The brain is a complex organ, but also a very fragile one, enclosed in a rigid box that protects it. But there are many diseases that can damage it: trauma, tumors, strokes, etc. Stroke is a vascular event that occurs suddenly, in full health, because a brain vessel is thrombosed or because a hemorrhage invades the brain.
The deficit
As a neurosurgeon I have been dealing for years with a particular hemorrhagic stroke due to the rupture of an intracranial aneurysm, a circumscribed dilation, like a small sac, of the wall of an artery, one of those vessels that carry blood to the brain.
The continuous pulsation of the blood can weaken it to the point of causing a rupture and, with it, a hemorrhage: the consequences can be dramatic, with a mortality rate reaching 50% and a third of survivors who remain with severe neurological deficits.
It is estimated that 5% of the population in Italy has an intracranial aneurysm and that, every year, there is one case of haemorrhage for every 10,000 people.
To understand the extent of the problem, let’s imagine a football stadium with 100,000 fans; 5000 of them will be carriers of an intact aneurysm and within a year 10 of them will have haemorrhage due to rupture of the aneurysm and 5 will die. Fortunately, not all aneurysms rupture.
But there is a problem: what to do if, with a CT or MRI performed for other causes, you find a brain aneurysm that has never ruptured?
Research
We do not have certain elements that tell us if one day that aneurysm will rupture and consequently we do not know whether to make the patient run the risk of treatment, whether endovascular or surgical. Who will be able to give us an answer? Research only.
For this, an Italian multicenter prospective study was carried out, with the extraordinary participation of all neurosurgery in Italy.
The results obtained on a thousand people with intact aneurysms treated by endovascular or surgical route were analyzed. These were compared with those of other multicentre international studies (published in the Lancet and New England Journal of Medicine) which, to obtain information on the risks associated with having an intact intracranial aneurysm, had analyzed its evolution without practicing any treatment.
The results of the Italian study, published in the Journal of Neurosurgical Science, tell us that treating unruptured intracranial aneurysms, as done in Italy, significantly improves the prognosis of affected patients. All this makes it clear that one should not be afraid to face the treatment of an aneurysm discovered by chance, because this, as the research results tell us, is the only way to prevent the damage of this serious disease.
* Professor of Neurosurgery Humanitas, Milan,
President of the AtenaOnlus Foundation, Rome
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