Aspirin in combination with enhanced blood pressure management is being tested for the prevention of brain aneurysm rupture
People with a brain aneurysm can usually live a normal life, says Professor of Neurosurgery Timo Koivisto. “However, smoking cessation and careful blood pressure management are extremely important.”
A brain aneurysm is usually not congenital but develops slowly over a person’s lifetime. Smoking and elevated blood pressure accelerate aneurysm growth and increase the risk of a rupture and an intracerebral haemorrhage. “These are risks that everyone can minimise. When patients ask me what else they can do, I tell them to take good care of their teeth.”
Indeed, studies have found oral bacteria within brain aneurysms. A ruptured aneurysm is associated with an inflammatory response, but the link to oral infections is not entirely clear.
Currently, researchers are also exploring whether an anti-inflammatory treatment could prevent a brain aneurysm from rupturing. Kuopio University Hospital (KUH) is involved in a European multi-centre study that explores the effectiveness of aspirin for this purpose.
Only a small percentage of brain aneurysms eventually rupture
Koivisto has been researching brain aneurysms since the 1990s, when he came to KUH to specialise in neurosurgery. Today, he is the Director of the KUH NeuroCenter and still performs brain surgery. The next four years he will also serve as Professor of Neurosurgery at the University of Eastern Finland, standing in on a part-time basis for Professor Ville Leinonen, who was elected as the Vice-Dean of the Faculty of Health Sciences.
It is estimated that 2–3 per cent of adults have a brain aneurysm. Most brain aneurysms are found by accident when an individual’s head is scanned for some other reason. “Nowadays, these findings are increasingly referred to us for evaluation from the private sector as well, as people spend their own money to have imaging studies done.”
A ruptured brain aneurysm causes a life-threatening subarachnoid haemorrhage. Only a small percentage of brain aneurysms will eventually rupture, but the challenge is to distinguish high-risk aneurysms from benign ones.
Risk assessment is based on aneurysm growth, size, shape and location, as well as on the overall condition of the patient. An aneurysm can be left under monitoring, or a decision on preventive treatment can be taken to close a high-risk brain aneurysm. However, a procedure to close a brain aneurysm is never performed just in case, because the procedure itself carries a risk.
People in eastern Finland no longer stand out
In the early days of Koivisto's career, it was believed that people in eastern Finland were particularly susceptible to developing a haemorrhagic brain aneurysm. “Today, however, the incidence is no different from that in other Western countries, as smoking has decreased and blood pressure management has become more effective.”
There have been many changes in the treatment, too. Endovascular techniques have replaced open surgery as the treatment of choice for ruptured brain aneurysms. A study conducted at KUH in the 1990s was one of the first to show that endovascular treatment was as effective as surgery.
“Our own cohort of patients has also taught us a lot about the prognosis. We have a registry of 7,000 patients with a brain aneurysm who have given us their consent to look, for example, at factors that affect recovery.”
Screening with consideration
Who should be screened for a brain aneurysm? According to Koivisto, that’s something that should be discussed. “In the past, relatives have been screened quite extensively if two in the family have had a ruptured aneurysm. However, the resulting health benefit is usually very small.”
“Family screening rarely finds brain aneurysms. And if a brain aneurysm is found, it rarely leads to a procedure. However, for the individual, both the finding and the follow-up imaging can be a cause of concern and stress for decades ahead.”
It would seem more useful to target screening at a clear risk group, such as women with hypertension, smokers, and women aged 50 to 60. “Unfortunately, the risk is higher for women than for men, and it increases with age.”
In recent years, KUH has been increasingly involved in national and international collaborative projects in neurosurgery, such as the FINISH project, which has studied the treatment outcomes and prognosis of chronic subdural haematoma, which is quite common in older adults. This slowly progressing subdural haematoma is often the result of a previous head injury, with blood-thinning medication increasing the risk.
According to Koivisto, the KUH NeuroCenter is a research-oriented unit that supports physicians’ involvement in research. The KUH Microsurgery Center, on the other hand, provides support for surgical expertise. The centre offers, among other services, simulation technology for surgical skills training, as well as a framework for research and innovation development.
Timo Koivisto
- Professor of Neurosurgery (30%), University of Eastern Finland, 1.1.2026–31.12.2029
- MD, University of Kuopio, 1990
- Board Certified Neurosurgeon, 1997
- PhD, University of Kuopio, 2002
- Title of Docent in Neurosurgery, University of Eastern Finland, 2008
- Executive Master of Business Administration (eMBA), University of Eastern Finland, 2016
Key roles:
- Chief Medical Officer, KUH NeuroCenter, 2021–
- Chief Physician of Neurosurgery, KUH 2012–2021
- Deputy Chief Physician of Neurosurgery and Deputy Chief Medical Officer of KUH NeuroCenter, KUH 2011–2021
- Visiting Professor, Macquarie University, Australia 2006–2007
- Staff Neurosurgeon and Clinical Lecturer, KUH 1997–2011
- Resident of Neurosurgery, KUH 1993–1997
