The three conditions
Brain aneurysm
A weak spot in the wall of an artery that balloons out. Most never burst. When one does, it causes a subarachnoid haemorrhage, a medical emergency.
Arteriovenous malformation (AVM)
A tangle of abnormal vessels where arteries connect straight to veins without the usual small vessels in between. AVMs can bleed or cause seizures.
Cavernoma
A small cluster of thin-walled vessels that looks like a mulberry on MRI. Many cause no trouble; some bleed in small amounts or cause seizures.
Warning signs
A sudden, severe headache, often described as the worst headache of your life, coming on in seconds, especially with vomiting, a stiff neck, fainting or confusion. Also sudden weakness, loss of speech, or a first seizure.
Unruptured aneurysms and AVMs are often found on a scan done for headache, dizziness or an injury. Finding one by chance is not an emergency, but it should be seen by a neurosurgeon.
Diagnosis
A CT scan shows bleeding. A CT angiogram or MR angiogram shows the vessels. A catheter angiogram (DSA), in which dye is injected through a thin tube from the groin or wrist, gives the most detailed map and is often needed before treatment. Cavernomas are best seen on specific MRI sequences.
Treatment options
- Observation for small unruptured aneurysms and many cavernomas, with repeat scans and blood pressure control
- Microsurgical clipping: a small titanium clip placed across the neck of an aneurysm under the operating microscope
- Endovascular coiling or stenting: the aneurysm is closed from inside the artery through a catheter, without opening the skull
- AVM surgery, embolisation or radiosurgery, alone or combined
- Removal of a cavernoma that has bled or causes seizures, when it can be reached safely
Whether to treat an unruptured aneurysm, and how, depends on its size, shape and position, your age and health, and family history. Clipping and coiling each suit different aneurysms.
Dr Gupta’s training in vascular neurosurgery
Cerebrovascular neurosurgery is one of Dr Gupta’s stated areas of work. His fellowship at the Arkansas Neuroscience Institute, USA was in cerebrovascular and skull base neurosurgery, and he trained in microneurosurgery at NIMHANS, Bengaluru.
Recovery
Recovery from an unruptured aneurysm treated by clipping is usually a hospital stay of several days and a few weeks off work. Recovery after a bleed is longer and depends on how severe the bleed was. Follow-up scans check that the aneurysm or AVM stays closed.
Questions
I was told I have a small aneurysm. Does it need treatment?
Not always. Many small unruptured aneurysms are watched with repeat scans and blood pressure control. The decision depends on its size, shape, position, your age and family history, and is worth going through with a neurosurgeon.
What is the difference between clipping and coiling?
Clipping closes the aneurysm from outside with a small clip, through an operation. Coiling closes it from inside the artery, through a catheter. Each suits different aneurysms, and the choice is made on the angiogram.
Is a cavernoma dangerous?
Many cavernomas never cause problems and are only watched. Treatment is considered if one bleeds, causes seizures, or grows, and if it can be reached safely.
About Dr Gupta
This page explains the condition in general terms and is written for patients and families. It is not a diagnosis. Decisions about treatment are made in consultation, with your scans. In an emergency, go to the nearest hospital emergency department.