How is a Brain Aneurysm treated?

A brain aneurysm, also called a cerebral or intracranial aneurysm, is a spot of weakness of a brain artery. It is similar to a balloon on an artery. Because the artery wall is weakened where the aneurysm is, there is a risk that it will rupture. A ruptured aneurysm causes bleeding into the brain (subarachnoid hemorrhage). This is a life-threatening event that requires emergency treatment. If you suspect a ruptured aneurysm, call 9-1-1 immediately.

An aneurysm that has not ruptured but is large or causing symptoms also may be recommended for treatment. The goal of treatment for both ruptured and unruptured aneurysm is to reduce the risk of blood flow from the aneurysm and into the brain. Not all aneurysms require treatment. In fact, most do not. We spend time trying to understand the future risk of bleeding from an aneurysm vs the risk of treatment, and the robustness of treatment. When the risk of treatment is less than the risk of leaving the aneurysm alone, we suggest treatment.

This can be done in two ways:

  • Surgical repair is conventional surgery that involves removing a piece of the skull (craniotomy) to expose the aneurysm. The neurosurgeon then places a metal clip at the aneurysm’s neck to prevent blood flow into the aneurysm sac and closes the skull. We also specialize in more complex repairs that require suturing brain vessels, such as brain bypass. Some aneurysms are best treated by parent vessel sacrifice, either done surgically or endovascularly.
  • Endovascular treatment is minimally invasive and performed from within the blood vessel. A catheter is threaded through the groin up through the body to treat the aneurysm. One procedure, called “coiling,” fills the aneurysm with thin wire-like material to prevent rupture; this is sometimes combined with stent placement. Other treatments involve flow diverters to deflect blood from the aneurysm or otherwise rerouting of blood flow around the aneurysm.

Endovascular Coiling Procedure: This video animation demonstrates the treatment of a brain aneurysm by inserting coils into the aneurysm both without and with the assistance of a stent to block blood flow into the aneurysm, but still allow blood to flow in the regular vessel. (This animation does not have sound.)

Flow Diversion Stent Procedure: This video animation demonstrates a flow diversion stent procedure, which is one type of endovascular technique to treat brain aneurysms. (This animation does not have sound.)

Stent-Assisted Coiling Procedure: This video animation demonstrates the endovascular treatment of a brain aneurysm by inserting coils into the aneurysm with the assistance of a stent to block the blood flow into the brain aneurysm but still allow blood to flow in the regular vessel. (This animation does not have sound.)

Read two Case Studies that show the benefits of our Advanced Minimally-Invasive Options for Aneurysm and Stroke Patients. Although endovascular repair is often considered first, surgical clipping is sometimes deemed safer based on the aneurysm’s anatomy, the shape of surrounding blood vessels and individual patient needs. When necessary and depending on the condition, Brigham and Women’s Hospital offers hybrid treatment.

Hybrid treatment is performed with cutting edge technology that combines both open and endovascular techniques, yielding the safest solution. This is done in our hybrid, bi-plane suite where a surgeon can work both under a microscope and continue to use endovascular imaging from within the vessel.

What are the Brain Aneurysm treatment options at Brigham and Women’s Hospital?

Brigham and Women’s Hospital provides specialized, individualized therapeutic and emergency care for patients with symptoms of a brain aneurysm or a ruptured brain aneurysm. The Center for Cerebrovascular Diseases is dedicated to providing the best diagnosis, treatment, care, and outcomes for patients with aneurysms and a wide range of cerebrovascular disorders. The Brain Aneurysm Program includes national leaders in the diagnosis and treatment of aneurysms who leverage revolutionary imaging techniques to repair aneurysms while preserving surrounding brain tissue. We bring together neurosurgeons, interventional neuroradiologists, neurologists, and radiation specialists to provide the individualized treatments. Often in one appointment, patients will see the right specialists for their individual needs, instead of returning for multiple separate appointments with different specialists.

Posterior Communicating Artery (PCOM) Aneurysm Clipping: In this video, Nirav J. Patel, MD, Department of Neurosurgery at Brigham and Women’s Hospital, performs surgery to decompress a communicating artery aneurysm (PCOM) which was compressing on a patient’s ocular motor nerve. The surgery was performed using micro-dissection techniques, allowing Dr. Patel to reach the aneurysm without cutting the tissue of the brain. This is a typical operation for repairing a brain aneurysm.

New Treatments and Research for Brain Aneurysms

Through innovative neurosurgical techniques, we help patients whose conditions may be deemed inoperable elsewhere. Our clinical trials bring new therapies to patients, such as:

  • WEB-IT (WEB Intrasaccular):
    • The study is a prospective, multicenter single-arm cohort. Patients with wide neck bifurcation aneurysms (WNBAs) have few choices for safe and effective endovascular treatment. In this study, all patients with qualifying WNBAs will be treated with the WEB. The primary effectiveness outcome of the study is the likelihood of complete intracranial aneurysm occlusion on the 1-year angiogram as adjudicated by a core laboratory.
  • PulseRider Aneurysm Neck Reconstruction Device:
    • The objective of this study is to evaluate the safety and effectiveness of the PulseRider Aneurysm Neck Reconstruction Device in conjunction with coil embolization in the endovascular treatment of unruptured wide-neck intracranial aneurysms.
  • PREMIER:
    • The purpose of this study is to assess the safety and effectiveness of the Pipeline™ device in the treatment of unruptured, wide-neck intracranial aneurysms.
  • Hydrogel Endovascular Aneurysm Treatment Trial (HEAT):
    • This research study is being done to test the effectiveness of a new generation FDA approved device for treating aneurysms compared to the current standard device for endovascular aneurysm treatment which is bare platinum coils.

For information about our open clinical trials, please contact one of our Clinical Research Coordinators at neurosurgerycrc@bwh.harvard.edu.

Contact the Center for Cerebrovascular Disease

The Center for Cerebrovascular Diseases is home to six neurosurgeons – among them world leaders in the treatment of brain aneurysms. In additional to their exceptional technical skill, our neurosurgeons are known for their clear communication, compassion, ample time spent with patients, and personal care and attention.

We understand that confronting an aneurysm can be frightening for many patients and families, and we are aware of the challenges this presents. Our guiding principle is to put the patient and family first. We emphasize healing in a comfortable, relaxed environment. Your physicians are accessible to you throughout your care – before, during and after the treatment period.

Our team of neurosurgeons with deep expertise in treating aneurysms includes:

To schedule an appointment with a physician in the Center for Cerebrovascular Diseases, please contact our Patient Coordinator at: (617) 732-6600. We see new patients with unruptured aneurysms as soon as the next business day.

If you are a physician seeking to refer a patient to the Center for Cerebrovascular Diseases, please call (617) 732-6600 or you can access our physicians’ office phone numbers. To contact one of our physicians with a question, patient referral or second opinion, you may also email: BWHNeurosurgery@partners.org.

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