Brain Aneurysms: Surgical Options and Concerns - Neurosurgery

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Could you please provide more details or specify your question?


Hello Dr.
Chiu,
I would like to ask you a few questions.
I originally consulted an ophthalmologist, but since they couldn't find any issues, I was scheduled for an MRI recently.
It revealed that I have a vascular malformation in my right brain.
The doctor informed me that this is congenital and has been present for twenty-three years, but there is some evidence of bleeding.
To prevent potential significant bleeding in the future, the recommendation is to remove it.
However, I am uncertain about how to proceed.

I consulted two doctors: Dr.
Jiang Mingfu at Taipei Medical University suggested that because the malformation is located deep within the brain, the risks of surgery are too high and not worth it.
He recommended that I seek evaluation from a specialist in Gamma Knife surgery.
On the other hand, Dr.
Du Yongguang at National Taiwan University stated that surgery is necessary.
He believes that the malformation is not too deep and that there should not be any significant issues, and he thinks Gamma Knife treatment would not be effective.
My current concern is that I feel the brain is a very sensitive area, and I am afraid that surgery could lead to many side effects.
I worry that after the surgery, I might not be myself anymore.
I believe that using Gamma Knife treatment, which does not involve opening the skull, would be better and less invasive.

I would like to ask the following questions:
1.
Am I mistaken in my thinking? Should we avoid surgery on the brain if possible?
2.
Will the surgery really change me? I am also very concerned about damaging other areas and affecting my other functions.
Although the surgeon mentioned that any side effects would be temporary and would eventually resolve, this is my brain, and the consequences are irreversible.
Once the surgery is done, everything is decided.
I truly trust the professionals, and I know I need to remove the vascular malformation, but is surgery absolutely necessary?
3.
If I undergo surgery, will they need to open the entire skull, or can they make a small incision near the tumor?
4.
Is there a concern that Gamma Knife treatment might not completely address the issue? So is it generally better to opt for surgery whenever possible? I have the impression that most doctors tend to favor surgical options.
Thank you, Dr.
Chiu, for taking the time to read my letter.
I greatly appreciate it.

Joe, 20~29 year old female. Ask Date: 2005/06/01

Dr. Qiu Yushu reply Neurosurgery


Hello: The Gamma Knife is not a universal solution.
You can consult Dr.
Chung Wen-Yu, a neurosurgeon at Veterans General Hospital, to explore its possibilities.
Additionally, Professor Du Yong-Guang from National Taiwan University is quite experienced in this area of surgery (one is my junior, and Professor Du is my mentor!).
Thank you! Wishing you good health!

Reply Date: 2005/06/01

More Info


Understanding brain aneurysms and the surgical options available is crucial for making informed decisions about treatment. A brain aneurysm, or a cerebral aneurysm, is a bulge in a blood vessel in the brain that can potentially rupture, leading to serious complications such as hemorrhagic stroke. Your concerns about surgery and the potential for long-term effects are valid and shared by many patients facing similar situations.

1. Is it better to avoid surgery if possible?
Your instinct to avoid surgery is understandable, especially when it involves such a sensitive area as the brain. Generally, the medical community advocates for a conservative approach when dealing with asymptomatic aneurysms, particularly if they are small and not causing any immediate issues. However, in your case, the presence of bleeding and the recommendation from your doctors to consider surgical options suggest that the risks associated with leaving the aneurysm untreated may outweigh the risks of surgery.
2. Will surgery change who I am?
Concerns about changes in personality or cognitive function post-surgery are common. While it is true that any brain surgery carries risks of complications, including potential changes in neurological function, many patients do not experience significant long-term changes. Surgeons are trained to minimize these risks, and they often use advanced imaging techniques to plan the procedure carefully. It’s important to discuss these fears with your neurosurgeon, who can provide insights based on their experience and the specifics of your case.

3. What does the surgical procedure entail?
The type of surgery performed will depend on the aneurysm's location, size, and the overall condition of your brain. Traditional open surgery typically involves making a larger incision to access the aneurysm directly. However, in some cases, a less invasive approach may be possible, such as endovascular coiling, where a catheter is inserted through the blood vessels to place coils inside the aneurysm to promote clotting and prevent further bleeding. Your surgeon will explain the best approach for your specific situation.

4. Concerns about Gamma Knife treatment
Gamma Knife radiosurgery is a non-invasive treatment option that uses focused radiation to treat brain aneurysms. While it can be effective, it may not be suitable for all types of aneurysms, particularly those that have already shown signs of bleeding. One concern with this method is that it may not provide immediate results, and the aneurysm may not be completely obliterated, leading to a risk of future complications. Therefore, it is essential to have a thorough discussion with your healthcare provider about the effectiveness and appropriateness of this treatment for your specific aneurysm.

In conclusion, while the desire to avoid surgery is understandable, it is crucial to weigh the risks of leaving the aneurysm untreated against the potential benefits of surgical intervention. Engaging in open discussions with your neurosurgeon about your fears, the specifics of your condition, and the available treatment options will help you make an informed decision. Remember, the goal is to ensure your long-term health and well-being, and your medical team is there to support you through this process.

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