After an MRI/MRA at the suggestion of my ENT (pulsatile tinnitus) they found an unruptured aneurysm. The Cleveland Clinic neuroradiologist advised right ICA 5-6 mm berry, cavernous segment that is extradural. The radiologist that interpreted the imaging suggested intradural. He advised no worries at this time his research yielded no case history of ruptures of extradural aneurysm and said if it did rupture it would not be life threatening and advised imaging in 12 months. His opinion treatment more risks than observation. I am very healthy and 51. I sent my imaging to Johns Hopkins and Neurosurgeon advised angiogram followed with pipeline stent. He thinks intradural and called it a clinoidal aneurysm. Stated not much risk with pipeline stent 1 to 2% as opposed to 2% per year of my aneurysm rupturing. I have a future consultation with Beth Israel Hospital as soon as I receive CD of image and have spoken to UPMC in PA as well regarding another opinion. Very anxious and frustrated with two different courses of treatment. Want to obtain an angiogram but want to feel comfortable with the best hospital and dr. (high volume, high success rate) and not sure which or who that is at this point. Any comments or suggestions would be greatly appreciated.
Did you have symptons? Did your neurosurgeon give you options, i.e. clipping, coil/stent or observation. How is rehab for the coil/stent treatment. What issues have you experienced? Thanks.
Christa said:
I also had a unruptured anni right behind my left eye. I opted for the platinum coil with the pipeline stent.
My proceedure was just recent and I am trying to get on with my job and my homelife.
As hard it may seem, you just have to make the decision that is right for you.
Sinus infections for the last year and the last one in March of this year all symptoms were gone except for heartbeat in my ear. He said I had pulsatile tinnitus and suggested imaging to see if any issues with blood vessels and there was the aneurysm. Still have heartbeat in my ear, although the neuroradiologist doesn't feel it's related at all to aneurysm.
Kitty...you were blessed with/by your ENT specialist...
Our brainstem has (almost) all the of the 12 cranial nerves on each side (L/R)...
You may want to ask your neuro-docs which CNs may relate to your sensation/feeling/hearing...
The vestibulocochlear is the cranial nerve (CN) VIII... you may also want to research that to add to your questions to help you make your right decision for you.
You may also want to search for the: internal carotid artery anatomy and physiology to better understand the area of the segments...
We have no expertise...tho it may bring you to more questions to better understand what to ask for your decision process...
You were so blessed by your ENT to question potential blood vessel issues... send him/her the highest compliments imaginable...across the country...
P.S.: the other two (L/R) CNs, the CN 1 - olfactory nerve is in the medial temporal lobe area; and the CN II - optic is to our retina...
I had put the "Visual Pathway" under the category of 'Resources'...and, have not gotten to more CNs yet...
kitty said:
Sinus infections for the last year and the last one in March of this year all symptoms were gone except for heartbeat in my ear. He said I had pulsatile tinnitus and suggested imaging to see if any issues with blood vessels and there was the aneurysm. Still have heartbeat in my ear, although the neuroradiologist doesn't feel it's related at all to aneurysm.
Yes very glad my ENT suggested the MRI. Thank you very much for the info I will research.
patioplans said:
Kitty...you were blessed with/by your ENT specialist...
Our brainstem has (almost) all the of the 12 cranial nerves on each side (L/R)...
You may want to ask your neuro-docs which CNs may relate to your sensation/feeling/hearing...
The vestibulocochlear is the cranial nerve (CN) VIII... you may also want to research that to add to your questions to help you make your right decision for you.
You may also want to search for the: internal carotid artery anatomy and physiology to better understand the area of the segments...
We have no expertise...tho it may bring you to more questions to better understand what to ask for your decision process...
You were so blessed by your ENT to question potential blood vessel issues... send him/her the highest compliments imaginable...across the country...
P.S.: the other two (L/R) CNs, the CN 1 - olfactory nerve is in the medial temporal lobe area; and the CN II - optic is to our retina...
I had put the "Visual Pathway" under the category of 'Resources'...and, have not gotten to more CNs yet...
kitty said:
Sinus infections for the last year and the last one in March of this year all symptoms were gone except for heartbeat in my ear. He said I had pulsatile tinnitus and suggested imaging to see if any issues with blood vessels and there was the aneurysm. Still have heartbeat in my ear, although the neuroradiologist doesn't feel it's related at all to aneurysm.
Kitty, someone posted a link to US News that rated hospitals for neurosurgery. Sorry I can’t find it but do a quick search and it should come up. Remember you will have follow ups, each year or every six months, so make sure you take that it account. And there maybe a need to meet them for symptoms in between the scheduled appointments.
It’s not uncommon for Dr.s to disagree. Different specialists specialize in different treatment options, so they’re probably going to go with what they do best.
Research the BAF on when to have surgery and Unruptured aneurysms. If there’s not enough information on the BAF, look at the American Stroke Association, or the International Study of Unruptured Intracranial Aneurysms or NIH.
In the meantime breathe, do your research and take in a lot of questions when you visit the doctors.
Mine was listed as 47 there was a big tie. It looks like most of the higher rated hospitals are in more populated areas which makes sense given aneurysms aren’t all that common. And it seems like part of the ratings are on nurses, and Medicare. I wonder if the ratings would be different with private pay insurance?
Another thing you could do is ask members who they would recommend in your area.
The neuroradiologist explained extradural aneurysm have almost no likelihood of rupture since outside the brain and if a rupture would occur it would be not life threatening. He explained if he thought my aneurysm was intradural (inside brain) he would have already treated. The Johns Hopkins neurosurgeon believes its intradural and suggests surgery. Reason I am seeking another opinions. One dr. says no worries risks of treatment are worse than observation and another dr. says surgery risk less than observation. I have read the study you referred to along with many other articles and bottom line if mine is intradural I want to have it treated if another dr. feels its extradural and not much risk of rupture I may wait. Thanks for all the info.
Yes I have reviewed the rankings. I am in Cleveland and the dr. who recommends observation and an extradural location of my aneurysm is at the Cleveland Clinic which is rated highly. But then the Hopkins surgeon said surgery. I thought perhaps he would say first do angiogram and then decided treatmentm but he said angiogam and then pipeline stent. Yes if anyone has any recommendations on surgeons please pass on. Thanks. Did you have coiling? How long ago?
Oh Kitty, maybe one of them can do this - High-resolution T2-weighted 3-D FSE MR imaging is capable of confirming whether a cerebral aneurysm at the paraclinoid region is intradural or extradural, because of the MR imaging’s high spatial resolution. The images may help in identifying patients with intradural aneurysms who require treatment, and they also can provide valuable information in the treatment plan for paraclinoid aneurysms.
The Clinic dr. suggested this in 1 year. I did read this article(I have a stack of research about 2" thick) and now that you have brought it up (thank you) I think I will ask and push the Clinic dr. to provide this MR now. Thank you very much.
No problem hope it helps! I did have coiling, one for a rupture in which I won my first helicopter ride, and “spa treatment” in ICU for 28 days. I vasospasmed for 26 days. Then I had another aneurysm develop six months later and that was coiled - one night stay and back home. So no chance to research, hadn’t even heard of aneurysms. I have problems with words (aphasia) not as bad now as it was the first year, and I have Foreign Accent Syndrome as a result. But I owe my life to the wonderful nurses, the many doctors, a med student, and especially Dr Stacey Quintero-Wolfe, along with Trouble who I teased Dr. Q-W as the actual being that saved me lol! You can always read people’s stories by going to their page, scroll down to their profile information. If the member gave enough, you’ll get a clear idea of what they or a loved one went through or are going through.
Thank you again for your suggestions and sharing your story. I guess I am lucky (and very grateful) to be able to research and receive information from you along with others.
I also had an unruptured annie that was found, in part, because of my pulsative tinnitus, which disappeared after surgery! I loved my neurosurgeon I saw, so I didn't feel the need for a 2nd opinion (who moved 2 years ago to PA to Wilkes Barre). I don't care for my new one too much, but since I need to see him annually, I will unless I end up needing more surgery (most people don't need to see their surgeons every year - I do and will the rest of my life because of the location of mine on the basilar tip).
I think you need to wait to pick a doctor before having an angiogram. Dr. Schirmer (the one who did my surgery) took into consideration my age (I was 56) and health when he recommended I get coiling and a stent (my annie was small, but he felt it was dangerous) - clipping could have left me with severe brain damage. Even if the annie ruptured and it may not kill you, a bleed can cause a lot of damage. Another thing you might consider is proximity - you are talking about seeking opinions in different states, which is great that you can. At least in my case, it turned out that I will need annual MRAs and visits to a neurosurgeon, so I am glad that at least for the time being he is close by. A good friend of mine went to Boston to fix her AVM, which was diagnosed after my annie was fixed, and she had to wait awhile for the surgery (they do have some good ones there, though).