Duke's Cerebrovascular Center offers expert diagnosis and treatment options for patients with brain aneurysms.

Brain aneurysms are bulges on a patient’s blood vessels in the brain that result from weakening of the vessel wall. Aneurysms predispose a patient to brain hemorrhaging, which can cause serious brain damage or even death.

Diagnosis 

Our doctors use the most advanced technological equipment and procedures to diagnose a brain aneurysm. We use conventional and three-dimensional CT and cerebral angiography to examine the brain's blood vessels and diagnose an aneurysm.

After diagnosis, the team of specialists then determines the best course of treatment for the patient.

Treatment 

If an unruptured aneurysm is detected, Duke physicians consider the size and location of the aneurysm as well as the patient's age and medical condition before proceeding with treatment.

When a patient has a ruptured aneurysm, doctors begin treatment as quickly as possible to prevent further rupture that could lead to stroke or death. 

A team of specialists including neurosurgeons and interventional neuroradiologists help to determine whether endovascular or microsurgical treatment is the best course of treatment for the patient.

Our ultimate goal is to exclude the aneurysms from the normal blood circulation and to preserve the flow of blood in the uncorrupted arteries.

Endovascular Treatment

Endovascular treatment is a minimally invasive treatment of the aneurysm that, when performed safely with long-term blockage of the aneurysm, is always considered the first option for treatment.

Using specialized angiography with road-mapping techniques, a system of tubes runs from the groin, to the neck, and up into the brain where a microcatheter is placed within the aneurysm. Small intravascular coils are inserted through the microcatheter and into the aneurysm to block the aneurysm but still allow for normal circulation. 

Our physicians and surgeons employ the most recent medical advances to treat our patients, including the use of stents to treat wide-necked aneurysms that used to only be treatable through microsurgical techniques.

Microsurgical Treatment

When endovascular treatment is not an option for patients, microsurgical treatment is used to surgically clip the aneurysm using non-magnetic titanium clips.

The surgeon makes a tiny window in the skull bone that allows him/her to clip the aneurysm which usually lies just beneath the brain or between the lobes of the brain. This allows the surgeon to avoid interacting with the normal brain and, thus, diminishes potential risks.

Occasionally, a surgeon may need to perform a brain artery bypass to exclude the aneurysm from the circulation.

At Duke, microsurgery is performed under a high magnification operating microscope in a process called neuroendoscopy. A team of specialist neuro-anesthesiologists attend these surgeries to make sure the patient is properly sedated and the brain is protected by the anesthesia. Neurophysiologists are also available to monitor the brain.

Occasionally, microsurgical treatment is best for the patient despite being more invasive.

Aneurysm Treatment Examples

An angiography revealed a broad-based basilar-tip aneurysm in a 45-year-old female.

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Doctors performed stent-assisted coiling of her basilar-tip aneurysm. She recovered with no neurologic deficits. 

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A 63-year-old female presented with right side weakness. An MRI revealed she had a giant, calcified basilar-tip aneurysm.

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The team decided that microsurigical clipping would be best option to treat the aneurysm.

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The aneurysm was clipped using skull base approaches and andenosie arrest. Her symptoms have recovered completely.

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A 38-year-old male suffered a seizure. An MRI revealed he had a giant, calcified internal carotid aneurysm.

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Another view of the calcified internal carotid aneurysm.

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The team decided that microsurgical clipping would be best option to treat the internal carotid aneurysm.

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A 58-year-old female came to the Cerebrovascular Center with a sudden headache. MRI revealed she had a giant, paraclinoid aneurysm.

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The team of doctors decided microsurgical treatment followed by a cerebral bypass was the best treatment option.

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Doctors performed a cerebral bypass via the saphenous vein in her leg. The bypass was followed by occlusion of the intenal carotid artery.

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A 40-year-old male presented with progressive hemiplegia and prior brain stem strokes.

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He was found to  have a giant dissecting aneurysm of the basilar artery.

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Doctors performed a radial artery bypass from the external carotid to posterior cerebral artery followed by endovascular occlusion of the vertebral artery. The patient's symptoms are improving daily.

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Appointments

For information about scheduling an appointment with a specific doctor, visit the Contact Us page.

Physicians

Physicians offering this service include:

• Britz, Gavin W.
  • Surgery / Neurosurgery
• Enterline, David S.
  • Radiology / Neuroradiology
  • Radiology / Neurointerventional Radiology
• Smith, Tony P.
  • Radiology / Vascular and Interventional Radiology
  • Radiology / Neurointerventional Radiology
• Zomorodi, Ali R.
  • Surgery / Neurosurgery

Locations

This service is available at:

• Duke Health Center at Morreene Road (Neuroscience)
  932 Morreene Road, Durham, NC 27705
• Duke Neurosurgery of Raleigh
  3480 Wake Forest Road, Suite 558, Raleigh, NC 27609
• Duke University Hospital
  2301 Erwin Road, Durham, NC 27710