Brain Aneurysms


What are brain aneurysms?

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Brain aneurysms (also called cerebral aneurysms or intracranial aneurysms) are a weakness in a blood vessel of the brain that leads to a “bubble” or “bulge” that can rupture or bleed. When a brain aneurysm ruptures, this is called a subarachnoid hemorrhage (SAH), which is a severe form stroke that often causes severe disability or death.

Although they are more common in adults than children, brain aneurysms can occur at any age. In the United States, 2-5% of people develop brain aneurysms, most commonly in their 5th, 6th, and 7thdecades of life. 

Why rely on Washington University experts for your care?

Washington University vascular neurosurgeons, in partnership with Barnes-Jewish Hospital, offer internationally recognized care for the treatment of aneurysms.

  • Washington University neurosurgeons treat 200+ cerebral aneurysms annually.
  • 70% of patients qualify for minimally invasive (endovascular) treatment.
  • Medical outcomes consistently better than national averages.
  • Experienced and dual trained vascular neurosurgeons are available 24/7 for endovascular and microsurgical aneurysm treatment.
  • Brain Aneurysm Support Group for patients and family members.

How do we diagnose an aneurysm?

Detailed visual information is needed to make an accurate diagnosis of an aneurysm. In our Stroke and Cerebrovascular Center, advanced imaging tests are available including:

  • Computed tomographic (CT) imaging: Uses X-rays to create pictures of the brain.
  • Computed tomographic angiography (CTA): A special type of CT scan that injects dye through an IV to help physicians look at the patient’s brain blood vessels.
  • Magnetic resonance imaging (MRI): A test that uses a large magnet to look at the brain.
  • Magnetic resonance angiography (MRA): A special type of MRI that injects dye through an IV to help physicians look at the patient’s brain blood vessels.
  • Angiogram/arteriogram: A test that involves inserting a small tube / catheter into an artery in the groin or wrist so that dye can be injected to get a detailed look at the patient’s brain blood vessels.

Treatment Options

A small brain aneurysm that has not ruptured may only need to be monitored; however, if the aneurysm is large, has high-risk features, or has burst, it may require treatment.

Treatment commonly entails either microsurgical clipping or endovascular embolization, which is less invasive than surgery. A patient’s overall health, age and features of the aneurysm help determine which treatment is used.

Microsurgical clipping

This surgery requires a neurosurgeon to remove a small section of the skull to create a window through which an operating microscope is used to see the aneurysm. The neurosurgeon places a small metal clip at the neck or opening of the aneurysm, which stops its blood flow and prevents it from rupturing or bleeding.

For the majority of our aneurysm patients, we use a “keyhole” approach that limits the length of the incision and the size of the skull opening, enabling our patients to go home after just two days in the hospital.

Rarely, the neurosurgeon needs to clamp an entire artery leading to the aneurysm. In this case, a microsurgical bypass procedure may be needed to reroute blood to vital areas of the brain.

Endovascular embolization

Endovascular embolization is a minimally invasive procedure that is performed inside the blood vessels by specially trained interventional neuroradiologists. A small plastic tube called a catheter is placed into the artery, usually in the groin. The neuroradiologist then guides the catheter up into the arteries of the neck using X-rays to visualize the procedure. Detachable coils are threaded through the catheter and placed in the aneurysm to fill it, effectively reducing or cutting off the flow of blood into the aneurysm. Sometimes stents (metal tubes) are used.

Safe and Quick Recovery and Follow-Up Care

Neurological Intensive Care Unit

Patients with ruptured brain aneurysms and those who undergo open surgery are admitted to the Barnes-Jewish Hospital Neuro-Intensive Care Unit. This specialized 44-bed unit provides advanced life support for aneurysm and stroke patients.

Critical Care Area

Patients whose aneurysms have not ruptured and who are having endovascular treatment may be admitted for overnight observation in the Critical Care Area. This post-anesthesia recovery area is specially designated for patients undergoing neurological procedures.

Neurological Step-Down Unit

Patients whose aneurysms have not ruptured and who are having endovascular treatment may be admitted for overnight observation in the Neurological Step-Down Unit, a recovery area specially designated for patients undergoing neurological procedures. This specialty area is also used for aneurysm patients who were initially admitted to the Neurological Intensive Care Unit.  Here specially trained nurses, therapist, dieticians and social workers assist with recovery so patients can return home.

The Rehabilitation Institute of St. Louis

Ruptured aneurysm patients often need rehabilitation before going home. One option offered through Washington University School of Medicine is the 40-bed inpatient unit at The Rehabilitation Institute of St. Louis. The unit is dedicated to patients with neurological disease. It is staffed by a team of health care providers that includes neurologists, psychiatrists, and psychologists as well as physical, occupational and speech therapists.

Brain Aneurysm Support Group

The Brain Aneurysm Support Group offers education, support and resources for individuals who have been affected by a brain aneurysm – survivors, family members, caregivers and any others.