A balloon-like swelling of the wall of a brain artery is called a brain aneurysm.

Just as the wall of a balloon becomes thinner when it is inflated, the wall of the blood vessel of the brain aneurysm is thinner than the original, so it can be torn even with the increase in blood pressure that is normally endured.

It's called a cerebral aneurysm rupture, and it's a terrible thing to burst an artery inside the brain.

If you miss the golden time, most die or have serious neurological sequelae, and even if you are treated while keeping the golden time, 13.5% die within three months and 16.1% within four years.

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Cerebral aneurysm graced the Korean media's timeline twice this year. The first was the death of actress Suyeon Kang in May, and the second was the death of a nurse at Asan Hospital in July.

The unfortunate deaths of the two caused great waves in the film industry and the medical world, respectively.

In particular, the 'Asan Hospital Nurse Incident', in which a patient had to be transferred to Seoul National University Hospital for surgery because there was no brain surgery neurosurgeon, revealed the bare face of essential medical care in Korea.

In this article, if you accidentally discovered a cerebral aneurysm during a health checkup, we summarized the facts you should remember when a cerebral aneurysm ruptured.


Pre-treatment of cerebral aneurysms can also be dangerous

It is an absolute proposition that 'surgery or procedure should be performed as soon as possible in the case of a ruptured cerebral aneurysm'.

However, it is controversial that 'an unruptured cerebral aneurysm should be treated in advance'.

This is because it is necessary to consider which is greater between the probability of spontaneous rupture of a cerebral aneurysm and the risk when treating a cerebral aneurysm.

The probability of a small cerebral aneurysm less than 10 mm in diameter bursting per year is 0.05%.

The risk of death when treating a cerebral aneurysm with craniotomy is 3.8%, and the risk of death when embolization using a coil is 1%.

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For example, let's assume that a 50-year-old man who was found to have a brain aneurysm with a diameter of 3 mm during a health checkup lives to be 90 years old.

The probability of bursting by age 90 with no treatment is calculated as 2% (0.05% X 40 years).

It is higher than the 1% risk of death for embolization but lower than the 3.8% risk of death for craniotomy.

Embolization seems to be a better choice, but depending on the location and shape of the cerebral aneurysm, embolization may be more dangerous than craniotomy in some cases.

Fortunately, with advances in medical technology, the risk of dying from craniotomy and embolization is lower than in the past.

However, it is still difficult to say definitively because the probability of rupture varies depending on individual genes, eating habits, and health conditions.



First, let's look at the probability of rupture according to the location and size of the cerebral aneurysm.



90% of cerebral aneurysms are located in the front of the brain, and the probability of rupture over 5 years is proportional to the size of the cerebral aneurysm diameter.

0% if it is less than 7mm, 2.6% if it is 7-12mm, 14.5% if it is 13-24mm, and 40% if it is larger than 25mm.

Aneurysms located in the back of the brain are rare (10%), but the probability of rupture is higher than those located in the front.

The probability of rupture at 5 years also depends on the diameter of the cerebral artery: less than 7 mm is 2.5%, 7-12 mm is 14.5%, 13-24 mm is 18.4%, and greater than 25 mm is 50%.

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at this alone, if the diameter of the cerebral aneurysm is greater than 7 mm or the aneurysm is located in the back of the brain, it is advantageous to remove the risk of rupture with embolization or craniotomy.

But it's not that simple.

This is because the probability of rupture varies greatly depending on the individual's health conditions, such as the family history of the patient with cerebral hemorrhage, high blood pressure, and obesity.

For this reason, treatment guidelines for unruptured cerebral aneurysms are difficult to describe specifically and clearly, and differ from country to country.

The trend in Korea is to observe the course of cerebral aneurysms of 5 mm or less located in the anterior part of the brain, to the posterior part, to have a ruptured cerebral aneurysm in the past, to have a family member with a ruptured cerebral aneurysm, or to have multiple cerebral aneurysms with high blood pressure. If the aneurysm is present or the shape of the aneurysm is unusual, preventive surgery or procedure is recommended.

The reason why it is expressed as a tendency is that there is no specific and clear guideline in Korea.


Different hospitals may have different judgments?

A man in his 40s chose a cerebrovascular MRI at a health checkup hospital, and a cerebral aneurysm with a diameter of 2.5 mm was found, and he was recommended for neurosurgery at a university hospital.

At the university hospital, an additional cerebrovascular CT scan was performed using a contrast medium, and the result was that there was no cerebral aneurysm.

It's easy to think that one of the two hospitals was misdiagnosed, but that might not be the case.

This is because even if there were no errors in both hospitals, the opposite result could come out.

The most accurate method for cerebral aneurysm is digital subtraction angiography (DSA).

DSA, which involves pushing a long wire directly into the cerebral blood vessel and injecting a contrast agent, is the most accurate method for examining cerebral aneurysms, but the problem is that serious neurological complications can occur in about 2%.

In order to avoid complications of the examination, examination methods in which contrast medium is injected into the blood vessels of the arm and CT is taken (CT angiography, CTA) or MRI is detected without contrast medium (MR angiography, MRA) are widely used.



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