BVS Doctors

Brain Aneurysm Surgery in Istanbul

A brain aneurysm arises when a weak point in the wall of a cerebral artery balloons outward. It is found in roughly 3–5% of the population, and most remain silent for a lifetime without any symptom. The real issue is correctly distinguishing which aneurysm should simply be monitored and which requires treatment. When treatment is needed, two methods take the stage: microsurgical clipping and coiling performed from inside the vessel. Both are methods that report 90–95% success in the literature, and the choice depends entirely on the patient. On this page we explain, in plain language, our aneurysm assessment and treatment rationale for patients reaching us in Istanbul.

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What Is an Aneurysm, and Who Is More Prone to It?

Aneurysms typically develop in the circle of Willis at the base of the brain, at points where vessels branch; they most often favour the anterior communicating artery, the posterior communicating artery and the middle cerebral artery. Size directly affects rupture risk: while the annual rupture probability is quite low in small sacs under 7 mm, this probability climbs as the diameter grows. The two main modifiable risks to emphasise are smoking and uncontrolled blood pressure; to these are added older age, female sex and excessive alcohol. Hereditary and structural causes include a family history of aneurysm, polycystic kidney disease (ADPKD), Ehlers-Danlos Type IV and Marfan syndrome. For this reason, screening with MRA is considered in people who have two or more aneurysms/haemorrhages among first-degree relatives and in certain genetic diseases.

Symptoms and the Haemorrhage (SAH) Emergency

A significant proportion of unruptured aneurysms cause no symptoms and are caught incidentally on an MRI or CT performed for another reason. Larger ones can press on neighbouring structures and cause a drooping eyelid, double vision or loss of vision. When an aneurysm ruptures, subarachnoid haemorrhage (SAH) develops — a true life-threatening emergency: a sudden pain that bursts within seconds, described by patients as “the worst headache of my life”, may be accompanied by neck stiffness, nausea-vomiting, sensitivity to light and loss of consciousness. In such a picture one must go to the emergency department without losing time and call the emergency number. After bleeding, re-bleeding and acute hydrocephalus in the early period, and the vasospasm peaking on days 7–10 later on, are the prominent dangers and are closely monitored in intensive care.

Should We Monitor or Treat?

Surgery is not always required for an unruptured aneurysm; the decision is patient-specific and risk is calculated with tools such as the PHASES score. For small sacs in the anterior circulation, annual imaging follow-up with MRA/CTA and control of risk factors (quitting smoking, balancing blood pressure) is often sufficient. Treatment comes to the fore in the following situations: aneurysms above a certain diameter, those growing rapidly, symptomatic sacs causing pressure signs, smaller sizes with a family history, and young patients with a long expected lifespan. In other words, the sentence “I have an aneurysm” does not by itself mean “I must be operated on”.

Coiling — From Inside the Vessel, Without an Incision

In coil embolisation, the aneurysm is reached with a thin catheter advanced from the groin, and platinum spiral coils are placed inside the sac to isolate the aneurysm from the blood flow. In wide-necked sacs, balloon- or stent-assisted techniques come into play, and in some large aneurysms, flow-diverter stents are used. The procedure is performed under general anaesthesia, does not require opening the skull, recovery is relatively fast (usually a 2–3 day stay), and it is preferred especially in older patients or those at high surgical risk. Its most important weakness is that in some cases the aneurysm can reopen over time (recanalisation), and it usually requires dual antiplatelet medication for a period along with intermittent control angiography.

Microsurgical Clipping — The Open Method

In clipping, the skull is opened and a small titanium clip is placed at the neck of the aneurysm under the microscope, permanently separating the sac from the circulation. During the procedure, whether the clip is correctly seated is checked with ICG angiography, micro-Doppler and neurophysiological monitoring. Offering a permanent solution and a very low chance of reopening are its greatest strengths; it comes to the fore especially in wide-necked complex aneurysms, those located on the middle cerebral artery, and sacs that reopen after coiling. By contrast, it requires opening the skull and its recovery is somewhat longer than coiling (usually a 5–7 day stay). Which method is chosen is decided by weighing together the aneurysm’s diameter, neck width, location and the patient’s overall condition.

Frequently Asked Questions

Does a brain aneurysm always rupture?

No. The great majority of aneurysms never rupture and remain unnoticed; the annual rupture probability is quite low in sacs under 7 mm. Risk varies with size, location, family history and growth rate, and is estimated with tools such as the PHASES score.

Is coiling or clipping better?

Both are effective methods reporting 90–95% success in the literature; the ‘better’ one is the one best suited to that patient. Coiling is less invasive and recovers quickly but carries a risk of reopening; clipping offers a permanent solution but requires opening the skull. The decision is made according to the aneurysm’s features and patient factors.

With which symptom should I rush to hospital immediately?

If you have the worst headache of your life that bursts within seconds (a feeling that ‘something snapped in my head’) together with neck stiffness, nausea-vomiting or clouded consciousness, go to the emergency department without losing time and call the emergency number. This picture may be a subarachnoid haemorrhage due to a ruptured aneurysm.

There is an aneurysm in my family — am I also at risk?

Most aneurysms are not hereditary. However, if two or more first-degree relatives have a history of aneurysm or brain haemorrhage, the familial risk rises; in that case screening with MRA may be recommended. You can obtain a preliminary assessment by sharing your MRI/CT images from Istanbul via phone or WhatsApp (+90 532 414 35 35).

WhatsApp · 0532 414 35 35