{"id":826,"date":"2016-12-08T15:47:29","date_gmt":"2016-12-08T15:47:29","guid":{"rendered":"http:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/?p=826"},"modified":"2017-01-14T16:58:11","modified_gmt":"2017-01-14T16:58:11","slug":"intracranial-aneurysms-non-neurosurgical-provider-primer-series-part-3","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/frontlines-clinical-medicine\/2016\/12\/08\/intracranial-aneurysms-non-neurosurgical-provider-primer-series-part-3\/","title":{"rendered":"Intracranial Aneurysms for the Non-Neurosurgical Provider: Primer Series, Part 3"},"content":{"rendered":"
\"Bianca

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Bianca Belcher, MPH, PA-C, practices neurosurgery in Boston, MA.<\/p>\n

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In part 3 of this primer series, I will discuss a basic overview of monitoring patients who are not undergoing treatment for intracranial aneurysm as well as potential treatment options for those who are. (See part 1<\/a> for a summary of natural history studies and part 2<\/a> for information on patient risk factors.)<\/p>\n

Many times the decision is made not to intervene because the modifiable and\/or non-modifiable factors make the risk of intervention greater than the risk of not intervening. In these cases, we continue to follow the patient with imaging. The type of scan, the intervals of imaging, and duration that we follow patients vary based on several factors such as the patient\u2019s age and the size, morphology, and progression of the aneurysm. If monitoring is the appropriate course and if the first image was of good quality, then we will typically see the patient in clinic in 6 months with an MRA or CTA. If an MRA will provide the quality that we need, it is the preferred method of following a patient because there is no radiation. If nothing has changed with the patient\u2019s risk factors and imaging also remains unchanged, we push the next clinic appointment and imaging to one year, then see the patient again in two years. If we observe a change in the aneurysm, we are very likely to offer treatment.<\/p>\n

If treatment is the appropriate next step, there are essentially two paths that we discuss with patients: open surgical clipping and endovascular treatment. From the patient\u2019s perspective, there are advantages and disadvantages to both. Within the endovascular path of treatment there are several choices, described below.<\/p>\n

Open Surgery: Craniotomy for Clipping<\/strong><\/p>\n

General Advantages<\/em><\/strong>:<\/strong><\/p>\n