Brain Aneurysm Surgery in New Jersey

A   brain or cerebral aneurysm is a berry-like bulge in the blood vessels supplying the brain. Most aneurysms do not cause any pain, and patients may not realize they have one. However, if a cerebral aneurysm ruptures causing a brain hemorrhage called a subarachnoid hemorrhage, the consequences are often devastating. Finding the right specialist is essential to address a brain aneurysm safely and prevent potentially life-threatening effects like brain hemorrhage or a stroke.

Centers for Neurosurgery, Spine & Orthopedics (CNSO) delivers comprehensive care for a full range of brain, spine, and nerve conditions, including brain aneurysms. Patients in New Jersey receive treatment from a compassionate and committed team of specialists who support and educate patients at every step of their journey. Learn more about brain aneurysms, brain aneurysm surgery, and the other treatment options available to patients at CNSO.

What Is a Brain Aneurysm?

An aneurysm is a bulge or a small ballooning out in the wall of an artery. Because arteries are responsible for blood flow away from the heart, they are designed to withstand high arterial pressures. If part of the arterial wall is weakened or thinned, the high pressure in the artery may cause the weakness to stretch or balloon outward, resulting in the development of an aneurysm.

Aneurysms can occur anywhere in the body, but they are most dangerous in the brain. Any brain aneurysm needs to be carefully evaluated by a neurosurgeon, who is an expert in neurovascular surgery, to determine whether the brain aneurysm is at risk of growing and rupturing. High-risk brain aneurysms, if not addressed, can grow and change over time, further weakening the artery wall and increasing the likelihood of a rupture and a subarachnoid hemorrhage. If a rupture occurs, the result is an uncontrolled brain hemorrhage (bleeding inside of the skull) often leading to devasting brain damage, coma, and death. A brain aneurysm rupture causing subarachnoid hemorrhage is a medical emergency requiring immediate evaluation and treatment.

Brain Aneurysm Signs and Symptoms

Unruptured brain aneurysms are not always symptomatic, especially if they are small. However, larger aneurysms that are steadily growing can create pressure on brain tissues and nerves. This pressure produces symptoms that may include:

• Pain: Large brain aneurysms may cause mild to severe head pain. The pain is often felt above and behind one eye, indicating where the aneurysm is located.
• Vision changes: If the aneurysm is near or compressing the cranial nerves for vision or moving the eye, the patient may experience blurred or double vision.
• Pupil dilation: Some aneurysms grow large enough to impact the nerve that controls pupil constriction, resulting in one pupil that stays constantly dilated.

Most patients only experience symptoms of an aneurysm after it ruptures or bursts. If this happens, symptoms appear very suddenly and are always severe. They include:

• Headache: Ruptured aneurysms typically cause a sudden and extremely intense headache, often described as the worst in the patient’s life.
• Vision changes: Intense headaches are often accompanied by blurred or double vision, caused by bleeding that interferes with sensory processing.
• Light sensitivity: Aneurysm patients may be highly sensitive to light, experiencing increased pain or irritation when exposed to bright light.
• Stiff neck: When blood leaks into the brain following a rupture, it causes inflammation. This may result in pain or stiffness in the neck.
• Nausea: Inflammation and irritation of the brain tissue may also trigger the body’s vomiting reflex, causing intense nausea and vomiting.
• Seizures: Hemorrhage can interrupt normal brain activity, triggering a seizure characterized by limb weakness, loss of balance, confusion, or difficulty understanding speech.
• Loss of consciousness: In the case of a very severe rupture and hemorrhaging, the patient may lose consciousness as their brain functions shut down.

Ruptured aneurysms are potentially life-threatening. An individual who experiences any of the symptoms described above should seek medical help immediately to avoid long-term complications.

Causes and Risk Factors for Brain Aneurysms

Brain aneurysms are caused by a weakness in the artery wall. They can occur in anyone at any age but are most frequent in adults between the ages of 30 and 60. They are also more common in women than in men. In addition, certain genetic, health, and lifestyle factors may increase an individual’s likelihood of developing an aneurysm. These include:

• A history of aneurysm in a parent, sibling, or child
• Untreated high blood pressure
• Cigarette or tobacco smoking
• Connective tissue disorders, which weaken artery walls
• Polycystic kidney disease
• The presence of an Arteriovenous malformations (AVMs)
• Drug abuse, especially of cocaine or amphetamines
• Head trauma

Not all aneurysms will burst. The likelihood of rupturing is influenced by the aneurysm’s size, location, and rate of growth. It may also be impacted by health and lifestyle factors including:

• High blood pressure, which weakens arteries
• History of tobacco smoking
• Family history of aneurysms
• Personal history of aneurysms and ruptures

How Are Brain Aneurysms Diagnosed?

Most unruptured brain aneurysms are not diagnosed. If they produce no symptoms, they are likely to go unnoticed unless they are detected when reviewing brain imaging tests for an unrelated condition. If a patient experiences intense headaches or other symptoms of a ruptured aneurysm, the CNSO neurosurgeon will perform medical testing to diagnose the cause. These tests will help the surgeon determine the best treatment for the patient’s condition. Medical tests for aneurysms include:

• Computed tomography (CT) scan: This test is often the first requested. It uses X-rays to create two-dimensional images or “slices” of the brain and skull. These can show the size, location, and shape of an aneurysm.
• CT angiography (CTA): When ordering a CT scan, the neurosurgeon may inject a contrast dye in advance of the test. This makes structures appear more clearly in the scan, resulting in more detailed and accurate imagery.
• Magnetic resonance imaging (MRI): MRI machines use radio waves and a magnetic field to create two- and three-dimensional images of the brain. These images are useful for locating an aneurysm and determining whether there has been bleeding into the brain.
• Cerebrospinal fluid (CSF) analysis: This test is used to evaluate the cerebrospinal fluid, which cushions the brain and spinal cord. By measuring the chemicals present in the fluid, medical specialists can detect bleeding around the brain.

Treatments for Unruptured Brain Aneurysms

CNSO takes a conservative approach to treatments whenever possible. When assessing a new patient’s case, the comprehensive care team first considers whether an evidence-driven, non-invasive approach will be effective in addressing the patient’s condition.

When it comes to unruptured brain aneurysms, not all of them require treatment. The care team weighs all factors before deciding on a treatment plan, including:

• The size and location of the aneurysm
• If the patient has more than one brain aneurysm
• Family history including family members who have brain aneurysm(s) or have members who have died suddenly of a brain hemorrhage
• History of smoking
• The patient’s overall health
• The patient’s medical history

If the aneurysm is small, not increasing in size, and does not produce any symptoms, it may be monitored conservatively and not require an operation. Initially, semi-annual then annual MRI or CTA scans will be used to monitor the aneurysm and ensure that it does not grow larger. Overtime, imaging may be spaced out even further.

In the meantime, the patient’s care team will aggressively treat any coexisting medical problems that may be contributing to the aneurysm’s formation, increase in size, or risk of rupture. Medications and dietary adjustments may be prescribed to carefully control blood pressure. In addition, the patient should stop smoking and should not use cocaine or other stimulant drugs. These steps are essential to prevent further damage and minimize the risk of a rupture.

Brain Aneurysm Surgery at CNSO

If the brain aneurysm has ruptured, immediate medical intervention is necessary. The expert neurosurgeons at CNSO employ multiple approaches to treat ruptured aneurysms. The method used is determined by the risk of stroke, the potential for aneurysm recurrence, and the chances of damaging other blood vessels or the brain surrounding the aneurysm. The experts at CNSO carefully analyze the size, shape, location, and risk factors to tailor the best treatment for the patient’s brain aneurysm.

Methods include:

Microvascular Clipping

Microvascular clipping is historically the primary surgical treatment for aneurysms. During the procedure, the neurosurgeon cuts a small opening in the skull to access the aneurysm. They then use a microscope and precise instruments to attach a tiny, clothespin-like metal clip onto the aneurysm’s neck. The clip seals off the blood flow to the aneurysm, preventing a brain bleed or further growth.

This method is highly effective. Aneurysms that have been occluded with microsurgical clips are unlikely to rebleed or recur, making this the preferred option for certain aneurysms for a permanent solution.

Endovascular Embolization

This is a minimally invasive treatment and an alternative to surgical clipping. The neurosurgeon inserts a catheter into an artery, usually at the groin, and then carefully threads it through the body toward the aneurysm site. The catheter is used to place a detachable coil or mesh sphere into the aneurysm. This creates an artificial clot, blocking blood flow into the aneurysm. Embolization of a cerebral aneurysm is quite effective, however, it has a higher rate of recurrence than microsurgical clip occlusion.

Flow Diversion Stents

Another treatment approach uses a flow diversion device. As with endovascular embolization, the procedure begins with threading a catheter from the groin toward the aneurysm site. The catheter is used to place a hollow plastic or mesh tube, called a stent, into the parent artery, which rediverts blood flow along its appropriate path, preventing flow into the aneurysm. Without blood flow into the aneurysm, it eventually clots off and occludes.

Stents are typically used to treat aneurysms that are large or that cannot be treated using surgical clipping or embolization.

Recovering After Brain Aneurysm Surgery

The expected recovery period after an aneurysm treatment depends on whether the aneurysm has ruptured. For unruptured brain aneurysms, full recovery after microvascular clipping typically takes two to four weeks. This period may be shorter for minimally invasive treatments like embolization or a stent.

If the aneurysm ruptured before treatment, the recovery period may last for several weeks up to a few months. The length depends on the severity of brain damage caused by the cerebral hemorrhage from the ruptured brain aneurysm. Patients may also need speech, occupational, and physical therapy to regain their full function, or to relearn how to function with a permanent disability.

Find Treatment for Brain Aneurysms at CNSO

If diagnosed with a brain aneurysm, it is critical a patient undergoes a careful evaluation to determine the risk of the aneurysm rupturing. Finding the right team of specialists to evaluate and treat a brain aneurysm is critical to improve a patient’s chances of successful and effective treatment and a complete recovery. The committed and compassionate neurosurgical team at CNSO includes leading board-certified neurosurgeons, physiatrists, rehabilitation specialists, and certified physical therapists. These experts deliver comprehensive care for brain aneurysms, supporting patients at every stage from diagnosis to surgery and recovery. CNSO has several convenient locations across New Jersey, including Bergen, Passaic, Essex, Morris, and Hudson counties. To learn more about brain aneurysm treatments, contact CNSO today.

Frequently Asked Questions About Brain Aneurysm Surgery

What is a brain aneurysm?

A brain aneurysm is a weakness in the wall of a cerebral (brain) blood vessel that causes a bulging or ballooning out of the wall of the vessel.

What causes a brain aneurysm?

Brain aneurysms are caused by weak points in blood vessel walls. A variety of risk factors may contribute to the formation of an aneurysm, including high blood pressure, smoking, stimulant use, genetic factors, and certain other health conditions.

What are the symptoms of a brain aneurysm?

Most brain aneurysms do not produce symptoms. Large or actively growing ones may press against cranial nerves or brain tissue, resulting in the following symptoms:

• Headaches
• Eye pain
• Blurry or double vision
• One dilated pupil
• Numbness on half of the face

What happens if a brain aneurysm ruptures?

If a brain aneurysm grows too large, it can rupture or burst. This causes uncontrolled bleeding into the brain called a subarachnoid hemorrhage, potentially causing serious and devastating brain damage, coma, and death. Ruptured aneurysms require emergent evaluation and medical and surgical intervention.

What are the symptoms of a ruptured aneurysm?

The most common and recognizable symptom of a ruptured aneurysm is a sudden and intense headache, described as the worst headache of one’s life. Furthermore, patients may also experience neurological symptoms, such as:

• Blurred or double vision
• Light sensitivity
• Nausea or vomiting
• Stiff neck
• Seizures
• Paralysis or numbness
• Changes or loss of consciousness

Is surgery always the treatment for a brain aneurysm?

Treatment is not always recommended for a brain aneurysm. Patients who have a small aneurysm and no risk factors for a subarachnoid hemorrhage from the aneurysm rupturing typically are monitored without surgical treatment. If an aneurysm is ruptured or has a high risk of rupturing, a variety of options are available, including minimally invasive treatments and surgery.