#MayoClinicNeuroChat about Brain Aneurysms

My husband had a rupture in January 2013. He had a coiling then that saved his life. 6 months later at a followup angiogram we learned he needed a clip which he had done in Sept 2013. He was a smoker and high BP. He currently still takes bp meds but recently started smoking again. What are the chances this new/old habit will cause a problem for his aneurysm?

Smoking does increase the risk factor for aneurysms. I hope he can sum up the courage to quit smoking again, I know it easier said than done. You are in my thoughts, this has to be difficult for you. Please know we are here for you. Here is a link for smoking cessation: http://www.mayoclinic.org/healthy-lifestyle/quit-smoking/basics/quitsmoking-basics/hlv-20049487

The aneurysm was in COM artery This Is my husband and he is in sub acute care rehab facility getting Ot Pt and speech therapy. Dr said he has brain swelling. It has been 1 week. His Ot and pt are going good but memory and communicating skills need lots of work.

Hi, @love2dance. I took your question to Dr. Freeman, who says, "This is usually always temporary from anesthesia, unless the aneurysm is near/affecting brain structures of Papez circuits or some other complication during surgery such as bleeding (delicate aneurysms) or other problems. These are discussed prior to surgery with the patient so they have a clear understanding of the risk vs benefit. Only aneurysms that pose a benefit of surgery and greater than surgical risks are operated on. For example, if an aneurysm clipping poses a 5% or less risk of the surgery but a 10% risk of rupture, this is how surgery is discussed with the patient (‘risk/benefit ratio’) in which the patient makes the decision with their doctor."

Hi, @deanatay. I took your question to Dr. Freeman. His answer is below:
This depends on whether the aneurysm is ruptured or not. If ruptured, the treatment would be surgery. If unruptured, 3mm aneurysms are typically monitored or observed since the risk of surgery/intervention can outweigh the short-term/long-term benefits. Aneurysms of 5mm are more likely to be treated surgically, and it depends on the growth rate. Mayo Clinic conducted the ISUIA trial (International Study of Unruptured Intracranial Aneurysm in the New England Journal of Medicine http://www.nejm.org/doi/full/10.1056/NEJM199812103392401#t=article ).
A good rule of thumb for patients is that aneurysms 7mm or greater become greater risk for those carotid aneurysms (ie., ‘behind the eye’), whereas those 4mm or greater in the back of head region (called PCOM, PCA, etc) should be considered for treatment. Those less than 7mm of the carotid should be carefully discussed with their surgeon since this ISUIA should be carefully decided and on other indivualized risk factors, such as age, growth rate, comorbidities and other important factors.
Finally some aneurysms behind the eye are within the cavernous sinus, which is potentially less risky to fix with a newer ‘flow diversion technology’ but again, patients are encouraged to talk about the ‘risk vs. benefit and alternatives’ with their doctors. Mayo Clinic has experts in all these areas and were principle investigators of the ISUIA trial.
Also a recent study lead by Dr Robert D Brown at Mayo and other international investigators called PHASES can help decide in this matter (http://thelancet.com/journals/laneur/article/PIIS1474-4422(13)70263-1/fulltext).

Hi @abissol41. I sent your question to Dr. Freeman and this is his response:

"This is a great question. He needs to quit smoking to reduce his risk of future aneurysms and there is not a good number we can cite for his particular aneurysm future risk without knowing if he has any residual risk factors as studied. Also, smoking turns on genes we now know that change the risk. Therefore, he needs to seek a smoking cessation program. There are now teams at Mayo Clinic in smoking cessation with medications, acupuncture, counseling etc that can help him. Mayo has an integrated smoking cessation program. Besides brain aneurysm, smoking cessation can help his other health including reducing the future risk of lung cancer, lung disease (e.g., COPD, emphysema), and cardiac disease like heart attack and ischemic stroke. Not to mention, quitting smoking can help him save money given the high price of cigarettes! Therefore, we as doctors cannot underscore that message enough since it sounds like he has already had brain aneurysms successfully and could prevent future problems from something so simple and effective. In the words of Benjamin Franklin “An ounce of prevention is worth a POUND of cure.” Smoking and aneurysms increases his risk of future aneurysm rupture or future aneurysm development (unruptured by 1.7-2X) the normal patient." https://www.ncbi.nlm.nih.gov/pubmed/10478344

That is Sean Bretz's Birthday and he will be 29! Thanks to Drs Tawk and Freeman for giving Sean the gift of
Iife and "Saving the life of a Lifesaver" Myself and family will always be grateful! Noel Bretz

I had a giant aneurysm in the cavernous sinus treated with 4 pipeline stents. I had pain for a year before the surgery as the aneurysm was pressing on trigeminal nerve. This was 8 years ago and have had constant pain from both trigeminal and occipital neuralgia and my pain DR says I have central pain/ post stroke pain? 2 months after surgery I got severe burning pain in both knees and over past 8 years it has spread to my feet and hips and is equal on both sides. Location of the aneurysm and the complicated surgery are cause he says, the last of the 4 stents wouldn't open and they spent over two hours trying to open the stent with every option available including balloons and may have damaged other areas and nerves in cavernous sinus including thalamus?. The cavernous sinus is where all the trauma started and he said that is why I have all the pain still 8 years later and it has spread to lower body. Any thoughts on surgery in cavernous sinus and central pain? Was told that no Dr. would ever do normal surgery there due to complications and the stent was only option. 24/7 head pain and lower body too, not much of a life.

Am praying you meet the right doctor to help this situation. Please don't give up. I hope all reading this will have some valid suggestions!

Hi Dr Tawk and Freeman. Just wanted to let u know that today February 8 is Sean Bretz's birthday. He would not be here celebrating this day without you both and the Mayo Clinc. Thanks to all. Kate