What are Brain Aneurysms?
Brain aneurysms are balloon-like bulges in the brain’s blood vessels. Also called cerebral or intracranial aneurysms, brain aneurysms are caused by weakened blood vessel walls. As blood flows through the weak area of the artery, it pools and creates the bulge or aneurysm.
Aneurysms are most often found below the brain or the area around the brain known as the subarachnoid space. If the weakened area of the affected artery breaks open, blood spills into the subarachnoid space. This condition, known as subarachnoid hemorrhage, can cause devastating brain damage and is often fatal.
How is a Brain Aneurysm Diagnosed?
Ideally, brain aneurysms will be discovered before bursting. Although many patients with brain aneurysms are otherwise healthy and have no symptoms before aneurysms burst, some aneurysms are diagnosed before rupturing. Symptoms of unruptured aneurysms include:
- Changes in vision
Unruptured aneurysms may also be diagnosed during specialized imaging studies of the brain done for various reasons, such as CTA and MRA. Aneurysms are not often discovered on routine brain imaging studies, like CT and MRI scans.
You are at higher risk of developing an aneurysm if:
- You smoke
- You have high blood pressure (hypertension)
- You have a family history of brain aneurysm
- You have a brain arteriovenous malformation (AVM), where blood flows directly from your arteries to your veins
- You have one of the following rare genetic conditions:
- Polycystic Kidney Disease
- Ehlers-Danlos Syndrome
- Marfan Syndrome
- Fibromuscular Dysplasia (FMD)
Aneurysm rupture causes bleeding into the brain (subarachnoid hemorrhage) and usually causes a severe and sudden headache which may be accompanied by loss of consciousness and seizures. Once an aneurysm bursts, urgent treatment is required and patients experiencing these symptoms should be immediately transported to the emergency department.
MedStar Georgetown University Hospital’s Neuroscience ICU, the largest in Washington, D.C., is highly skilled in treating ruptured aneurysms and accepts emergency patient transfers from other hospitals in the mid-Atlantic region.
How are Unruptured Brain Aneurysms Treated?
Patients with unruptured brain aneurysms should be evaluated by a specialized cerebrovascular neurosurgeon. At MedStar Georgetown University Hospital, your neurosurgeon will evaluate a number of factors including the size, shape, and location of the aneurysm in consultation with other experts on our neurology and neurointerventional team to determine the best course of treatment to cure your aneurysm.
Surgery is not always required for low-risk aneurysms, which can be managed with continued observation, but other aneurysms will be life-threatening if left untreated. Your neurosurgical team will counsel you on the safest way to treat your aneurysm. If your aneurysm requires treatment, the most recent microsurgical treatments and endovascular surgeries are available at MedStar Georgetown University Hospital.
Some forms of aneurysm are more effectively treated through endovascular surgery. During this procedure, your interventional neuroradiologist inserts a catheter (a long, thin tube) and wire into your body through a small incision in an artery in your groin. Using X-ray guidance, the interventional neuroradiologist threads the catheter and wire up through the blood vessels into the arteries of the brain. Different endovascular approaches to treat aneurysms that we offer include:
- Coiling: When the catheter and wire reach the aneurysm site, metal coils are packed into the aneurysm to limit or prevent blood from flowing into the aneurysm, reducing the risk of rupture.
- Stent-assisted coiling: In addition to adding metal coils to the aneurysm site, a cylindrical wire mesh known as a stent is positioned in the brain artery to help the coils stay in place. While this procedure provides additional support to the vessel, patients undergoing the procedure must continue to take antiplatelet medications to lower their risk of developing a stroke.
- Flow diversion (Pipeline): For patients with specific kinds of aneurysms, a special kind of stent may be permanently placed in the affected brain artery to redirect blood flow away from the aneurysm. One type of special stent is the Pipeline Embolization Device. The Pipeline device is only FDA-approved for the treatment of large or giant wide-necked unruptured aneurysms in a certain part of the internal carotid artery. The special stent causes a blood clot to slowly form in the aneurysm, further reducing the risk of aneurysm rupture. The special stent comes with additional risks and is not recommended for patients whose aneurysms can be more safely treated by endovascular coiling or microsurgical clipping. Patients undergoing the procedure must continue to take antiplatelet medications to lower their risk of developing a stroke.
Microsurgical clipping is the safest treatment for some forms of aneurysm and provides the highest cure rate of any aneurysm treatment. During this procedure, your neurosurgeon removes the aneurysm while repairing the wall of the weakened artery by gently closing the neck of the aneurysm with a small titanium clip.
MedStar Georgetown University Hospital’s cerebrovascular neurosurgeons use state-of-the-art technology and microsurgical techniques to minimize your risk, including video monitoring of blood flow through important arteries during surgery. An assisting neurologist performs electrophysiological monitoring in the operating room, keeping the neurosurgeon updated on the your nervous system activity. This specialized technique does not disturb the brain. Our patients undergoing microsurgical treatment typically return home in two to three days and soon resume normal activity.