Treat or watch and wait?

So I have met with a second surgeon here in Seattle who is supposed to be great, Dr McDougall (used to be at Hopkins), recommended by Dr. Malek at Tufts (He heads his dept there and friend who knows him asked who to see in Seattle). So my aneurysm is right in the size range where some docs would say operate, some would say wait and watch and both docs I have seen said it’s my call because neither choice is clearly the best. Both docs would treat mine with flow diversion coupled with coiling if I decide to treat it. It’s on the ICA behind my right eye, 8mm, and I have no other risk factors for an aneurysm. A bit smaller and watch and wait would be the choice, a bit bigger and operate would be the choice. Ugh. How have others possibly made that decision? Oh, and I am an otherwise healthy 56 year old.

@sbseattle we are so glad you’ve posted, thank you! I moved your post from the BAF where announcements on virtual support groups are made to General so members will hopefully see it.

I didn’t know anything about cerebral aneurysms until I ruptured at age 53 and it’s been a lot of learning and finding this support group which has helped enormously. I’m glad you were able to find someone who knew about Dr. McDougal. My aneurysm was 5 mm in the LICA bifurcation but it is also a multilobed with over two dozen daughter sacs. So although the size was small, it was the type that would’ve been in the we need to fix it category. I also had an extremely stressful job or so I’ve been told and habits that weren’t the best, no drugs are overuse of alcohol. Had some health issues that wouldn’t have effected the aneurysm per the literature I’ve read. I have no family history but have had a good amount of knocks on the noggin, some more serious than others.

I believe one of the things that has helped others was an angiogram to allow the surgeon to see the thickness of the aneurysm’s wall. Have you had that or was it suggested?

It’s a really difficult choice you’re facing and I imagine other members will have their beliefs. There are two large studies that were done several years ago, one on ruptured aneurysms and one on unruptured aneurysms. They contradict each other, unfortunately. We have to trust in our surgeon’s experience and their continued learning as medical science is ever changing.

Some folks don’t like the what if it ruptures and will choose to have it fixed. There are real possibilities of things going awry, anesthesia being at the top of the list. I’ve had a lot of procedures since I ruptured and the anesthesia takes longer and longer to get over even though my surgeon directs the Nurse Anesthetist to use the least amount possible. There’s a speech the surgeon and then the anesthesiologist will give outlying all the many risks, starting from stroke to death and lots of things in between. I don’t trust an anesthesiologist who blows off the risks. Then there’s the contrast dye, I’m one of those who have an allergy to it and each time reactions were worse than the last, my last angiogram this past June resulted in severe anaphylaxis but I was able to get “Dr. Quintero Wolfe, we have a problem” out right before I couldn’t speak due to the swelling. I cannot have contrast dye any longer unless it’s to save my life. And then there’s the catheter used during the angiogram which has its on risks. My arteries are tortuous but I’m fortunate that Dr. Quintero Wolfe is also an expert in AVMs so squiggly is right up her alley. Have you had a heart to heart talk with Dr. McDougall on all the risks?

Would I have preferred not to rupture? Absolutely, it’s been one of the most impactful life changes I’ve experienced. But since I have never liked hospitals, I may have chosen not to have it fixed, unless I had a family history. I realize this isn’t helping. Perhaps making a list with pros and cons will help, talk to the people you love and ask them to help with the list. Maybe one question you can ask yourself is can you live with an aneurysm and be on the watch and wait list? Some members can’t tolerate that stressor. Another might be how well do you handle stress? There may be diet and exercise changes to your life if the doctor has made those suggestions and you may ask yourself can you honestly change your lifestyle to what has been suggested.

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