Can Brain Aneurysm Be Treated Without Open Brain Surgery?

Yes. Endovascular coiling seals brain aneurysms from inside the blood vessels — no craniotomy, no brain surgery. It is now the preferred treatment for most brain aneurysms worldwide.

What Is a Brain Aneurysm?

A brain aneurysm is a weak, bulging spot on the wall of a brain artery — like a thin balloon that fills with blood. Most aneurysms develop at branching points of arteries at the base of the brain. They may remain small and cause no symptoms for years. The danger is rupture: when an aneurysm bursts, it causes bleeding around the brain (subarachnoid haemorrhage), which is fatal in about 40% of cases and leaves many survivors with permanent brain damage. Even unruptured aneurysms carry a risk of future rupture and may need treatment.

Traditional Treatment — Surgical Clipping

For decades, the only way to treat a brain aneurysm was open neurosurgery. The surgeon performs a craniotomy — opening the skull by removing a section of bone — then carefully navigates through brain tissue to reach the aneurysm and places a tiny metal clip across its neck to seal it off from the blood circulation. While effective, clipping is a major brain surgery with significant risks: brain swelling, stroke, infection, seizures, and a recovery period of 4–8 weeks. Many elderly or medically unfit patients cannot undergo this operation.

How Endovascular Coiling Works

Endovascular coiling is performed entirely from inside the blood vessels — the skull is never opened. Dr. Rohit Agarwal inserts a catheter through a small puncture in the groin artery. Under live X-ray guidance, a microcatheter is navigated through the blood vessels up into the brain and positioned inside the aneurysm sac. Tiny platinum coils are then carefully packed inside the aneurysm. These coils promote blood clotting within the aneurysm, effectively sealing it off from the parent artery and eliminating the risk of rupture. For complex aneurysms, advanced techniques like balloon-assisted coiling, stent-assisted coiling, or WEB devices may be used.

Coiling vs Clipping — The Evidence

The landmark ISAT (International Subarachnoid Aneurysm Trial) — the largest randomised trial comparing the two approaches in 2,143 patients — showed that coiling produced significantly better outcomes than clipping: fewer patients were dead or dependent at 1 year after coiling. This evidence changed neurovascular practice worldwide, making endovascular coiling the first-line treatment for most aneurysms amenable to both approaches.

Results — Dr. Rohit Agarwal's Experience

At Medanta Lucknow, Dr. Rohit Agarwal has performed over 250 endovascular aneurysm procedures with a 98% technical success rate. His team was the first in India to perform WEB-assisted coiling — an advanced technique using a mesh device that allows treatment of wide-neck aneurysms that were previously difficult to coil. These outcomes place Medanta Lucknow among the highest-volume neuro-intervention centres in northern India.