relatively higher in older adults, women, those with a family history, or those with certain genetic disorders, and it occurs most frequently in people in their 50s and 60s. For individuals over the age of 40 who are entering a transitional period of life and have these risk factors, it is advisable to undergo a brain examination at least once as a preventive measure."

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