Department of  Neurosurgery
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Aneurysm

Brain aneurysms are weak artery walls in the brain that bulge and may rupture or burst. They look like berries attached to the artery by a “neck” and come in several forms. 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 aneurysms.

Washington University cerebrovascular surgeons, in partnership with Barnes-Jewish Hospital, offer nationally recognized care for the treatment of aneurysms. The surgeons are part of a multidisciplinary team in the Barnes-Jewish Hospital Stroke and Cerebrovascular Center that also includes interventional radiologists who offer minimally invasive endovascular procedures for the treatment of aneurysms. Following procedures, a team of critical care neurologists coordinate care in a dedicated neuro-intensive care unit. Neurologists from the Center also coordinate neuro-rehabilitation care at The Rehabilitation Institute of St. Louis.


Symptoms

Burst Aneurysms

A burst aneurysm is a life-threatening condition that can cause brain injury or even death. It usually causes internal bleeding (a subarachnoid hemorrhage) between the skull and the brain.If you experience any of these symptoms, call 9-1-1 immediately:

  • Sudden, severe headache
  • Nausea and vomiting
  • Double vision
  • Stiff neck
  • Loss of consciousness

Patients with ruptured aneurysms also are at risk for other complications, including hydrocephalus (buildup of cerebrospinal fluid that puts pressure on the brain) and cerebral vasospasm (abnormal narrowing of brain blood vessels). Medical complications that may develop following an aneurysm rupture include pneumonia; blood infections; bladder or kidney infections; injury to the heart; or blood clots in the lungs or legs.

Unruptured Aneurysms

Most people with unruptured brain aneurysms have no symptoms. When an aneurysm presses on the brain or nerves, however, these symptoms may appear:

  • Numbness
  • Weakness or paralysis of the face, arm or leg
  • A drooping eyelid
  • An enlarged pupil
  • Decreased vision or double vision
  • Pain above and behind the eye
  • Localized headache
  • Seizure

Risk Factors

These factors may increase the risk of developing an aneurysm:

Diagnosis

Detailed visual information is needed to make an accurate diagnosis of an aneurysm. In the Barnes-Jewish Stroke and Cerebrovascular Center, advanced imaging tests are available. Common diagnostic tests are: 

  • Computed tomographic (CT) imaging: Uses X-rays to create pictures of cross sections of the brain
  • Computed tomographic angiography (CTA): A type of CT test that adds a special dye – injected through an IV into the patient’s arm – to help physicians look at blood vessels
  • Magnetic resonance imaging (MRI): A diagnostic tool that uses a large magnet and radio waves to look at the brain
  • Magnetic resonance angiography (MRA): MR performed after an injection of dye to examine the blood vessels of the brain
  • Angiogram/arteriogram: diagnostic procedure that uses insertion of a catheter, a special dye and X-rays to see how blood flows through the brain

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 section of the skull and use a microscope to locate the artery feeding the aneurysm. The neurosurgeon places a small metal clip at the neck or opening of the aneurysm, which stops its blood supply and prevents it from bleeding.

Rarely, the neurosurgeon needs to clamp an entire artery leading to the aneurysm. In this case, a bypass procedure, shown below, 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.

 

 

Recovery and Follow-Up Care

Neuro-Intensive Care Unit: Patients with ruptured aneurysms and those who undergo open surgery are admitted to the Barnes-Jewish Hospital Neuro-Intensive Care Unit. This specialized 20-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.

Neuro-Step-Down Unit and Floor: After their stay in the Neuro-Intensive Care Unit, patients may be moved to the Neurological Step-Down Unit and floor. Here specially trained nurses, therapist, dieticians and social workers assist with recovery so patients can return home.

The Rehabilitation Institute of St. Louis: Aneurysm patients may 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 cerebrovascular 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.

See information on next meeting.

Cerebrovascular Conference

A multidisciplinary Cerebrovascular Conference is held once a week. All cerebrovascular cases are reviewed by neurosurgeons and interventional neuroradiologists to determine an optimal, individualized treatment plan. 

Physicians wishing to submit cases for review should contact the Cerebrovascular Nurse Coordinator at 314-747-8871.

Faculty

Neurosurgery Providers - Cerebrovascular Surgeons

Interventional Neuroradiology Providers

  • DeWitte T. Cross, MD
  • Colin P. Derdeyn, MD
  • Christopher J. Moran, MD

Critical Care Neurology Providers

  • Rajat Dhar, MD
  • Michael Diringer, MD
  • Salah G. Keyrouz, MD
  • Terrance Kummer, MD, PhD

Neuro-Rehabilitation Providers

  • Alex Carter, MD
  • Maurizio Corbetta, MD
  • Robert Fucetola, PhD
  • Thy Huskey, MD

Highlights

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 interventional neuroradiologists and vascular neurosurgeons available 24/7 for endovascular and microsurgical aneurysm treatment.

Brain Aneurysm Support Group for patients and family members.