I was diagnosed with several brain aneurysms: Are they all treated the same?
With more than one brain aneurysm, each lesion is evaluated separately based on its size, shape, and location. Learn how the plan is organized and what to ask.
By Dr. Martin Roberto Casas MartínezOct 1, 20266 min read
In this article
- Why might each aneurysm need its own assessment?
- What is the “inventory” of lesions, and what does it include?
- What does prioritizing mean when there is more than one aneurysm?
- Are the management options the same for each lesion?
- How is follow-up organized for each aneurysm?
- Frequently asked questions
- What should I ask the specialist about each aneurysm?
- References
Summary: Not necessarily. When an imaging study shows multiple brain aneurysms, each lesion is assessed separately based on its size, shape, location, and relationship to symptoms, and the plan may differ for each one: some may be monitored with imaging, while others may be candidates for treatment. If you experience a sudden, extremely severe headache or another sudden neurological symptom, call 911.
Receiving a report that describes more than one aneurysm raises an immediate question: if they found several brain aneurysms, will they all be treated the same way? This article explains why each lesion is assessed individually, how that information is organized, and what may be helpful to ask; the care team determines the priority and approach based on each case.
Why might each aneurysm need its own assessment?
Because a brain aneurysm—an abnormal widening in the wall of an artery in the brain—is assessed based on its own characteristics, and two aneurysms in the same person may be in different arteries, have different sizes, and have shapes that affect the clinical assessment.
Mayo Clinic notes that before recommending a treatment plan, the care team considers the aneurysm’s size, location, and overall appearance, as well as the person’s age, overall health, and family history.
What is the “inventory” of lesions, and what does it include?
The inventory is the map the specialist creates for each aneurysm using the available information: location, size, shape, status (ruptured or unruptured), and associated symptoms. This map, together with the medical history, is the basis for organizing the plan.
- •Location: which artery and segment each lesion is in; some areas are more accessible than others for different approaches.
- •Size: the maximum diameter, measured in millimeters on the imaging study.
- •Shape: saccular or “berry” (a rounded sac, the most common type), fusiform (the entire circumference of the artery is dilated), or irregular, such as with a small additional bulge in its wall (a daughter sac).
- •Status and symptoms: whether any lesion has ruptured and whether any is pressing on nerves or nearby structures. An unruptured aneurysm can also cause symptoms.
What does prioritizing mean when there is more than one aneurysm?
Prioritizing means the care team identifies which lesion or lesions need attention sooner and which can be followed with regular imaging under active monitoring. It does not mean ignoring the rest, nor does it imply a fixed order that applies to every patient.
According to Mayo Clinic, for unruptured aneurysms, the care team weighs whether the risk of not treating the aneurysm outweighs the risk of the procedure, and that balance may differ for each lesion. Factors that may influence the decision, none of which is a rule on its own, include symptoms attributed to a specific lesion, an irregular shape, and location.
The specialist weighs these factors together, provides information, and makes a recommendation; you take part in the decision.
Are the management options the same for each lesion?
No. Three general approaches may be considered independently for each aneurysm: imaging surveillance, surgical clipping, or endovascular treatment. Whether a lesion is a candidate for one approach or another depends on its characteristics and the full clinical context.
- •Imaging surveillance: regular follow-up with CT angiography or MR angiography (studies that show the arteries without a catheter) to detect changes in size or shape.
- •Surgical clipping: the neurosurgeon reaches the aneurysm through an opening in the skull and places a small metal clip at its base to exclude it from circulation.
- •Endovascular treatment: a catheter is inserted through an artery in the groin or wrist and guided to the aneurysm; according to Mayo Clinic, it may be treated with coils, coils supported by a stent, or a flow diverter (a fine-mesh stent that redirects blood flow).
Each option has benefits, limitations, and risks that the specialist should explain for each lesion.
How is follow-up organized for each aneurysm?
Follow-up is planned lesion by lesion: for those being monitored, the care team determines which study to use and when the next check will take place; for those treated, which imaging studies will confirm the result; in both cases, the team agrees with you on which symptoms to report right away.
It is helpful to record each follow-up visit with its date and imaging study so you know which aneurysm was reviewed and which one is next. If new symptoms appear—double vision, a drooping eyelid, pain behind the eye, or a different kind of headache—do not wait for your follow-up visit: tell your care team, and call 911 for sudden symptoms.
Frequently asked questions
Does having several aneurysms mean the risk of rupture is added together?
There is no general rule or simple way to add the risks together. The specialist assesses each aneurysm based on its size, location, and shape, along with personal factors such as age, blood pressure, smoking, and family history. Ask how they estimate your risk.
Can two aneurysms be treated in the same procedure?
It depends on the location of the lesions, the type of treatment, and the person’s health. In some cases, the care team may propose this; in others, procedures are scheduled at different times. It is a good idea to ask directly.
What should I do if the report does not describe each aneurysm separately?
Bring the complete imaging studies, not just the report, so the specialist can review them. If they are not enough to characterize each lesion, the specialist may request additional studies, such as CT angiography, MR angiography, or catheter angiography, before determining the plan.
What should I ask the specialist about each aneurysm?
If you have a sudden, extremely severe headache, sudden double vision, weakness on one side of the body, difficulty speaking, or loss of consciousness, call 911 first. These questions may be helpful at your appointment:
- •How many aneurysms were identified, and what are the size, location, and shape of each one?
- •For each lesion, what is the current recommendation—monitoring, intervention, or something else—and why?
- •If any are being monitored, what test will be used, when is the next follow-up, and what symptoms should I report right away?
For non-urgent questions or to request an individual assessment, you can contact the office.
Informational notice: This content is for informational purposes and does not replace a medical consultation or constitute a diagnosis.
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