Diagnosis brain aneurysm

I have the diagnosis – what does that mean now?

You probably weren't looking for this finding. Most people learn about their aneurysm by chance – and are then confronted with a word that sounds threatening. Therefore, first things first: An unruptured aneurysm is not an emergency. You have time. Time to gather information, time to seek advice, and time to make a decision without rushing into it.

The risk in numbers

Across all aneurysms, the risk of bleeding is very low: Of 1,000 people with an aneurysm, only about one per year experiences a bleed – 999 do not. However, this average says little about your personal risk . It depends on the size of the aneurysm, its location, its shape, your age, whether you have high blood pressure, whether you smoke, and whether there is a history of brain hemorrhages in your family. We will assess this for you.

Why treatment is not automatically the safe option

Eliminating an aneurysm - whether with platinum coils (coiling) or internal baskets, or with an external clip (microsurgical clipping) -is not without risk . The risk of suffering permanent damage or death as a result of the procedure is up to 4%. Therefore, in the case of an aneurysm with a very low risk of bleeding, treatment can do more harm than good. Treatment is an option - not the norm.

What makes sense now – three steps

1. Gain clarity regarding the findings. Bring your image data (CD/DVD or upload) with you – the assessment of an aneurysm is not possible without the original images .

2. Have an individual risk assessment performed. We base this on established classifications, some of which we developed ourselves (PHASES, UIATS), and – additionally, and so far only within the context of studies – on modern blood biomarkers from our own research. We will discuss the results with you, not behind your back.

3. Focus on what's within your control. Maintaining stable blood pressure and quitting smoking are the only two things you can do yourself – and they're also the most effective. They reduce the risk of an aneurysm growing or bleeding, and they take effect immediately. You don't need surgery or our permission.

Treat or observe?

To make this decision, we weigh two risks against each other:

1. the risk of the aneurysm rupturing in the coming years

2. the risk associated with preventative treatment. 

Treatment is only advisable if the former significantly outweighs the latter. This decision is based on the European guideline on the management of unruptured aneurysms (ESO Guideline 2022), to which our team made a leading contribution. This assessment is not a formula, but a medical decision that takes into account your life circumstances, pre-existing conditions, life expectancy, and – explicitly – your own preferences.

• Factors considered in the assessment include: the size, location, and shape of the aneurysm; growth observed during follow-up examinations; age; high blood pressure; smoking; previous bleeding; family history of aneurysms; comorbidities; and life expectancy.

• The available options are: observation with structured monitoring and consistent risk factor treatment; endovascular treatment (coiling, stent, flow diverter); microsurgical clipping; participation in studies (e.g., PROTECT-U).