In This Article
- Anywhere between 2–4% of people in the United States have a brain aneurysm
- Treating aneurysms before they rupture is important because 25% of people who have a burst aneurysm can have a poor result or even die
- Aneurysms can be caused by a variety of things, including trauma and genetics
James Rabinov, MD, a neurosurgeon at Mass General, is passionate about increasing aneurysm awareness. Dr. Rabinov recently shared his thoughts on diagnosing, treating and caring for patients with aneurysms.
Q: How common are aneurysms, and what causes them?
Rabinov: It is estimated that around 6 million people in the U.S., 2% of the population, have a brain aneurysm. These can be in the form of a discreet sac, an outpouching of an artery or a fusiform expansion of of an entire artery wall. Most aneurysms are single abnormalities, but multiple aneurysms can be found in 12-15% of patients. They can be caused by genetic conditions such as polycystic kidney disease, fibromuscular dysplasia or Ehlers Danlos which affect an artery wall. Cigarette smoking also increases the likelihood of aneurysm formation and rupture. Over a lifetime 20-50% of these may rupture if untreated, especially large and giant aneurysms.
Q: What happens to a patient if an aneurysm ruptures?
Rabinov: If an aneurysm breaks open, it results in intracranial hemorrhage. About 25% of patients make a good recovery after such an event, while 25% have a poor outcome or even die. Our goal is to treat an aneurysm before it ruptures. We evaluate patients in our outpatient clinic, educate them on the natural history of aneurysms, discuss treatment options and answer questions. The two most common options are endovascular therapy or open surgical clipping of an aneurysm. We offer treatment for patients based on the size and location of an aneurysm as well as general medical concerns and family history.
Q: How do you determine if a patient needs treatment?
Rabinov: Treatment is always done for patients who present with intracranial bleeding from an aneurysm. Our goal is to close the aneurysm and prevent further bleeding. Then through our extensive care plan, we help a patient recover if they have sustained a brain injury from the hemorrhage.
As an example, when a patient presents with subarachnoid hemorrhage around the brain, our team of doctors evaluates and stabilizes the patient in the ER. We have a well-organized evaluation and triage algorithm that includes CT/CTA to look for the bleeding and identify the source. After discussing treatment option with our specialists as well as the patient and their family, we can decide to close the aneurysm with image guided endovascular procedure.
Q: How, specifically, do you close an aneurysm?
Rabinov: Over 85% of patients with brain aneurysms can be treated with endovascular treatment. We perform a cerebral angiogram to characterize an aneurysm and then use a series of platinum filament or coils to close the aneurysm from inside. We may use a stent to support the coils and keep the artery open. New techniques include the use of flow diverting stents. These have a braided mesh design that reconstructs the artery wall and allows an aneurysm to heal.
Q: What is the recovery time usually like?
Rabinov: Electively treated patient usually go home the next day after treatment and are followed in clinic in a few weeks. Complex patients with subarachnoid hemorrhage are monitored in the Neurologic ICU for 14 days to provide additional care for any potential problems a patient may face as a result of the initial bleed.
Our specialists work to prevent infections, seizures, metabolic changes, hydrocephalus and vasospasm. These patients may benefit from further treatment at one of our rehabilitation centers. We follow all of our patients for at least five years after the initial treatment. The contributions of Emergency Medicine, Neurology, Rehabilitation Medicine and our nursing staff mean a lot to our patients during their treatment and recovery. We also have an aneurysm support group that meets at the hospital. That is a valuable resource for patients and families.
Learn more about the Cerebrovascular Program at Mass General
Learn more about the Fireman Vascular Center at Mass General