EMERGENCY:Sudden worst headache of your life — this may be a ruptured aneurysm —call040-46324365immediately — 24 hours, 7 days— 24/7
Cerebral Aneurysm: Understanding the Bulge in Your Brain Artery and the Decision You Now Face
A cerebral aneurysm is a weakened balloon like bulge in the wall of a brain artery. Many aneurysms remain silent and are discovered incidentally during MRI or CT scans, while others may rupture suddenly causing subarachnoid haemorrhage a life threatening brain emergency. The risk of rupture depends on factors such as aneurysm size shape location patient age smoking and blood pressure.
A balloon like bulge in the wall of a brain artery present in approximately 2 to 3 percent of people
Until rupture which causes subarachnoid haemorrhage
50 percent within 30 days without treatment
Increasingly found on MRI or CT scans done for other reasons
Surgical clipping Endovascular coiling Flow diversion Observation
040-46324365 — 24 hours
KIMS is a comprehensive cerebrovascular centre clipping and coiling both performed
A cerebral aneurysm is a balloon-like bulge in the wall of a brain artery — present in approximately 2–3% of people (1 in 30–50 individuals). Most cause no symptoms and are discovered incidentally on MRI or CT scans. The danger is rupture, which causes subarachnoid haemorrhage: 50% mortality within 30 days without treatment. The risk of rupture depends on size (higher above 7mm), shape (irregular or multilobulated), location (posterior circulation higher risk), and age. At KIMS Neuroscience Hyderabad, both surgical clipping (97.1% aneurysm closure rate) and endovascular coiling available.
- What it is
- Balloon-like bulge in a brain artery wall. Present in 2–3% of all people. Usually silent until rupture. Rupture causes SAH with 50% 30-day mortality without treatment.
- Ruptured aneurysm
- Causes the thunderclap headache (worst headache of life). Emergency: 040-46324365 immediately. See SAH page for full protocol.
- Incidental finding
- Increasingly discovered on MRI scans ordered for other reasons. Small, smooth aneurysms below 7mm may be safely observed. Larger or irregular aneurysms often warrant treatment. Every case assessed individually at KIMS.
- Surgical clipping
- Titanium clip placed across aneurysm neck during open surgery. Immediate, permanent occlusion. 97.1% closure rate. Long-term durability: rerupture rate <0.5% after clipping. Preferred for young patients.
- Endovascular coiling
- Platinum coils packed inside aneurysm through catheter from groin. No skull opening. Higher short-term safety for some aneurysm types. Recanalisation rate higher than clipping: follow-up MRA required.
- Who should be screened
- Two or more first-degree relatives with aneurysm/SAH · Polycystic kidney disease (ADPKD) · Prior SAH survivors · Known connective tissue disorders.
- Contact KIMS
- 040-44885000 (incidental aneurysm clinic) · 040-46324365 (emergency rupture) · neuroscience@kimshospitals.com
| Fact | Details |
|---|---|
| Prevalence | 2–3% of general population · Most never discovered · 20–30% of patients have multiple aneurysms |
| Rupture risk factors | Size >7mm · Irregular/multilobulated shape · Posterior circulation · Female sex · Tobacco use (doubles SAH risk) · Hypertension · Prior SAH from another aneurysm |
| Surgical clipping | 97.1% aneurysm closure · Rerupture <0.5% long-term · ICG fluorescence angiography intraoperative · Robotic guidance · Intraoperative neuromonitoring |
| Endovascular coiling | ISAT trial: better 1-year outcomes for aneurysms suitable for both techniques · Higher recanalisation rate · Follow-up MRA required · Preferred for posterior circulation |
| Flow diversion | Pipeline Embolisation Device for large/giant and fusiform aneurysms · Available at KIMS |
| Observation | Small (<7mm), smooth, incidental in older patients with comorbidities · Serial MRA schedule · Active decision, not passive |
| KIMS expertise | All locations including skull base and posterior circulation · Both clipping and coiling · Flow diversion |
About This Condition
What Is a Cerebral Aneurysm?
A cerebral aneurysm also called an intracranial aneurysm or brain aneurysm is a weak spot in the wall of a brain artery that bulges outward into a rounded sac or balloon shape. The artery wall at that point is thinner and weaker than normal and the pressure of blood flowing through it causes it to expand over time.
Most cerebral aneurysms cause no symptoms and are never discovered. They sit silently in the arteries at the base of the brain in the circle of Willis in the branches of the middle or anterior cerebral arteries for years or decades without the person knowing. They are not causing headaches. They are not causing any signs that something is wrong. The person has no idea they are there.
The danger is rupture. When the wall of an aneurysm finally fails under the sustained pressure of the circulation it tears and bleeds explosively into the space around the brain subarachnoid haemorrhage. This is one of the most catastrophic events in medicine. Without access to treatment the fatality rate from aneurysm rupture is 50 percent in the first 30 days.
Cerebral aneurysms are more common than most people realise. Approximately 2 to 3 percent of the general population one person in 30 to 50 has an unruptured intracranial aneurysm. With MRI scanning becoming more widely available in India aneurysms are being detected incidentally with increasing frequency found on scans ordered for headaches dizziness or other symptoms that turn out to be unrelated.
At KIMS Neuroscience Secunderabad Hyderabad The KIMS Neuroscience team performs aneurysm procedures surgical clipping endovascular coiling flow diversion and complex skull base approaches. Every incidentally discovered aneurysm receives an individualised risk assessment and a clear unhurried discussion of the options.
Book Cerebrovascular Consultation
Our cerebrovascular team is available for urgent and elective consultations.
040-46324365International enquiries: neuroscience@kimshospitals.comTypes of Cerebral Aneurysm
Saccular aneurysm berry aneurysm
A rounded berry shaped sac attached to the artery at a narrow neck. Saccular aneurysms account for approximately 90 percent of all cerebral aneurysms. They most commonly occur at arterial branch points where blood flow creates turbulence and mechanical stress on the vessel wall. The most frequent locations are the anterior communicating artery ACOM the posterior communicating artery PCOM the middle cerebral artery bifurcation MCA the internal carotid artery ICA and the basilar artery tip.
Fusiform aneurysm
A spindle-shaped widening of an entire arterial segment rather than a discrete sac. More common in older patients with atherosclerosis and hypertension. Less amenable to clipping or coiling flow diversion devices are often the preferred treatment.
Dissecting aneurysm
A tear in the inner lining of the arterial wall, allowing blood to track between the layers. Can occur after trauma, during sudden physical exertion, or spontaneously. Dissecting aneurysms are an important cause of stroke and SAH in younger patients.
Multiple aneurysms
Approximately 20–30% of patients with a cerebral aneurysm have more than one. When one aneurysm ruptures, the others require individual risk assessment the challenge of deciding which to treat and when is one of the most complex decisions in cerebrovascular surgery.
Who Is at Risk? Risk Factors for Cerebral Aneurysm
Non modifiable risk factors
Family history :
A person with two or more first degree relatives who have had a cerebral aneurysm has a 12 percent prevalence of aneurysm themselves far higher than the general population rate of 2 to 3 percent. Family history should trigger consideration of screening MRA MR angiography.
Female sex :
Aneurysms are more common in women particularly after menopause and ruptured aneurysms are more common in women than men.
Certain genetic conditions :
Polycystic kidney disease ADPKD is associated with a significantly elevated prevalence of cerebral aneurysms approximately 8 to 10 percent. Patients with ADPKD should be offered aneurysm screening. Ehlers Danlos syndrome Marfan syndrome and hereditary haemorrhagic telangiectasia also carry elevated risk.
Modifiable risk factors the ones you can control
Hypertension :
The most important modifiable risk factor for both aneurysm formation and rupture. Blood pressure control is not just secondary prevention it is primary prevention for aneurysm growth and rupture.
Tobacco use :
A powerful independent risk factor for aneurysm formation growth and rupture. Tobacco use approximately doubles the risk of subarachnoid haemorrhage from an aneurysm rupture. Complete cessation is the most important lifestyle recommendation for any person with a known aneurysm.
Alcohol use :
Heavy alcohol use is associated with elevated aneurysm rupture risk.
Cocaine and stimulant use :
Cocaine and stimulant drugs can cause acute severe hypertension and trigger aneurysm rupture.
How Is a Cerebral Aneurysm Found?
Incidental discovery — the increasingly common scenario
With CT and MRI scanning becoming more accessible in Hyderabad and across India, aneurysms are increasingly found on scans performed for other reasons, a headache investigation, an eye pressure complaint, or a brain assessment after a minor injury. The patient had no idea. The radiologist reports a finding. A referral is made. This is a significant and disorienting experience. A person who felt completely well learns that their brain contains an abnormality with potential lethal consequences. The consultation at KIMS Neuroscience is designed to transform this fear into informed understanding and into a clear decision made calmly, together.
Following SAH from rupture
When SAH occurs, CT and CT angiography identify the aneurysm in the acute setting. DSA (digital subtraction angiography) characterises it precisely before treatment. This scenario is covered in detail on our Subarachnoid Haemorrhage page.
Symptomatic aneurysm — the posterior communicating artery warning
A specific and important presentation: a large aneurysm of the posterior communicating artery (PCOM) can compress the third cranial nerve as it enlarges causing a painful, dilated, unresponsive pupil with drooping of the eyelid (ptosis) and inability to move the eye upward or inward. This is a neurosurgical emergency. A patient presenting to KIMS with a painful, dilated, and unresponsive pupil is assessed immediately this may be a pre-rupture warning of a growing PCOM aneurysm, and emergency treatment can prevent rupture and SAH.
Screening — when is it recommended?
Active aneurysm screening with MR angiography (MRA) is recommended at KIMS for:
- Persons with two or more first-degree relatives who have had a cerebral aneurysm or SAH
- Patients with autosomal dominant polycystic kidney disease (ADPKD)
- Patients who have survived a previous SAH to monitor the treated aneurysm and assess any additional aneurysms
- Patients with genetic connective tissue disorders associated with aneurysm risk
Assessing an Unruptured Aneurysm — The Risk-Benefit Decision
The most important conversation in unruptured aneurysm management is this: does risk of leaving the aneurysm untreated exceed the risk of treating it?
This is not a simple calculation. It is an individual assessment that weighs multiple factors simultaneously.
Factors influencing rupture risk
Size :
Aneurysms below 7mm in diameter carry a relatively low annual rupture risk approximately 0.1–0.3% per year for small aneurysms in the anterior circulation. Above 7mm and particularly above 10mm rupture risk increases substantially. Giant aneurysms above 25mm carry a rupture risk of 6% per year or more.
Shape :
Irregular, multilobular, or aneurysms with a daughter sac a bleb emerging from the main sac carry significantly higher rupture risk than smooth regular-shaped aneurysms of the same size. Shape assessment on high-resolution imaging at KIMS is a key component of the risk discussion.
Location :
Posterior circulation aneurysms basilar artery posterior communicating artery and posterior inferior cerebellar artery carry higher rupture risk than equivalently sized anterior circulation aneurysms. PCOM and ACOM aneurysms have elevated risk compared to MCA aneurysms of the same size.
Previous SAH from another aneurysm :
Aneurysms found incidentally in a patient who has survived SAH from a different ruptured aneurysm have a higher rupture risk than truly incidental findings.
Growth on serial imaging :
An aneurysm that has demonstrably grown on follow-up MRA is at significantly elevated rupture risk and typically warrants treatment.
Factors influencing treatment risk
Age :
Treatment risk increases with age particularly for open surgery. The risk-benefit balance for an incidental 6mm aneurysm shifts substantially between a 40-year-old and a 75-year-old.
Overall health :
Surgical fitness for general anaesthesia and open craniotomy is assessed individually for every patient.
Aneurysm anatomy :
Some aneurysms are technically straightforward to clip or coil. Others large wide-necked aneurysms in complex anatomical locations carry higher procedural risk.
The KIMS Approach
At KIMS Neuroscience, the risk-benefit discussion is individualised, evidence-based, and unhurried. the KIMS Neuroscience team reviews every unruptured aneurysm case with the full imaging, calculates the patient-specific rupture risk, and presents both treatment options and the option of observation with honest figures.
Treatment
Treatment Options at KIMS
Option 1: Surgical Aneurysm Clipping
Surgical clipping is a microsurgical procedure in which the neurosurgeon opens the skull (craniotomy), navigates to the aneurysm under a surgical microscope, and places a titanium clip across the neck of the aneurysm. The clip permanently seals the aneurysm from the circulation, preventing it from receiving blood flow and from ever rupturing.
The durability advantage of clipping :
Surgical clipping provides the most durable aneurysm occlusion available. Global benchmark outcomes for microsurgical clipping of unruptured aneurysms show a favourable neurological outcome in at least 95.9% of patients and an aneurysm closure rate of at least 97.1%. Recurrence rates after clipping are very low the long-term rerupture rate in the clipping arm is approximately 0.5% making clipping the most definitive single treatment for most aneurysms.
When clipping is preferred :
Young patients (the durability advantage compounds over decades). Middle cerebral artery (MCA) aneurysms surgical access to MCA is technically well-suited to clipping. Wide-necked aneurysms that are not easily coilable. Aneurysms with associated intracerebral haematoma requiring simultaneous surgical evacuation. Complex aneurysms requiring direct visualisation and manipulation.
At KIMS :
All aneurysm surgery is performed with intraoperative neuromonitoring (continuous monitoring of motor and sensory pathways throughout surgery), ICG (indocyanine green) fluorescence angiography which confirms complete aneurysm occlusion and normal parent artery flow while the patient is still on the operating table and the Stealth AutoGuide robotic cranial guidance system.
Option 2: Endovascular Coiling
Endovascular coiling is performed through a catheter guided from the femoral artery in the groin through the circulation to the cerebral arteries. Under X-ray guidance in the neurointerventional suite, soft platinum coils are deployed inside the aneurysm sac. The coils fill the aneurysm and promote thrombosis the aneurysm clots from the inside and is excluded from the circulation.
The short-term outcome advantage of coiling :
For ruptured aneurysms suitable for either treatment, the landmark ISAT trial demonstrated better functional outcomes at one year with coiling. Endovascular coiling has lower short-term procedural risk for certain aneurysms particularly basilar artery aneurysms and other posterior circulation lesions and is the preferred approach for patients with poor neurological grade SAH for whom surgical risk is elevated.
The durability considerations :
Coiling has a higher recanalisation rate than clipping the coils can compact over time, and the aneurysm can partially reopen. Long-term rerupture rates after coiling are approximately 1.5% three times higher than after clipping, though still low in absolute terms. Coiled patients require follow-up MRA to monitor for recanalisation and may require re-treatment.
When coiling is preferred :
Posterior circulation aneurysms basilar tip, PICA, AICA. Older patients or those with poor medical fitness for open surgery. Narrow-necked aneurysms of any location. Patients with poor-grade SAH for whom surgical risk is prohibitive.
Option 3: Flow Diversion (Pipeline Embolisation Device — PED)
Flow diverter stents are a relatively recent endovascular technique designed for aneurysms not suitable for coiling particularly large or giant aneurysms, fusiform aneurysms, and wide-necked aneurysms where coils would not reliably occlude the sac.
A flow diverter is a high-density mesh stent deployed across the neck of the aneurysm. It redirects blood flow past the aneurysm rather than into it the aneurysm progressively thromboses and is excluded from the circulation over weeks to months. The Pipeline Embolisation Device (PED) is the most widely used flow diverter.
Flow diversion is available at KIMS Neuroscience for selected aneurysms where it represents the best available option.
Option 4: Observation (Watchful Waiting)
Not all aneurysms require treatment. For small (below 7mm), smooth, incidentally discovered aneurysms in older patients with medical comorbidities where the treatment risk exceeds the estimated rupture risk observation with serial MRA imaging is the appropriate management.
At KIMS, observation is never a passive decision. It involves a defined imaging schedule (typically MRA at 6 months, then annually), specific criteria for reassessing the treatment decision (if growth, shape change, or new symptoms occur), and clear instructions for the patient on what warrants emergency assessment.
the KIMS team's Aneurysm Expertise at KIMS
The KIMS Neuroscience team performs aneurysm procedures at KIMS Hospitals encompassing the full spectrum from small incidental aneurysms to complex giant and posterior circulation lesions, and from elective unruptured cases to emergency ruptured aneurysm surgery in critically ill patients.
The team's subspecialty training in skull base and cerebrovascular surgery, including a fellowship at Wayne State University Detroit, and three decades of subspecialist neurosurgical practice at KIMS give the cerebrovascular team the experience and technical capability to manage all aneurysm types.
The KIMS neurointerventional suite is equipped for both microsurgery and endovascular procedures, with intraoperative imaging and monitoring available for every case.
Related Conditions
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FAQs
Frequently Asked Questions
EMERGENCY:Ruptured aneurysm emergency — sudden worst headache of your life —call040-46324365immediately — 24 hours, 7 days— 24/7
Clipping and coiling both available at KIMS.
The KIMS Neuroscience cerebrovascular team provide complete cerebral aneurysm management incidental aneurysm risk assessment, elective clipping and coiling, flow diversion, emergency ruptured aneurysm surgery, and long-term imaging follow-up. Hyderabad's most experienced aneurysm centre.
neuroscience@kimshospitals.com