Brain Aneurysm

A brain aneurysm is a balloon-like bulge of a brain artery caused by a weakening in the blood vessel’s wall. As blood flows through the weak area of the artery, it pools and fills the bulging space.

A ruptured brain aneurysm is always an emergency. Brain aneurysms are usually found below the brain or the area around it (the subarachnoid space). If the aneurysm ruptures, blood hemorrhages into the subarachnoid space. Subarachnoid hemorrhage can cause devastating brain damage or hemorrhagic stroke and is often fatal without expert treatment.

MedStar Health unites an expert team of neurosurgeons with specialized training in brain aneurysm care. Our neurointensivist team has developed a proven protocol for emergency aneurysm management. With the latest technology and surgical techniques, we welcome even the most complex cases and referrals for patients throughout the Mid-Atlantic region.

Brain aneurysm: Ask Dr. Vikram Nayar

Neurosurgeon Dr. Vikram Nayar describes how aneurysms form and answers common questions about the condition.

Symptoms of brain aneurysms

There are almost never early warning signs or symptoms of a brain aneurysm. Signs that may occur after a rupture include:

Severe and sudden headache
Seizure(s)
Loss of consciousness

When this happens, it's always an emergency requiring immediate medical treatment.

Causes and risk factors

Brain aneurysms can form in patients who are otherwise healthy, with no apparent cause. Some factors that increase the risk of developing an aneurysm include:

Smoking
High blood pressure (hypertension)
Family history of brain aneurysm
Presence of a brain arteriovenous malformation (AVM)

Aneurysms may be associated with a few rare genetic conditions such as polycystic kidney disease, Ehlers-Danlos syndrome, Marfan syndrome, and fibromuscular dysplasia.

Diagnosing a brain aneurysm

Unruptured brain aneurysms are sometimes diagnosed after patients have imaging studies of the brain for unrelated conditions. While brain aneurysms usually are not identified on routine CT scans or MRI scans, they can be seen on specialized CTA and MRA imaging exams.

Treatment options

MedStar Health neurosurgeons who specialize in brain aneurysms will work together to recommend the best treatment plan for you. A ruptured brain aneurysm is always an emergency that usually requires surgery. But for an unruptured aneurysm, the best treatment depends on the size, shape, and location of the brain aneurysm.

Unruptured brain aneurysms should be evaluated by a specialized cerebrovascular neurosurgeon. Brain aneurysms with no significant risk of causing problems may not require surgery—right away or ever. Your neurosurgeon will order follow-up imaging to watch for changes in the size, shape, and stability of the aneurysm over time.

Some brain aneurysms are life-threatening if left untreated. Your neurosurgical team may recommend a procedure to remove or repair the aneurysm.

Microsurgery

Microsurgical clipping is the safest treatment for some forms of aneurysm and provides the highest cure rate. During this procedure, the neurosurgeon removes the aneurysm and repairs the wall of the weakened artery by gently closing the neck of the aneurysm with a small titanium clip.

MedStar Health’s cerebrovascular neurosurgeons use state-of-the-art technology and microsurgical techniques to minimize risk, including video monitoring of blood flow through important arteries during surgery. A neurologist performs electrophysiological monitoring in the operating room, keeping the neurosurgeon updated on your nervous system activity.

This specialized technique does not disturb the brain. Our patients undergoing microsurgical treatment typically return home in 2 to 3 days and soon resume normal activity.

Endovascular surgery

During an endovascular procedure, a catheter (a long, thin tube) and wire are inserted into a small incision in an artery in your groin. Guided by imaging technology, an interventional neuroradiologist will thread the catheter through the blood vessels into the arteries of the brain.

MedStar Health offers three advanced endovascular surgery options for brain aneurysms:

Coiling

When the catheter and wire reach the 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

A stent is permanently placed in the affected brain artery to redirect blood flow away from the aneurysm. One type of stent is the pipeline embolization device (PED), which is approved for treating large, wide-necked, unruptured aneurysms in a certain part of the internal carotid artery. This stent causes a blood clot to slowly form in the aneurysm, reducing the risk of aneurysm rupture.
Flow diversion is not recommended for aneurysms that can be safely treated with other procedures. Patients who get the procedure must take antiplatelet medications to lower their risk of developing a stroke.
Flow diversion (pipeline)

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 more support, patients who get the procedure must take antiplatelet medications to lower their risk of stroke.