Brain Aneurysm

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Almost all patients with brain aneurysms, also known as cerebral brain aneurysms, can be treated safely and effectively using the latest techniques, with minimal downtime. In many cases, patients may require no treatment at all. Our aneurysm specialists are fellowship-trained, board-certified neurovascular experts who have treated thousands of patients with brain aneurysms.

Brain aneurysm treatment is complex and nuanced, and should only be done by experienced vascular neurosurgeons who are skilled in all available treatments.

New Jersey Brain and Spine has the most experienced and sophisticated neurovascular program in the region. Each year, we evaluate nearly 1,000 brain aneurysm patients and perform about 100 to 130 aneurysm treatments. Our patient outcomes are superior to those reported in the national literature.

We identify the most conservative treatment appropriate for each patient, and treat most of our patients with  minimally invasive techniques, enabling them to go back to work in one to two weeks.

We know that a brain aneurysm diagnosis can lead to anxiety and fear. This is a completely normal reaction and we are here to support you. We want you to know we have helped thousands of other aneurysm patients, and we will help you get through this as well.

What is a brain aneurysm?

Cerebral angiogram AP view of a basilar tip aneurysm. White arrows indicate vector of blood flow. Yellow circle identifies the aneurysm neck and red line demarcates aneurysmal dome and origin of bleeding.

An aneurysm occurs when the wall of a blood vessel bulges or balloons outward. The most common type of brain aneurysm is a saccular or “berry” aneurysm. Dissecting aneurysms and fusiform aneurysms are other, less common types of aneurysms.

A cerebral aneurysm, also known as a brain aneurysm, is a bulge or ballooning in a blood vessel in the brain. These aneurysms can be life-threatening if they rupture, as they can cause bleeding in the brain, also known as a subarachnoid hemorrhage.

Most brain aneurysms develop slowly over many years. In some patients, aneurysms can suddenly rupture and cause bleeding around or within the brain.

What are the symptoms or risk factors of a brain aneurysm?

Symptoms of a brain aneurysm:

When most brain aneurysms are diagnosed, they have not yet ruptured and are not causing any major symptoms. Some patients may experience headaches or double vision. Very frequently, patients with a brain aneurysm are diagnosed because they had an imaging scan ordered for unrelated reasons.

For unruptured aneurysms, there are usually no symptoms at all, which is why it’s important to be aware of the risk factors for developing a cerebral aneurysm, especially a family history of brain aneurysms.

Risk factors of a brain aneurysm:

Risk factors for cerebral aneurysms include:

• Smoking
• High blood pressure
• Family history of brain aneurysms
• Certain genetic conditions
• Individuals who have had a previous brain injury or infection
• Those who have used certain illegal drugs, such as cocaine

To reduce the risk of developing a cerebral aneurysm, it’s important to maintain a healthy lifestyle, manage any existing health conditions, and avoid smoking. Regular check-ups with a healthcare provider can also help detect aneurysms early on, allowing for prompt treatment if necessary.

If you or a loved one have risk factors for developing a cerebral aneurysm, it’s important to undergo screening, typically with a special MRI of the brain called an MRA.

What are the symptoms of a ruptured brain aneurysm?

If an aneurysm ruptures and causes bleeding in the brain, patients often feel a severe, sudden onset headache. Most patients say the headache only takes seconds to intensify, and many describe it as “the worst headache of their life.” Other symptoms include vomiting, confusion, or loss of consciousness. Ruptured aneurysms are life-threatening emergencies which require rapid treatment at specialized centers.

Symptoms of a ruptured cerebral aneurysm can also include nausea, vomiting, stiff neck, sensitivity to light and sudden loss of consciousness.

How are brain aneurysms diagnosed?

Most of our brain aneurysm patients are initially diagnosed because they underwent a brain imaging scan for unrelated reasons. The following are the three most common forms of diagnosis:

1. CT and MRI scans
2. CTA and MRA scans
3. Angiography

Treatment options for a brain aneurysm depend on the size and location of the aneurysm, as well as the overall health of the patient.

CT and MRI scans:

Most brain aneurysms are initially diagnosed on CT (computed tomography) scans or MRI (magnetic resonance imaging) scans.

CTA and MRA scans:

A CTA or MRA scan is a specialized imaging scan that allows doctors to see the blood vessels of your brain as well as most aneurysms. CTA and MRA scans are excellent for aneurysm screening but do not provide the highest quality detail your doctor may need to fully see an aneurysm.

Angiography:

An angiogram is a specialized test which allows your doctor to see the exact details of even the smallest brain aneurysms. An angiogram is a minimally invasive procedure in which a small catheter or tube is inserted into the blood vessels to inject contrast. The procedure is done with light sedation and typically takes less than an hour. Angiography is the gold-standard imaging test to precisely measure and define the exact details of a brain aneurysm. In some patients, treatment decisions are made only after a formal angiogram is completed. Angiograms are typically performed in the outpatient setting, with patients going home the same day and typically returning to work within three days.

Should my aneurysm be treated or observed over time?

There are many safe and effective treatment options. Because of the complexity and nuances of non-ruptured brain aneurysms, treatment should be tailored to each patient individually. Patients should always consult with a neurosurgeon with cerebrovascular expertise.

Your doctor will weigh several factors when determining whether to treat a non-ruptured brain aneurysm. The key is determining how likely the aneurysm is to bleed in your lifetime. Key factors your doctor will consider include your:

• Aneurysm size
• Aneurysm location
• Aneurysm shape
• Age and medical history
• Family history of brain aneurysms
• Additional risk factors, such as smoking or hypertension

What are the treatment options for a non-ruptured brain aneurysm?

Surgical options include clipping, which involves placing a clip at the base of the aneurysm to block it off from the rest of the blood vessel, or endovascular aneurysm coiling, which is a minimally invasive procedure that involves placing small metallic coils into the aneurysm to prevent blood flow. In some cases specialized stents are used as well.
It’s important to note that not all cerebral aneurysms require treatment, as they may be small and unlikely to rupture. However, if an aneurysm is found to be at high risk of rupture, aneurysm treatment is essential to prevent serious complications.

At New Jersey Brain and Spine, our Neurovascular team is specialty trained and highly experienced in the evaluation and treatment of brain aneurysms, we typically evaluate several hundred brain aneurysm patients per year and we perform over 100 aneurysm treatment procedures per year. Most of our patients are treated using minimally invasive endovascular aneurysm repair rather than open surgery.

There are several options available for non-ruptured brain aneurysms, including:

1. Observation of small or low-risk aneurysms
2. Minimally invasive endovascular aneurysm treatment
3. Surgical aneurysm treatment

Observation of small or low-risk aneurysms:

In many cases, patients with brain aneurysms may require no treatment. Instead, doctors will observe the aneurysm over time (typically with an MRA or CTA every one to five years). This approach is used if the aneurysm has a statistically low risk of rupture in your lifetime. If the aneurysm is unchanged over time, no treatment will be needed.

Minimally invasive endovascular aneurysm treatment

Aneurysm coiling, stenting, and flow diversion

Most of our brain aneurysm patients are treated using the latest endovascular, or minimally invasive techniques, in which small catheters and microcatheters are inserted through the arteries and into the aneurysm. The catheters place soft platinum coils into the aneurysm. The aneurysm coils effectively shut off blood flow in the aneurysm to prevent it from bleeding. In some cases, a specialized metallic stent is placed in the artery to hold the aneurysm coils in place. In other cases, a special type of “flow diverting” stent is used, with or without aneurysm coils.

Recovery after endovascular coiling, stenting, or flow diversion is fairly quick. Patients can be out of bed the same day. Usually the treatment entails a one- to two-day hospital stay for observation. After discharge, patients can expect a gradual return to normal activity over the next one to two weeks.

Surgical aneurysm treatment

Microsurgical aneurysm clipping

Left: Cerebral angiogram demonstrating direction of carotid artery bloodflow (white arrows), location of aneurysmal neck (yellow hashed line) and turbulent blood flow within aneurysm (red arrows) dome (perimeter marked by red line). Right: Aneurysm has been treated with a full and complete packing of platinum coils. Coils do not extend beyond aneurysm neck (yellow hashed line) and there is no obstruction or narrowing of parent vessel. Notice that dome of aneurysm no longer fills with contrast dye. A microcatheter in the carotid artery is indicated (white arrows).

In some patients, there is no safe or effective endovascular option to treat an aneurysm. In these cases, microsurgery is the safest and most effective treatment. During microsurgery, an incision is made behind the hairline and the surgeon uses a microscope to place a small metallic clip across the aneurysm neck. The clip prevents further blood flow into the aneurysm. Although the recovery time may be longer, aneurysm clipping is the most durable and time-tested treatment option, usually with the same statistical risk as endovascular treatment options.

Most patients who undergo microsurgical aneurysm clipping are out of bed within two days, and out of the hospital within two to five days. They usually experience some mild to moderate swelling of the forehead, which subsides in several days, and may require pain medications for three to five days. Patients can typically return to work in four to six weeks.

What are the treatment options for a ruptured brain aneurysm?

Once a brain aneurysm ruptures, it requires immediate treatment by a dedicated team of brain aneurysm experts, including neurosurgeons and neurocritical care specialists. The aneurysm needs to be secured by either aneurysm coiling or clipping to prevent any further bleeding.

Ruptured aneurysm patients are usually critically ill and their treatment is highly complex. The best possible patient outcomes can only be delivered by a team of highly specialized neurovascular experts at high-volume brain aneurysm treatment centers.

We deliver superior outcomes

Brain aneurysm treatment is complex and should only be provided by highly experienced neurosurgeons with cerebrovascular expertise. At New Jersey Brain and Spine, we are proud to be the most experienced and sophisticated neurovascular program in the region, with patient outcomes that are superior to those reported in the national literature. 

What drives our superior outcomes:

• Skill – Our brain aneurysm specialists are fellowship-trained, board-certified neurovascular experts who have treated thousands of patients with brain aneurysms.
• Experience – Each year, we evaluate between 700 and 1,000 brain aneurysm patients and perform about 100 to 130 brain aneurysm treatments.
• Conservative approaches – We have vast experience with complex procedures (we perform more than any other area practice), yet we view surgery as a last resort and always recommend the most conservative care when appropriate. Most of our brain aneurysm patients are treated using minimally invasive techniques and can be back to normal activity in one to two weeks.
• Empathy and understanding – We treat each patient as if they are family, and we deliver highly personalized care to help them get back to their best life as quickly as possible.

Additional Resources

If you are looking for additional information about brain aneurysms, please check out the following organizations:

• Brain Aneurysm Foundation
• Joe Niekro Foundation