Understanding Flow Diversion (Flow Diverter) for Brain Aneurysms: Procedure and Benefits

A brain aneurysm is a condition in which a bulge develops in a weakened area of an artery in or around the brain. The constant pressure of blood flow can push the weakened section of the blood vessel outward, forming a balloon-like bulge. As blood continues to flow into the aneurysm, it may become larger and the blood vessel wall may become thinner, increasing the risk of rupture.

Flow diversion is one of the minimally invasive methods that can be used to treat brain aneurysms. The procedure involves placing a special device called a neurovascular stent inside the main blood vessel where the aneurysm has formed. The stent helps redirect blood flow so that it does not flow directly into the aneurysm sac.

Over time, the amount of blood flowing into the aneurysm may decrease and eventually stop. This allows the body’s natural healing process to work together with the flow diversion device to help repair the blood vessel and cause the aneurysm to shrink.

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How is a flow diversion procedure performed?

Flow diversion is a minimally invasive procedure that does not require a craniotomy or opening of the skull. The procedure generally involves the following steps:

The patient is given anesthesia before the procedure begins.
The doctor inserts a small tube called a catheter through a blood vessel in the leg and carefully guides it toward the blood vessels in the brain.
A flow diverter stent of the appropriate size is placed at the tip of the catheter.
Once the catheter reaches the location of the aneurysm, the doctor places the stent inside the blood vessel without inserting the device into the aneurysm sac.
The stent is then deployed to redirect blood flow away from the aneurysm.
Once the stent is in the correct position, the catheter is removed and the doctor monitors blood flow to make sure the stent is functioning properly.
After the procedure is completed, the patient is awakened and transferred to the recovery room.
Over the following 12–24 months, the medical team monitors the healing process of the blood vessel. During this period, new cells may grow around the stent and help repair the area of the blood vessel where the aneurysm developed.

Benefits of flow diversion for brain aneurysms

Flow diversion can be one of the treatment options for an unruptured brain aneurysm. Some of the potential benefits of this procedure include:

Minimally invasive: The stent is placed inside the blood vessel without directly entering the aneurysm sac, which may reduce risks associated with directly treating the aneurysm.
Shorter recovery: Because it does not require open surgery, some patients may be able to go home the following day and return to their activities relatively quickly, depending on their individual condition.
May help reduce the risk of aneurysm recurrence: Flow diversion can gradually help close off the aneurysm, potentially reducing the chance of the aneurysm developing again in the treated blood vessel.
Lower radiation exposure: The procedure may involve lower radiation exposure compared with some other endovascular techniques.

Is a ruptured brain aneurysm dangerous?

A ruptured brain aneurysm is a serious condition because it can cause bleeding around the brain tissue. The bleeding can increase pressure inside the skull and cause brain swelling. This condition typically causes a sudden and severe headache known as a thunderclap headache. A ruptured brain aneurysm can also lead to serious complications, including:

Subarachnoid hemorrhage: Bleeding into the space between the brain and the thin tissues that protect it.
Hemorrhagic stroke: Bleeding inside or around the brain.
Vasospasm: Narrowing of the blood vessels that can reduce the flow of oxygen to the brain.
Hydrocephalus: A buildup of cerebrospinal fluid or blood that increases pressure inside the skull.
Seizures: Uncontrolled electrical activity in the brain that can worsen brain damage caused by a ruptured aneurysm.
Coma: A prolonged state of unconsciousness that may last for several days to weeks.
Death: A ruptured brain aneurysm can result in death in approximately 50% of cases.

Be aware of brain aneurysm symptoms, whether ruptured or unruptured

Brain aneurysm symptoms can vary depending on whether the aneurysm is still intact or has ruptured. Most unruptured aneurysms do not cause symptoms. However, larger aneurysms can put pressure on nearby nerves or brain tissue and cause various symptoms.

Symptoms of an unruptured brain aneurysm:

Headache.
Vision problems.
Enlarged pupil.
Numbness or tingling in the head or face.
Pain above or behind the eye.
Seizures.

A ruptured brain aneurysm, meanwhile, can cause bleeding and usually produces more severe symptoms, such as:

Symptoms of a ruptured brain aneurysm:

A sudden, extremely severe headache (thunderclap headache), often described as the worst headache a person has ever experienced.
Nausea and vomiting.
Stiff neck.
Blurred or double vision.
Sensitivity to light.
Seizures.
Drooping eyelid and dilated pupil.
Pain above or behind the eye.
Confusion.
Weakness or numbness.
Loss of consciousness.

If you experience these symptoms, especially a sudden and severe headache, seek medical attention immediately to receive appropriate treatment.

Brain aneurysm treatment at Mandaya Royal Hospital Puri by Dr. Joy

Dr. dr. Mardjono Tjahjadi, Sp.BS, Subsp. N-Vas, F. N-Onk, PhD, FICS, IFAANS

Dr. dr. Mardjono Joy Tjahjadi, Sp.BS, Subsp. N-Vas, F. N-Onk, PhD, FICS, IFAANS or Dr. Joy, as he is commonly known, is a neurosurgeon specializing in neurovascular conditions or diseases affecting the blood vessels of the brain. His interest in this field is supported by his education and training at various neurosurgical centers, including a cerebrovascular clinical fellowship at Helsinki University Central Hospital, Finland, as well as doctoral (PhD) studies at the University of Helsinki. His research in Finland also focused specifically on brain aneurysms, including surgical approaches to aneurysms in the vertebrobasilar blood vessels.

Finland has a long history of research and treatment related to brain aneurysms. The country is known to have a relatively high incidence of subarachnoid hemorrhage caused by ruptured aneurysms compared with many other countries, making cerebrovascular disease an important area of research there. After completing his education and research in Finland, Dr. Joy also pursued training in neuro-endovascular or neurointerventional procedures at Seoul National University Bundang Hospital in South Korea.

In addition to treating patients with brain aneurysms and other cerebrovascular conditions, Dr. Joy is also active in academia. He is the author of “Memahami Aneurisma Otak” (Understanding Brain Aneurysms), which has been published in two editions and discusses brain aneurysms, from understanding the condition and diagnosis to available treatment options.

At Mandaya Royal Hospital Puri, Dr. Joy treats various conditions affecting the brain and its blood vessels, including brain aneurysms, narrowing of the brain’s blood vessels, brain hemorrhage, and brain tumors and cancer. His expertise also includes several approaches to aneurysm treatment, such as clipping, endovascular coiling, and flow diversion.

Dr. Joy is available at Mandaya Royal Hospital Puri on:

Monday: By appointment
Tuesday: 14:00–17:00 WIB
Wednesday: By appointment
Thursday: 08:00–12:00 WIB
Friday: 14:00–17:00 WIB
Saturday: 08:00–12:00 WIB

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*The information provided on this page is intended for educational purposes and general information only and does not represent the full range of medical services that may be provided by each doctor. To determine the appropriate treatment for your condition, you are advised to consult directly with the relevant doctor.

If you have any questions, suggestions, or need further information, please contact our call center at 0811-1900-2000.