Open versus endovascular treatment for cerebral aneurysms

Doctors to address issue at symposium in MoBay

Sunday, January 07, 2018

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DOSTORS Brandon J Davis, dual-trained neurosurgeon and endovascular surgeon at Memorial Neuroscience Institute of Memorial Healthcare System in South Florida, and Dean Hertzler, paediatric neurosurgeon at Joe DiMaggio Children's Hospital, have both been invited to participate as guest speakers at the 16th Annual Caribbean Neurosciences Congress and Symposium (CANS).

The event will take place from January 25–28 at the Half Moon Convention Centre in Montego Bay, St James.

Dr Davis is expected to share insight about 'Open vs Endovascular Treatment for Cerebral Aneurysms, Arteriovenous Malformations (AVMs) and AV Fistulas', while Dr Hertzler is expected to talk about concussions, traumatic brain injuries and spine trauma, as well as the management of minor and major neurosurgical trauma.

The symposium is organised and hosted by the Caribbean Neurological Association along with the division of neurosurgery at the University Hospital of the West Indies. A recent release said this venture continues as it provides critical updates for doctors, invaluable teaching for residents in training, and also an opportunity for trainees to interview for electives and fellowships with visiting faculty.

One of the topics that Dr Davis is expected to address relates to how having a brain aneurysm has been compared to a ticking time bomb inside the head and how half the people who experience a rupture run the chance of dying before getting to the hospital.

An aneurysm tends to develop at branching points of arteries and are caused by constant pressure from blood flow. An aneurysm is a weak area in a blood vessel that usually enlarges and is often described as a “ballooning” of the blood vessel. They enlarge slowly and become weaker as they grow, just as a balloon becomes weaker as it stretches.

About 1.5 to five per cent of the general population has, or will develop a cerebral aneurysm, while only between 0.5 and three per cent may suffer from bleeding, according to statistics. The good news is that people are not usually born with aneurysms. Most people develop it after the age of 40. Some aneurysms are due to infections, drugs such as amphetamines and cocaine that damage the brain's blood vessels, or direct brain trauma from an accident.

“My journey into medicine has always been a calling for me. For as long as I can remember, I have envisioned myself as a doctor, spending my time and energy perfecting what I love to do, which is healing the human body, mind and spirit. I am a proponent of continuing research to both cure disease and to help unlock nature's most marvelous mystery — the human mind,” expressed Dr Davis.

Dr Davis will also discuss test and treatments for aneurysms. Two non-invasive special imaging tests show the blood vessels in the brain and can detect an aneurysm.

The first is called CTA (computed tomographic angiography) and the second is called MRA (magnetic resonance angiography). Both of these screening tests detect most cerebral aneurysms larger than 3–5 millimetres.

However, the most reliable test, although more invasive, is called a diagnostic cerebral angiogram. During this, a small catheter is inserted through a blood vessel in the groin and guided into each of the blood vessels in the neck that go to the brain. This is less comfortable, but it is the most reliable way to detect all types and sizes of aneurysms. Before any treatment is considered, a diagnostic cerebral angiogram is usually performed to fully map a plan for therapy.

Each patient and each aneurysm is different. Doctors must evaluate the risk factors that favour treatment vs non-treatment and decide which technique may be best.

It's important to consult with experts in this field. This should include a discussion with a cerebrovascular neurosurgeon who specializes in surgically clipping aneurysms, a neurosurgeon with endovascular expertise and training, a neurointerventionalist (a neurologist with endovascular training) or a neuroradiologist who specialises in the less invasive treatment of cerebral aneurysms by coiling.

The best treatment depends on many things, including whether the aneurysm has ruptured or not.

A ruptured aneurysm usually requires treatment right away, because the re-bleeding rate remains quite high. However, the treatment time and options for treatment depend on the size, location and shape of the aneurysm, as well as the patient's overall medical condition.

Depending on a person's risk factors, open surgery may be recommended. Patients are placed under general anesthesia, an opening is made in the skull, the brain tissue is spread apart, and the aneurysm is surgically exposed. Then the neurosurgeon places a surgical clip around its base. The clip seals off the aneurysm so blood can't enter.

Depending on the aneurysm's size, location and shape, it may be treatable from inside the blood vessel. This minimally invasive procedure is similar to the cerebral angiogram. However, in addition to taking pictures, a catheter is directed through the blood vessels into the aneurysm itself. Then, using X-ray guidance, the endovascular surgeon carefully places soft platinum micro-coils into the aneurysm and detaches them. The coils stay within the aneurysm and act as a mechanical barrier to blood flow, thus sealing it off.

“While an important part of my work takes place in the operating room, the most rewarding part of my job is connecting with patients and their families. It is an honour and a privilege to be trusted with healing the body and mind of another human being. It is a trust that should be earned and cherished for a lifetime,” exclaimed Dr Davis.




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