Best Brain Aneurysm Treatment in Hyderabad, India

Based on the above information (symptoms, age, family history, medical history, etc.), a neurosurgeon advises the following tests to diagnose the aneurysm and determine if blood has leaked into the space between the skull bone and the brain:

• Computed tomography (CT) scan
• Computed tomography angiography (CTA)
• Magnetic resonance imaging (MRI):
• Magnetic Resonance Angiography (MRA)
• Digital Subtraction Angiography (DSA)
• Cerebral angiogram
• Ultrasonography
• Nuclear imaging
• Lumbar puncture
• Cerebrospinal fluid analysis 
  

Computed tomography (CT) scan

• A CT scan is typically the initial test that will be selected by a neurosurgeon when a subarachnoid haemorrhage (SAH) is suspected.
• It is a painless and fast test that uses X-rays to create two-dimensional images or slices of the brain and skull to diagnose blood in the brain. As mentioned above, it is often suggested as the first test to identify a rupture. 
• In around 90% of patients, a high-quality CT scan without contrast can diagnose rupture and bleeding (SAH) within the first 48 hours after symptoms start.
• The location and extent (amount of blood) of the aneurysm (if present) in the subarachnoid space (between the brain and the surrounding membrane) can give clues about where it has ruptured. 
• Finding an aneurysm near the area of the most significant bleeding on the scan supports the diagnosis and helps guide further treatment decisions.
• A CT scan is helpful for patients with multiple aneurysms. In addition to identifying and locating these vascular issues, this scan can also reveal other unexpected conditions, such as arteriovenous malformations (abnormal tangles of blood vessels), bleeding within brain tissue, or fluid buildup in the brain (hydrocephalus). 
• Furthermore, these scans can provide information about how much blood is present in spaces around the brain, helping the neurosurgeon predict the possibility of complications. 

Computed tomography angiography (CTA)

• CTA is a non-invasive test that injects a contrast dye into the patient's vein. This is followed by a CT (Computed tomography) scan, which produces detailed pictures of blood flow in the brain's arteries.
  
• This test is a fast and painless scan that shows the size, location, and shape of an unruptured or ruptured aneurysm. Neurosurgeons often prefer this test to examine blood vessels in the brain and determine whether blood has leaked into the brain.
  
• During the process, the patient lies on a table that slides into a CT scanner, which looks like a large ring. Occasionally, a contrasted dye can be injected to visualise the blood vessels clearly on an X-ray; a series of X-rays are taken to assess the arteries, look for abnormalities, and look for a possible aneurysm in the blood vessels. 
  
• This process produces sharper, more detailed pictures of blood flow in the brain arteries. Images from CT angiography (CTA) are quick to obtain and can be rotated, providing clear views of the brain's blood vessels relative to the skull base. This capability helps surgeons plan procedures effectively. 
  
• Some studies have shown that CTA is highly sensitive, accurately detecting aneurysms in 77% to 97% of patients, and specific, with accuracy ranging from 87% to 100%, making it reliable in clinical practice. 
• However, it may not always recognise the lesions involving the carotid artery at the base of the skull or within the cavernous sinuses filled with contrast dye. 
  
• Besides, there are concerns about the high radiation doses associated with CT scans, especially for patients who require frequent imaging. These factors must be considered when deciding on diagnostic imaging for patients with suspected intracranial aneurysms. 

Magnetic resonance imaging (MRI)

An MRI is a non-invasive imaging examination that uses computer-generated radio waves and a magnetic field to create detailed two-dimensional (2D) anatomical pictures (images) of the brain and can determine if there is any rupture that causes bleeding in the brain. 

Magnetic Resonance Angiography (MRA)

• Magnetic resonance angiography (MRA) delivers clear images of the brain arteries. It will show an aneurysm's size, location, and shape and helps detect intracranial aneurysms in both symptomatic and asymptomatic patients. 
• It is a sensitive (effective) method for detecting an aneurysm in symptomatic patients who have a high risk (i.e., patients with polycystic renal disease and those with one or more first-order family members with documented cerebral aneurysms).
• During this test, the patient will be placed on an examination table that slides into a magnetic resonance scanner. The blood vessels are imaged to identify a brain aneurysm and detect brain aneurysms larger than 3-5mm.
• MR angiography (MRA) has been used for about twenty years (two decades) as an imaging technique to detect aneurysms in patients who are not in urgent condition but show symptoms that suggest they might have one or who have a family history of aneurysms.

Digital Subtraction Angiography (DSA)

• This test gives detailed images of the blood vessels in the brain to identify a problem with blood flow. It involves inserting a small, thin tube called a catheter into an artery in the leg and directing it to the blood vessels in the brain. The contrast dye will be injected through the catheter to take X-ray images.
• Some researchers claim that CTA (computed tomography angiography) can now replace DSA (digital subtraction angiography) or catheter angiography as the best method to find brain aneurysms in cases of rupture, bleeding and sudden severe headaches (SAH). 
• This judgment is based on the fact that CTA can be performed quickly (fast) as part of a routine CT scan, making it safer since no catheters are inserted into blood vessels, lowering the risk of complications.
• However, most experts still consider DSA the gold standard for examining blood flow in the brain and aneurysms. 
• DSA is effective because it provides detailed images needed to measure aneurysms accurately. This is crucial for planning treatments like surgery or using endovascular methods. DSA also helps monitor changes over time by comparing images, which is essential for follow-up care after treatment.

Cerebral angiogram

It is the most reliable test for diagnosing cerebral aneurysms, as it allows the neurosurgeon to examine the brain's blood flow and blood vessels. 

In this test, the patient lies on an X-ray table. Afterwards, a catheter (a small tube) is inserted into the patient's leg and directed into each blood vessel in the neck that goes to the brain. Contrast dye is also injected through the catheter before X-ray images are taken to find blockages in arteries in the neck or the brain and detect any weak spots in an artery, such as an aneurysm.

This examination can help detect aneurysm's size, shape, and exact location and determine the cause of brain bleeding.

Ultrasonography

• Transcranial Doppler (TCD) ultrasonography is a non-invasive technique used in patients with bleeding in the subarachnoid space (subarachnoid haemorrhage (SAH) to detect vasospasm (sudden constriction of a blood vessel) in the arteries inside the skull. 
• TCD ultrasonography can track changes in the velocity of blood flow over time in patients with subarachnoid haemorrhage (SAH). These changes may reveal worsening conditions, helping neurosurgeons to choose specific treatments.

Nuclear imaging

• Some large (giant) aneurysms in the cavernous segment of the internal carotid artery may be treated by blocking the artery. 
• Before deciding on this treatment, surgeons determine whether the brain has enough reserve to handle the blood flow loss from the carotid artery and assess this using an endovascular balloon occlusion test, which is an endovascular procedure in which a balloon is temporarily inflated in an artery, to temporarily block the artery while monitoring cerebral blood flow with (single-photon emission computed tomography (SPECT), a nuclear imaging test that displays how blood flows to tissues and organs) scans. 
• Patients who tolerate the test without significant areas of reduced blood flow may be the considered candidates for carotid artery occlusion treatment.

Lumbar puncture

• A lumbar puncture involves inserting a thin needle into the lower part of the patient spine to collect a sample of CSF. 
• This puncture can be used in about 5% of patients in whom cranial CT shows no abnormalities despite symptoms or history suggesting bleeding (subarachnoid haemorrhage). 
• If the patient's cerebrospinal fluid seems bloody and doesn't clear up even after draining more fluid, this indicates blood has leaked into the space around the brain.
• The presence of xanthochromia, a yellowish discolouration of the cerebrospinal fluid, represents the presence of bilirubin from the breakdown of haemoglobin and is even more definitive (conclusive evidence) than a high red-cell count in the cerebrospinal fluid.
• In cases where bleeding occurs more than 12 hours before a lumbar puncture, the CSF may appear yellow due to haemoglobin breakdown products.
• In contrast, if the blood in the CSF is fresh, like from a recent traumatic spinal tap, it won't cause this yellow discolouration. This difference helps neurosurgeons distinguish between a haemorrhage that occurred some time ago versus recent trauma or bleeding.

Cerebrospinal fluid (CSF) analysis

• This analysis estimates the various components in cerebrospinal fluid, which protects and cushions the brain and spinal cord.
• A neurosurgeon often collects the CSF by performing a lumbar puncture (spinal tap), in which a thin needle is inserted into the individual's lower back (lumbar spine). A small amount of fluid is removed and examined to detect any bleeding around the brain. If bleeding is identified in a given sample, additional tests are required to detect the exact cause of the bleeding. 
• Patients with any ongoing new neurologic deficit who have no response to medical therapies (conservative treatment) should undergo urgent catheter angiography to confirm the presence of vasospasm (sudden constriction of a blood vessel), followed by angioplasty of the narrowed vessels or intraarterial administration of smooth-muscle relaxants.
• Balloon angioplasty and antispasmodic agents result in angiographically confirmed arterial dilatation in a high percentage of patients (90 to 98 per cent).