Dr. Benjamin Fox shares his insight on aneurysms including what they are, where they come from, and how to treat them.
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Aneurysms
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Learn more about Benjamin Fox, MD
Benjamin D. Fox, MD
Dr. Benjamin Fox is a board certified neurosurgeon with a subspecialty in brain aneurysms. He earned his Doctor of Medicine degree from Baylor College of Medicine in Houston, Texas. Dr. Fox continued his medical education by completing a general surgery internship and neurological surgery residency at Baylor College of Medicine. He then completed endovascular neurosurgery/interventional neuroradiology and cerebrovascular neurosurgery fellowships from the University of Tennessee Health Science Center in Memphis, Tennessee. An accomplished author, Dr. Fox has contributed numerous articles to peer-reviewed publications such as the Journal of Neurosurgery and Neurosurgery. Dr. Fox is one of the few specialists trained to treat brain aneurysms both surgically and endovascularly in the geographical region. This allows him to evaluate and approach a brain aneurysm from both vantage points and to be able to offer patients options when it comes to treatment. In addition to treating brain aneurysm, Dr. Fox practices general neurosurgery including brain and spine surgery and is accepting new patients. Dr. Fox is affiliated with Morton Plant Hospital.Learn more about Benjamin Fox, MD
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Aneurysms
Introduction: Here's another edition of the BayCare Health System’s podcast series BayCare HealthChat with Melanie Cole.
Melanie Cole: Welcome to BayCare HealthChat. I'm Melanie Cole, and today we're discussing aneurysms. Joining me is Dr. Benjamin Fox. He's a Neurosurgeon and Neuro-Interventionalist at BayCare. Dr. Fox. I'm so glad to have you join us today. We've heard this term aneurysm, tell us what that is. Where does it occur? How do they develop or form? What is an aneurysm?
Dr. Fox: Brain aneurysms basically come from the arteries in the brain. And in general, they're thought to come from a weak spot within the blood vessel. And what happens is a blood vessel at that spot, then kind of balloons out and becomes something that has the potential to rupture.
Host: Then what's the difference between an aneurysm and a stroke?
Dr. Fox: An aneurysm is basically the anatomical or the structural thing that can cause the rupture, a ruptured aneurysm is a type of stroke. The different types of strokes are strokes that come from hemorrhages, like ruptured aneurysms. They can also come from other blood vessels that just rupture and don't have an aneurysm in them. And then you have the other classification of strokes, which are, quote unquote, the dry strokes, which are embolic or ischemic strokes when a blood vessel is just plugged up.
Host: Thank you for clarifying that. I think that's a source of some confusion. Now tell us about risk factors. Who is at risk for an aneurysm? Are there certain people for whom this is a higher risk? Is there a genetic component in this? Tell us a little bit about risk.
Dr. Fox: So, the incidents of aneurysms, we think in the general population is about one to 5%. We know that aneurysms are seen more frequently in patients that have connective tissue disorders, such as Ehlers-Danlos, Marfan syndrome, patients that have polycystic kidney disease, fibromuscular dysplasia and some other conditions. We also know that they're seen more in patients that have modifiable behavioral risk factors, such as using nicotine, whether it's smoked, vaped, or other sources. Nicotine usage is associated with aneurysms. Cocaine, Amphetamine, Stimulants is also associated with aneurysm growth and formation. And in general, there is a genetic component to aneurysms. And in those families, usually you see two or three relatives that have aneurysms or ruptured aneurysms or strokes. And those patients, we would recommend screening their family members for aneurysms, but you would know that based on your family history.
Host: So, are these found incidentally, Dr. Fox, are there symptoms that would send somebody to see a neurologist or a neurosurgeon or their primary care provider? Many people get migraines, they get these intense headaches. Should they be concerned? Tell us a little bit about symptoms. And if there's a way to tell if someone has an aneurysm?
Dr. Fox: Most aneurysms are found incidentally or asymptomatically. They're found when people bump their head or in trauma, or for some other reason, get a cat scan or an MRI of their brain. And they're found incidentally. They can cause symptoms. It's rare for them to grow large enough to push on things to cause symptoms and the unruptured state of an aneurysm, but they can, and those can cause vision symptoms or compression of other parts of the brain. But the most common symptom that patients present with, with an aneurysm is an aneurysm rupture, which is a type of headache that has been described as the worst headache of your life or a Thunderclap type headache. It would not ever be confused with a migraine or a different type of headache in patients that have had headaches their whole lives. I've had patients that have had migraines and also had a ruptured aneurysm. And they've described the two as polar opposites in terms of their onset and severity. The difficulty is when patients that haven't had headaches start having headaches and things like that. So we know that many patients that have aneurysms never have headaches until, or if, the aneurysm ever ruptures. And we know many patients have headaches, we've searched and not found aneurysms in them. So there isn't a great correlation between unruptured aneurysms and headaches, but just in that ruptured state. So in general, I would recommend if someone is having nuance of headaches or changes in their headache pattern, that they discuss this with their doctor to see if they might need some imaging.
Host: So, if you determine that someone does have an aneurysm, an unruptured aneurysm, because I assume a ruptured one is an emergent situation that requires immediate care. Yes?
Dr. Fox: Correct. If you have a ruptured aneurysm, you need to get to the hospital immediately.
Host: So, if it's unruptured, then what? People must feel like a ticking time bomb. Tell us about treatment options if there are treatments available and when you decide to use them?
Dr. Fox: Believe it or not most unruptured aneurysms, we don't need to treat, but we can observe them. And we've learned over the decades that we've had data to follow, that smaller aneurysms and aneurysms in certain locations are quote unquote, low risk aneurysms. And they can be safely observed and watched. Other aneurysms that are larger, and in certain locations we would like to treat. And so there's multiple imaging modalities out there that we can use to look at aneurysms and follow them. There's a CT angiogram, there's an MR Angiogram, but the most specific and sensitive and accurate type or way we can look at these is using a more invasive catheter-based technique called a cerebral digital subtraction angiogram. And that helps give us the exact size, the exact location, and some of the characteristics. There are some characteristics of aneurysms that make them more high risk than other aneurysms as well, in addition to size and shape. And that degree of image quality will allow us to help make that decision. But yeah, when patients have unruptured aneurysms and we decide that it's a higher risk aneurysm and we decide to treat it, we have open surgical ways of treating it, as well as endovascular or through the groin, through the catheters, ways of treating these aneurysms.
Host: What's that like for a patient, first of all, tell us what it's like if you decide to do the watching and waiting and are there certain lifestyles that can minimize the risk of rupture? And if you do decide to do the procedure, what's that like for patients?
Dr. Fox: When we talk with our patients, after we have all the appropriate imaging, we counsel them on the risks of treatment, of the benefits of treatment, the alternatives of treatment, those sorts of facts and issues, and basically talk with them about, as you mentioned, there are ways to keep the risk of rupture down as much as they can, by changing some of the things in their lifestyle and behavior. Things like quitting smoking, getting nicotine out of their life, avoiding drugs, cocaine, amphetamine, keeping their blood pressure under control and living basically a healthy lifestyle. But apart from that, there isn't much more that a patient can do to try and alter the ability of these aneurysms to rupture or prevent it from rupturing. Many patients, once we explain these sorts of things to them and can share with them, the data that their aneurysm is very low risk of rupture and that we can monitor it on a yearly basis.
It gives them a lot of relief because some of them, and many of them are told they have a ticking time bomb in their head and not every aneurysm is a ticking time bomb. Many aneurysms are found late in life and have been there for a patient's entire life and they never ruptured. So, the patients that do have an aneurysm, that's a little higher risk and that we do need to treat. Obviously they're going to be a little more apprehensive and anxious, and we talk with them about the treatment modalities and help make a decision as to what is best for the aneurysm. And we can sometimes tailor them to patient preferences in terms of, if an aneurysm could go either way, open surgical or endovascular, for example, coiling, which would they prefer to do? Most patients end up going to the endovascular route because it's less invasive. And most of those patients spend one night in the hospital and go home the next day.
Host: If you do the procedure, are they now at risk for another aneurysm, Dr. Fox?
Dr. Fox: We know that the incidence of having another aneurysm, if you have one is between 20% and 30%. And we also know that there is a low likelihood that aneurysms can appear or grow over a five-year period. Although the incidence is fairly low. So, once we treat an aneurysm and it goes away, and those patients, we do check every five years to make sure they don't have a De Novo aneurysm. But most of the time, if we do a good thorough investigation and cerebral angiogram, we're able to find any other aneurysms that might be there and help talk with patients about whether or not they should be treated or not.
Host: Thank you so much, Dr. Fox, what interesting information. So, wrap it up. Do you have any final thoughts for listeners if they know someone with an aneurysm or they are someone who has been diagnosed themselves, what would you like them to know about aneurysms, treatment options and possibly preventing them in the first place?
Dr. Fox: I would say number one, if you have a headache that's worrisome or new or changing talk with your doctor so they can do the appropriate imaging modalities. I think another important issue is the fields have changed so much the surgical, as well as the endovascular fields have changed so much that there are individuals and specialists like me that are able to do both the surgical as well as the endovascular techniques to treat these aneurysms effectively. And it gives us a unique perspective as physicians to look at these aneurysms holistically and be able to offer these patients what's actually best for them, what's best for their aneurysm and personalize it a little bit as to what they would want to do, as opposed to someone that only does one side or the other. And they, unfortunately, sometimes they're talked into doing whatever that individual does, but I really think that seeing a specialist that is facile on both sides, it can be really beneficial to these patients and give them the angle from both a surgeon and an endovascular specialist at the same time.
Host: That's great information. Thank you so much, Dr. Fox for joining us today and really sharing your incredible expertise. What a great guest you are. To learn more about BayCare's Neuroscience services, please visit BayCareNeuro.org. And that wraps up this episode of BayCare HealthChat. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. I'm Melanie Cole.
Aneurysms
Introduction: Here's another edition of the BayCare Health System’s podcast series BayCare HealthChat with Melanie Cole.
Melanie Cole: Welcome to BayCare HealthChat. I'm Melanie Cole, and today we're discussing aneurysms. Joining me is Dr. Benjamin Fox. He's a Neurosurgeon and Neuro-Interventionalist at BayCare. Dr. Fox. I'm so glad to have you join us today. We've heard this term aneurysm, tell us what that is. Where does it occur? How do they develop or form? What is an aneurysm?
Dr. Fox: Brain aneurysms basically come from the arteries in the brain. And in general, they're thought to come from a weak spot within the blood vessel. And what happens is a blood vessel at that spot, then kind of balloons out and becomes something that has the potential to rupture.
Host: Then what's the difference between an aneurysm and a stroke?
Dr. Fox: An aneurysm is basically the anatomical or the structural thing that can cause the rupture, a ruptured aneurysm is a type of stroke. The different types of strokes are strokes that come from hemorrhages, like ruptured aneurysms. They can also come from other blood vessels that just rupture and don't have an aneurysm in them. And then you have the other classification of strokes, which are, quote unquote, the dry strokes, which are embolic or ischemic strokes when a blood vessel is just plugged up.
Host: Thank you for clarifying that. I think that's a source of some confusion. Now tell us about risk factors. Who is at risk for an aneurysm? Are there certain people for whom this is a higher risk? Is there a genetic component in this? Tell us a little bit about risk.
Dr. Fox: So, the incidents of aneurysms, we think in the general population is about one to 5%. We know that aneurysms are seen more frequently in patients that have connective tissue disorders, such as Ehlers-Danlos, Marfan syndrome, patients that have polycystic kidney disease, fibromuscular dysplasia and some other conditions. We also know that they're seen more in patients that have modifiable behavioral risk factors, such as using nicotine, whether it's smoked, vaped, or other sources. Nicotine usage is associated with aneurysms. Cocaine, Amphetamine, Stimulants is also associated with aneurysm growth and formation. And in general, there is a genetic component to aneurysms. And in those families, usually you see two or three relatives that have aneurysms or ruptured aneurysms or strokes. And those patients, we would recommend screening their family members for aneurysms, but you would know that based on your family history.
Host: So, are these found incidentally, Dr. Fox, are there symptoms that would send somebody to see a neurologist or a neurosurgeon or their primary care provider? Many people get migraines, they get these intense headaches. Should they be concerned? Tell us a little bit about symptoms. And if there's a way to tell if someone has an aneurysm?
Dr. Fox: Most aneurysms are found incidentally or asymptomatically. They're found when people bump their head or in trauma, or for some other reason, get a cat scan or an MRI of their brain. And they're found incidentally. They can cause symptoms. It's rare for them to grow large enough to push on things to cause symptoms and the unruptured state of an aneurysm, but they can, and those can cause vision symptoms or compression of other parts of the brain. But the most common symptom that patients present with, with an aneurysm is an aneurysm rupture, which is a type of headache that has been described as the worst headache of your life or a Thunderclap type headache. It would not ever be confused with a migraine or a different type of headache in patients that have had headaches their whole lives. I've had patients that have had migraines and also had a ruptured aneurysm. And they've described the two as polar opposites in terms of their onset and severity. The difficulty is when patients that haven't had headaches start having headaches and things like that. So we know that many patients that have aneurysms never have headaches until, or if, the aneurysm ever ruptures. And we know many patients have headaches, we've searched and not found aneurysms in them. So there isn't a great correlation between unruptured aneurysms and headaches, but just in that ruptured state. So in general, I would recommend if someone is having nuance of headaches or changes in their headache pattern, that they discuss this with their doctor to see if they might need some imaging.
Host: So, if you determine that someone does have an aneurysm, an unruptured aneurysm, because I assume a ruptured one is an emergent situation that requires immediate care. Yes?
Dr. Fox: Correct. If you have a ruptured aneurysm, you need to get to the hospital immediately.
Host: So, if it's unruptured, then what? People must feel like a ticking time bomb. Tell us about treatment options if there are treatments available and when you decide to use them?
Dr. Fox: Believe it or not most unruptured aneurysms, we don't need to treat, but we can observe them. And we've learned over the decades that we've had data to follow, that smaller aneurysms and aneurysms in certain locations are quote unquote, low risk aneurysms. And they can be safely observed and watched. Other aneurysms that are larger, and in certain locations we would like to treat. And so there's multiple imaging modalities out there that we can use to look at aneurysms and follow them. There's a CT angiogram, there's an MR Angiogram, but the most specific and sensitive and accurate type or way we can look at these is using a more invasive catheter-based technique called a cerebral digital subtraction angiogram. And that helps give us the exact size, the exact location, and some of the characteristics. There are some characteristics of aneurysms that make them more high risk than other aneurysms as well, in addition to size and shape. And that degree of image quality will allow us to help make that decision. But yeah, when patients have unruptured aneurysms and we decide that it's a higher risk aneurysm and we decide to treat it, we have open surgical ways of treating it, as well as endovascular or through the groin, through the catheters, ways of treating these aneurysms.
Host: What's that like for a patient, first of all, tell us what it's like if you decide to do the watching and waiting and are there certain lifestyles that can minimize the risk of rupture? And if you do decide to do the procedure, what's that like for patients?
Dr. Fox: When we talk with our patients, after we have all the appropriate imaging, we counsel them on the risks of treatment, of the benefits of treatment, the alternatives of treatment, those sorts of facts and issues, and basically talk with them about, as you mentioned, there are ways to keep the risk of rupture down as much as they can, by changing some of the things in their lifestyle and behavior. Things like quitting smoking, getting nicotine out of their life, avoiding drugs, cocaine, amphetamine, keeping their blood pressure under control and living basically a healthy lifestyle. But apart from that, there isn't much more that a patient can do to try and alter the ability of these aneurysms to rupture or prevent it from rupturing. Many patients, once we explain these sorts of things to them and can share with them, the data that their aneurysm is very low risk of rupture and that we can monitor it on a yearly basis.
It gives them a lot of relief because some of them, and many of them are told they have a ticking time bomb in their head and not every aneurysm is a ticking time bomb. Many aneurysms are found late in life and have been there for a patient's entire life and they never ruptured. So, the patients that do have an aneurysm, that's a little higher risk and that we do need to treat. Obviously they're going to be a little more apprehensive and anxious, and we talk with them about the treatment modalities and help make a decision as to what is best for the aneurysm. And we can sometimes tailor them to patient preferences in terms of, if an aneurysm could go either way, open surgical or endovascular, for example, coiling, which would they prefer to do? Most patients end up going to the endovascular route because it's less invasive. And most of those patients spend one night in the hospital and go home the next day.
Host: If you do the procedure, are they now at risk for another aneurysm, Dr. Fox?
Dr. Fox: We know that the incidence of having another aneurysm, if you have one is between 20% and 30%. And we also know that there is a low likelihood that aneurysms can appear or grow over a five-year period. Although the incidence is fairly low. So, once we treat an aneurysm and it goes away, and those patients, we do check every five years to make sure they don't have a De Novo aneurysm. But most of the time, if we do a good thorough investigation and cerebral angiogram, we're able to find any other aneurysms that might be there and help talk with patients about whether or not they should be treated or not.
Host: Thank you so much, Dr. Fox, what interesting information. So, wrap it up. Do you have any final thoughts for listeners if they know someone with an aneurysm or they are someone who has been diagnosed themselves, what would you like them to know about aneurysms, treatment options and possibly preventing them in the first place?
Dr. Fox: I would say number one, if you have a headache that's worrisome or new or changing talk with your doctor so they can do the appropriate imaging modalities. I think another important issue is the fields have changed so much the surgical, as well as the endovascular fields have changed so much that there are individuals and specialists like me that are able to do both the surgical as well as the endovascular techniques to treat these aneurysms effectively. And it gives us a unique perspective as physicians to look at these aneurysms holistically and be able to offer these patients what's actually best for them, what's best for their aneurysm and personalize it a little bit as to what they would want to do, as opposed to someone that only does one side or the other. And they, unfortunately, sometimes they're talked into doing whatever that individual does, but I really think that seeing a specialist that is facile on both sides, it can be really beneficial to these patients and give them the angle from both a surgeon and an endovascular specialist at the same time.
Host: That's great information. Thank you so much, Dr. Fox for joining us today and really sharing your incredible expertise. What a great guest you are. To learn more about BayCare's Neuroscience services, please visit BayCareNeuro.org. And that wraps up this episode of BayCare HealthChat. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. I'm Melanie Cole.