This book has been expertly written and illustrated for patients with brain aneurysms and their families and for physicians and paramedical professionals interested in learning more about this field. The book contains detailed information about the investigation and screening of brain aneurysms and critical chapters related to their treatment. A comprehensive section on coma caused by ruptured brain aneurysms discusses the difficult choices facing both families and physicians during the management of critically ill aneurysm and brain hemorrhage patients. The book explains the process of informed consent for the investigation and treatment of brain aneurysms and the rationale for the choices given and decisions made. The risks and benefits of various procedures encountered by brain aneurysm patients and how the procedures are performed are described in detail. Responses to frequently asked questions regarding "clipping versus coiling" aneurysms are provided, as are step-by-step details of the relevant open surgical and endovascular procedures. An in-depth chapter devoted to rehabilitation and recovery after treatment presents information on what patients can expect and need to be aware of during this process. Chapters also cover treatment-related complications, wound issues, follow-up after coiling or clipping, and recurrent or persistent brain aneurysms after treatment. Finally, detailed "case histories" of persons with unruptured and ruptured brain aneurysms personalize the experience of having an aneurysm. Being diagnosed with a brain aneurysm and undergoing treatment are some of the most significant events patients and their families are likely to experience. This practical book is a must-read for such persons.

Dr. Vini G. Khurana graduated with his medical and research degrees from the University of Sydney in 1995 and undertook his surgical internship at Royal Prince Alfred Hospital in Sydney, Australia. He received his Ph.D. in Biomedical Sciences and the Thoralf Sundt Neurosurgical Research Fellowship from the Mayo Clinic in Rochester, Minnesota, where he also completed his neurosurgical residency in 2005. Dr. Khurana, recently a Cerebrovascular and Skull Base Surgery Fellow at Barrow Neurological Institute in Phoenix, Arizona, under the tutelage of Dr. Robert Spetzler, has recently been appointed as Associate Professor of Neurosurgery for the University of Sydney in Australia. Dr. Robert F. Spetzler received his Bachelor of Science degree from Knox College in Galesburg, Illinois, and his M.D. from Northwestern Medical School, Chicago, Illinois. His postgraduate training was completed at Wesley Memorial Hospital Northwestern in Chicago, Illinois, and his neurosurgical residency was completed at the University of California San Francisco, California. He achieved his Board Certification in September 1979 from the American Board of Neurological Surgery. Dr. Spetzler’s academic credentials include Instructor of Neurosurgery at the University of California San Francisco, California; Assistant and Associate Professor of Neurosurgery at Case Western Reserve University School of Medicine, Cleveland, Ohio; and Professor of Surgery, Section of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona. Dr. Spetzler is the J.N. Harber Chairman of Neurological Surgery and Director of the Barrow Neurological Institute in Phoenix, Arizona.

CONTENTS

1. Why does one need to know about all of this, anyway?

2. About brain arteries

3. What is an aneurysm?

4. Vital statistics

5. Development of brain aneurysms

6. Symptoms

7. Complications

8. Detection

9. Screening

10. Treatment

11. What a patient should think about

12. What a treating physician should think about

13. Informed consent

14. The perioperative period and the operation itself

15. The periinterventional period and the procedure itself

16. Wound issues

17. The comatose patient

18. Complications of treatment

19. Recurrent, persistent or new aneurysm after treatment, and the need

for follow-up

20. Recovery and rehabilitation

21. Other types of brain aneurysms

22. The stories of four brain aneurysm patients

23. The brain-attack and brain aneurysm alert checklist

24. References and resources

 

CHAPTER 1. Why does one need to know about all of this, anyway?

 

Brain aneurysms occur in as many as one in 20 people in most societies and thus represent a global problem. Most of these aneurysms will never be detected and will never cause a problem. However, every year, 30,000 people in the United States alone and hundreds of thousands worldwide suffer the dreaded complication of a brain aneurysm, namely, rupture. This condition is also known as aneurysmal SAH.

 

A ruptured brain aneurysm is an unforgiving entity. Unlike most medical conditions, a brain aneurysm ruptures suddenly, usually without warning, and takes away or severely disables precious lives swiftly and without remorse. The human and economic costs of this disorder are staggering. Although physicians have long known about aneurysms and although technologies for their detection and treatment have improved, the overall outcome of aneurysmal SAH remains dismal. More than half of the people who seek treatment for a ruptured aneurysm will survive less than 6 months. Many of the survivors will not return to independent living. For these reasons, it is important to increase awareness about these brain lesions and the symptoms that they cause, about when individuals should be evaluated, about how aneurysms are treated, and about what to expect after diagnosis and treatment of an aneurysm. The goal of this book is to increase such awareness.

 

For individuals diagnosed with an unruptured brain aneurysm and for those who survive their rupture, knowledge about these entities is a precious commodity. Insight about brain aneurysms and their complications can empower patients and their family members by helping them to make informed decisions during their treatment.