The Cerebrovascular Center at MedStar Georgetown University Hospital is a center of excellence in the treatment of brain aneurysms.  Georgetown is one of a select few centers in the mid-Atlantic that can provide the highest level of expertise in each kind of treatment, including the most recent advances in microsurgery and endovascular therapy.

Emergency Treatment for Brain Aneurysms

A ruptured brain aneurysm (aneurysm that has broken open) causes a subarachnoid hemorrhage (SAH) when blood fills the area around the brain.  It is an emergency and requires urgent treatment. 

At MedStar Georgetown, we have the largest neuro-ICU in Washington, DC.  We have a protocol for the treatment of ruptured aneurysms, and we receive patients who are emergency transfers from other hospitals in the region.

Treatments for Unruptured Brain Aneurysms at Georgetown

If you have an unruptured brain aneurysm, you should be carefully evaluated by a cerebrovascular neurosurgeon who specializes in this condition.  Your brain aneurysm specialist will evaluate several factors, often in consultation with other doctors, to determine which treatment is best for you. 

At Medstar Georgetown, we seek to cure your aneurysm and help you return to normal life.  We consider both short-term safety and long-term safety when counseling you about your aneurysm.  It is important to provide the optimal initial treatment, to avoid recurrence of the aneurysm.  Aneurysms that recur (form again) usually require additional procedures in the future, with additional risks.  At Medstar Georgetown’s Cerebrovascular Center, we are distinguished by our ability to provide the full range of treatment options with superlative outcomes. 

Our treatments include:

Microsurgical Clipping

For some aneurysms, microsurgical clipping is the safest option.  Your neurosurgeon will use a small titanium clip to gently close the neck of the aneurysm, obliterating the aneurysm and repairing the wall of the involved artery. 

Clipping provides the highest cure rate of any treatment.  With the techniques we use at Georgetown, most patients can go home in two to three days, and can expect to return to normal life without limitations.

At Medstar Georgetown, our cerebrovascular neurosurgeons perform these procedures with minimal risk, using recent advances in microsurgical techniques and state-of-the-art technology, including:

  • Specialized microsurgical approaches to the aneurysm that do not disturb the brain.
  • Intraoperative ICG videoangiography to visualize and preserve blood flow through tiny but important arteries.
  • Electrophysiological monitoring of patients while they are under anesthesia. At Medstar Georgetown, we have neurologists who are dedicated to intraoperative monitoring.  The neurologist provides your neurosurgeon real-time data on how your nervous system is functioning during the operation.  This allows us to maintain the highest levels of safety during surgery.

Endovascular Surgery

For some aneurysms, endovascular treatment is the safer therapy.  A catheter (long, thin tube) and wire are introduced into an artery in the groin, and threaded up to the arteries of the brain by Xray guidance.  There are different forms of endovascular treatment:

  • Coiling: The catheter and wire are advanced through brain arteries into the aneurysm, and metal coils are packed into the aneurysm.  This limits or prevents blood from flowing into the aneurysm.
  • Stent-assisted coiling: A cylindrical wire mesh (stent) is left in the brain artery, helping coils stay in the aneurysm and not fall back into the artery.  Patients who undergo this procedure must continue to take antiplatelet medications to lower their risk of developing a stroke. 
  • Flow diversion (Pipeline): Flow diversion treatment involves the endovascular placement of a special kind of stent, such as the Pipeline Embolization Device.  The Pipeline is placed permanently in a brain artery across the opening of an aneurysm, and it is intended to redirect blood flow away from the aneurysm.  In a majority of patients, it causes a blood clot to form in the aneurysm over a period of months, decreasing the chance that the aneurysm will rupture.  Patients who undergo this procedure must continue to take antiplatelet medications to lower their risk of developing a stroke. 

Because of additional risks that are associated with using the Pipeline device, it is not recommended for aneurysms that are more safely treated by endovascular coiling or by microsurgical clipping.  The Pipeline is not FDA-approved for most brain aneurysms.  The FDA has approved the Pipeline for a specific group of aneurysms: large or giant wide-necked unruptured aneurysms of a certain part of the internal carotid artery (the petrous segment to the superior hypophyseal segment).

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