Brain Aneurysm

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Overview

Brain aneurysms -- weakened or bulging portions of an artery in the brain -- are often diagnosed incidentally during imaging scans for other issues. An aneurysm rupture, called a subarachnoid hemorrhage, is very dangerous and can be life-threatening.

If you have an unruptured brain aneurysm, Duke radiologists, neurologists, and neurosurgeons use sophisticated imaging tools to determine whether you will benefit from observation or treatment. If your aneurysm ruptures, our neurosurgeons work quickly to stop the bleeding and repair the blood vessel to reduce the risk of complications. We offer the latest open surgery and minimally invasive catheter procedures to repair aneurysms.

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Tests

Imaging Scans

Description

High-resolution, 3D images of the brain and its blood vessels are reviewed to analyze the size, shape, and location of the aneurysm, as well as potential bleeding or spasms that may signal an increased risk for stroke. Duke offers groundbreaking imaging options to determine brain aneurysm stability with more accuracy than ever. When MRI or CT scans are used to examine blood vessels (angiograms), they are called MRAs and CTAs.

Cerebral Angiography

Description

Through a small incision in your wrist or groin, a catheter is inserted into one of your major arteries and threaded through the circulatory system to your neck. A contrast dye is injected into the catheter and travels to the brain’s arteries. The dye highlights the location and characteristics of the aneurysm. Overall, this test takes about an hour.

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Duke Health offers locations throughout the Triangle. Find one near you.

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Treatments

Treatments Overview

Our neurosurgeons will work with you to determine the best way to treat your aneurysm. This can include both catheter-based (endovascular) or surgery-based methods. We help you choose the treatment that is best for your aneurysm type and accounts for your preferences and any other medical conditions.

Watchful Waiting, Risk Factor Reduction, and Medications

Description

Not all aneurysms need to be treated right away, so monitoring the aneurysm and how it may change over time might be your best option. We can also help you reduce your risk of aneurysm rupture. Drugs may be prescribed to reduce blood pressure and symptoms like seizures.

Endovascular Options

Description

Coil Embolization: Neurosurgeons thread catheters through a major artery in the groin or wrist and up to the brain. Then, through the catheter, tiny metal coils are placed in the weakened artery to block or reduce blood flow to the aneurysm. This allows the body to repair the blood vessel and prevents rupture.
Flow-Diverting Stent: This procedure is similar to coil embolization except that instead of metal coils, neurosurgeons place a tiny stent (metal mesh tube) in the weakened artery to divert blood flow away from the aneurysm. Eventually, the stent will cause the aneurysm to seal itself off.
Intrasaccular Flow Diversion: This newer procedure uses a mesh device to fill in the entire sac of the aneurysm and close it off.

Duke is one of a handful of centers in the U.S. offering “awake surgery” for endovascular surgical procedures that treat brain aneurysms. This option is ideal for people who cannot or do not want to undergo general anesthesia. Awake surgery speeds recovery after surgery and lowers the risk associated with general anesthesia.

Content

Microsurgical Clipping
Neurosurgeons make an open incision in the skull (a craniotomy) and place one or more small metal clips along the neck of the aneurysm. This blocks blood from entering the aneurysm sac, prevents it from becoming larger, and reduces the risk for future bleeding.

Cerebral Artery Bypass and Coiling
Through an open incision in the skull, neurosurgeons reroute blood flow around the weakened artery using a replacement blood vessel from another part of your body, usually your leg. The new artery bypasses the damaged blood vessels and restores healthy blood flow in the brain. After that, the surgeon inserts small coils into the aneurysm neck to close it.

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Why Choose Duke

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Emergency Diagnosis and Response
Many cerebrovascular diseases aren’t diagnosed until after a serious complication occurs. Our team is the region's leading resource for brain health emergencies, including aneurysms.

Advanced Training and Experience
Our neurologists and neurosurgeons are trained and experienced in aneurysm prevention, management, and treatment. Blood-flow disorders in the brain can be difficult to diagnose, but our specialists have the advantage of doing so regularly. From emergency situations in which weak artery walls create immediate risk, to less urgent cases where a comprehensive assessment determines whether surgery is necessary, we ensure you receive the most appropriate treatment for your condition.

Complex Procedures, Successful Outcomes
Unlike some hospitals, we are equipped and trained to perform surgery on large aneurysms, which is an extremely complex and often lifesaving procedure.

Sophisticated Microsurgical Techniques
Our surgeons use powerful microscopes that allow them to see tiny vascular structures in detail and in real time. This makes complex aneurysm surgeries safer and more precise.

Diagnostic and Imaging Expertise
We use the most advanced equipment and procedures to diagnose and treat brain aneurysms, including high-resolution 3D imaging of blood vessels in the brain. These tools enhance our ability to review your medical situation and present the safest and best treatment options.

Best Hospital for Neurology, Neurosurgery in NC

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our neurology and neurosurgery program is nationally ranked, and the highest ranked program in North Carolina by U.S. News & World Report for 2022–2023.

This page was medically reviewed on 04/25/2022 by

Andrew B. Cutler, MD, MS | Neurosurgeon