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Deadly Headaches (II)

Severe headaches cannot simply be alleviated with painkillers; moreover, headaches are a common symptom of brain tumors, cerebral hemorrhage, and central nervous system infections, and should not be overlooked. This article continues to discuss the diagnosis and treatment of cerebral arteriovenous malformations and cerebral aneurysms, aiming to find the most suitable treatment plans through diagnosis and assessment.

Brain Illustration

During the treatment process, neurovascular surgeons will conduct a comprehensive assessment based on diagnostic imaging such as the patient's age, physical condition, the size and location of the aneurysm, and the complexity of the surgery, to then recommend the most appropriate treatment plan for the patient. Detailed structural examinations include the following options:

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  1. Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA).

  2. Computed Tomography Angiography (CTA).

  3. Dynamic and 3D Digital Subtraction Angiography (DSA).

I.

Treatment Plans for Cerebral Arteriovenous Malformations

Besides the aforementioned assessment factors, neurovascular surgeons also decide on treatment plans based on the risk level of cerebral arteriovenous malformations (Grade I and II are low-risk; Grade III is moderate-risk; Grades IV and V are high-risk). Current treatment options include:

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  1. Conservative observation.

  2. Minimally Invasive Microscopic Excision Surgery.

  3. Endovascular Embolization.

  4. Radiosurgery, such as X-Knife, Gamma Knife, and Cyberknife.

II.

Treatment Plans for Cerebral Aneurysms

In clinical practice, treatment for cerebral aneurysms includes the following options:

 

Craniotomy and Clipping Treatment

This process uses titanium clips for closure. Initially, the surgeon opens a window in the patient's skull and then uses titanium clips to close off the aneurysm, preventing blood from continuing to weaken the vessel wall and thereby eliminating the risk of hemorrhagic stroke.

 

Endovascular Treatment

This involves sealing the aneurysm using titanium coils, flow-diverting stents, and other devices. It requires only a one-hour minimally invasive catheter surgery to close unruptured cerebral aneurysms, effectively dismantling the "time bomb" within the brain.

 

Under X-ray guidance, neurovascular surgeons use a fine catheter as thin as a strand of hair, inserted through the patient's femoral artery on the right side, navigating to the cerebral artery, and implanting a blood-diverting stent to prevent blood from entering the aneurysm sac. The aneurysm will gradually shrink over time. For larger cerebral aneurysms, the surgeon will use titanium coils to enhance the occlusion during the same procedure.

 

Overall, the objective of surgery is to exclude the aneurysm from the bloodstream and reinforce the vessel wall to prevent the aneurysm from rupturing suddenly, causing a severe hemorrhagic stroke that could be severely damaging or fatal.

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Conservative Treatment and Managing Risk Factors

If a patient opts for conservative treatment, the physician will manage the treatment with medications based on the examination results, overall condition, and needs. The patient must adhere to medication schedules, control their diet, and undergo regular MRI scans to monitor the brain's condition. However, regardless of the measures taken, if the patient fails to control risk factors, even aneurysms smaller than one millimeter could pose a risk of death from rupture during surgery as high as 36%, which must be carefully considered.

III. 

Comparison of Treatment Options for Cerebral Aneurysms

Clipping Treatment

Treatment using titanium clips for clamping

Pros: 

  • Low recurrence rate

Cons:

  • Requires craniotomy

  • Posterior circulation aneurysms are more challenging with a lower success rate

  • Risk of aneurysm rupture during surgery, and potential brain tissue damage

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Endovascular Treatment

Closure of aneurysms using titanium coils, blood flow diverting stents, and similar devices

Pros: 

  • Surgical success rate up to 90%

  • No need for craniotomy, less invasive, with only about a 0.5 cm incision

  • Does not pass through brain tissue, thus avoiding damage

  • Rapid recovery after surgery, with a short hospital stay

Cons:

  • Vascular blockage causes ischemic stroke

  • Aneurysm rupture (rebleeding) during surgery

  • Larger aneurysms may recur

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Conservative Non-surgical Treatment

Pros: 

  • No surgical risks

Cons:

  • Potentially fatal if the aneurysm ruptures later

Given the difficulty in detecting diseases such as cerebral arteriovenous malformations and cerebral aneurysms, early prevention and timely diagnosis and treatment are crucial. Early detection and proper monitoring and treatment can prevent the life-threatening risk posed by the sudden rupture of a cerebral aneurysm.

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