A brain aneurysm is a weak, bulging area in the wall of an artery in the brain. Many aneurysms never rupture and some need only monitoring, but a ruptured aneurysm causes bleeding around the brain and is a life-threatening emergency that needs immediate hospital care.
Treatment options include observation with scans, surgical clipping and endovascular coiling. For patients in Lahore, this page explains how these options compare, how the decision is made and what recovery involves.
Most brain aneurysms are "berry" (saccular) aneurysms that form at branching points of arteries at the base of the brain. They range from a few millimetres to several centimetres. An aneurysm may be:
Call an ambulance or go straight to the nearest emergency department. Do not wait to see if it improves. A smaller "warning" bleed can sometimes occur days before a major one, so any sudden severe headache should be checked urgently.
Usually silent. A larger aneurysm may press on nearby nerves, causing a drooping eyelid, double vision, a dilated pupil or pain around one eye. New nerve symptoms like these need prompt assessment.
Factors linked with aneurysms and rupture include high blood pressure, smoking, a family history in two or more close relatives, polycystic kidney disease, some connective tissue disorders, and female sex. Size, irregular shape and certain locations increase the risk of rupture.
Many small unruptured aneurysms are best monitored with periodic MRA or CTA. Controlling blood pressure and stopping smoking are important for everyone with an aneurysm. Treatment is not automatic; the risk of the aneurysm bleeding is weighed against the risk of treatment.
Clipping is an open operation through a craniotomy. Under the microscope, the neurosurgeon places a small titanium clip across the neck of the aneurysm, sealing it off from the circulation while keeping the parent artery open. Clipping is durable and may be preferred for some aneurysm shapes and locations, particularly wide-necked aneurysms or those with a large blood clot that also needs removal.
Coiling is performed by an interventional neuroradiologist. A fine catheter is passed from the groin or wrist to the aneurysm, and soft platinum coils are packed inside it to stop blood entering. Stents or flow-diverting devices may also be used. Coiling avoids opening the skull and may suit many aneurysms, though some need retreatment later and follow-up angiograms.
Neither is right for every patient. The best option is decided case by case, considering the aneurysm's size, shape, neck width and location, whether it has ruptured, the patient's age and health, and the available expertise. Ideally the neurosurgeon and interventional neuroradiologist review the case together. You can read more about this team approach on our vascular neurosurgery page.
A ruptured aneurysm almost always needs to be secured quickly, usually within the first day or two, to prevent re-bleeding. For unruptured aneurysms, treatment is more likely to be advised for larger or irregular aneurysms, those causing nerve symptoms, those that grow on follow-up, and in younger patients or those with a family history of rupture.
After a ruptured aneurysm, recovery is driven largely by the bleed itself. Patients usually stay in intensive care and hospital for around two weeks or more, because of risks such as vasospasm (narrowing of arteries causing delayed stroke) and hydrocephalus. Recovery can take months, and some people need rehabilitation. Bleeding around the brain is covered further on our brain haemorrhage page.
After planned treatment of an unruptured aneurysm, hospital stays are typically a few days for clipping and often shorter for coiling. Many patients return to normal activities within a few weeks after coiling and over about four to eight weeks after clipping, depending on their job and recovery. Follow-up imaging is usually arranged.
Both clipping and coiling carry risks, including stroke, bleeding during the procedure, seizures, infection (mainly after surgery) and anaesthetic risks. Coiled aneurysms may occasionally reopen and need further treatment. Your specific risks are explained before any decision.
If you have been told you have an aneurysm, a neurosurgeon can review your scans and explain your options. Book an appointment with Dr. Khawar Anwar for a non-emergency review.
Most small aneurysms never rupture. The risk depends on size, shape, location and personal factors. Monitoring and blood pressure control are often recommended.
Coiling is carried out by interventional neuroradiologists. The neurosurgical assessment helps decide whether clipping, coiling or observation is most suitable, and appropriate referral is arranged.
Most people can fly and do moderate exercise. Very heavy straining and uncontrolled blood pressure should be avoided. Ask for advice specific to your aneurysm.
Screening is usually considered when two or more first-degree relatives have had aneurysms, or with certain conditions such as polycystic kidney disease.
Yes, both stay in place permanently. Clips rarely need further treatment; coiled aneurysms are followed up because a small number reopen.
Dr. Khawar Anwar is a Consultant Neurosurgeon & Spine Surgeon at PINS / Lahore General Hospital, Lahore, with over 10 years of experience in brain and spine surgery. He sees patients in Lahore and Gujranwala and focuses on minimally invasive and endoscopic techniques where they are suitable for the patient.
See the full list on the certifications page or read more about Dr. Khawar Anwar.
See all clinics, maps and timings on the locations page.
To book, call or WhatsApp 0333-7574732 and tell us which clinic and day suits you. Please bring your MRI or CT scan (films and CD), reports and a list of your current medicines to the consultation. For sudden weakness, loss of bladder or bowel control, a sudden severe headache or a head or spine injury, go to the nearest emergency department first.