Brain Aneurysm Treatments

The neurologists and neurosurgeons at the Brain Aneurysm Center at Cushing Neuroscience Institute (CNI) within North Shore-LIJ Health System provide advanced treatments for ruptured and non-ruptured aneurysms and related conditions.

Our physicians are at the forefront of technical knowledge and accomplishments. Dr. David Chalif, co-director of the Brain Aneurysm Center, has performed over 1,500 aneurysm clippings, a procedure where a small titanium clip is placed across the neck of the aneurysm to prevent bleeding. Dr. Chalif also sits on the Brain Aneurysm Foundation’s Medical Advisory Board.

 Dr. David J. Langer is one of the few neurosurgeons in the country dually trained in both microsurgical and endovascular treatment of cerebral aneurysms. Dr. Langer is a leader in the use of NOVA (Non-invasive Optimal Vessel Analysis), an MRI technique that permits the measurement of blood flow in the brain noninvasively. This technology allows precise and accurate planning of surgical treatment of stroke and brain revascularization.

Many factors are evaluated when deciding on the appropriate treatment for a brain aneurysm. These include the presence or absence of hemorrhage; the size, shape and location of the aneurysm; and the age and medical condition of the patient. Aneurysm treatment options include minimally invasive endovascular coiling and microsurgical aneurysm clipping.

The Brain Aneurysm Center provides the following treatments for brain aneurysms and related conditions:

  • Intracranial Bypass. Intracranial bypass is a surgical procedure used to reroute blood around a blocked blood vessel in the brain to restore blood flow.  A small hole in the skull is made to expose the area of the brain that needs to be treated.  The neurosurgeon then takes a healthy blood vessel from an area outside the brain and connects it to a blood vessel inside the brain.  This reroutes blood around the aneurysm, restoring blood flow. In some cases, an intracranial bypass can involve taking a vein or artery from the arm or leg and use it to direct blood around a blockage. The first reported intracranial bypass surgery in the US was performed at Lenox Hill Hospital, part of the North Shore-LIJ Health System.
  • Pipeline® Embolization Device (PED) is available to patients as a state-of-the-art brain aneurysm treatment option.  The PED is a flexible, braided wire mesh tube which can be placed within the internal carotid artery in the brain, blocking off large or wide-necked aneurysms.  The device can also reduce the likelihood that an aneurysm will rupture. The PED device offers patients a better chance of long-lasting aneurysm occlusion and low complication rates. In the endovascular procedure, the PED is threaded up through a catheter placed in a blood vessel in the leg, up to the brain. The PED is implanted across the neck of the aneurysm, cutting off blood flow.  The blood that remains in the aneurysm will form a blood clot which prevents the rupture of the aneurysm and may also cause the aneurysm to shrink in size over time.  
  • Endovascular Coiling is a minimally invasive procedure that requires the insertion of a catheter into the femoral artery in the leg. Using real-time X-ray guidance, the catheter is then navigated through the blood vessel into the head and into the aneurysm. Soft platinum coils are then threaded through the catheter and deployed into the aneurysm. The coils conform to the shape of the aneurysm, fill the sac and block blood flow to prevent the aneurysm from rupturing. This procedure is performed under general anesthesia (light sedation). The hospital stay for uncomplicated aneurysm coil embolization is usually two to four days, and the full recovery time is five to seven days. For complicated endovascular coil embolization’s — especially if the aneurysm has bled — the hospitalization period can range from one to two weeks, depending upon the patient’s medical condition and the complications caused by the bleeding.
  • Aneurysm Clipping is a surgical procedure performed on both ruptured and unruptured aneurysms. The aneurysm is surgically exposed through a small opening in the skull called a craniotomy. Once the aneurysm is located under microscopic guidance, the neurosurgeon places a surgical clip or clips around the base of the aneurysm. The clips cut off the blood flow to the aneurysm and allow flow through the normal vessels. Aneurysm clipping surgery is done under general anesthesia and also involves a neuro-monitoring team that observes the electrical functioning of the brain during the surgical procedure to ensure the best outcome.
  • Laser-assisted cerebral bypass surgery is a surgical procedure used to restore blood flow to the brain. A cerebral bypass is like a coronary bypass in the heart, but in the brain. Laser assisted cerebral bypass surgery is utilized when an aneurysm cannot be treated with clipping or coiling.

Rehabilitation

Rehabilitation may not always be necessary to recover from a brain aneurysm. Patients in good condition after a subarachnoid hemorrhage may return home directly from the hospital after treatment. Patients who are treated for unruptured aneurysms typically do not require rehabilitation and return to their normal activities within several days.

However, for many aneurysm patients, rehabilitation is a critical part of recovery, especially after a major hemorrhage. The effects of a ruptured aneurysm may cause one to change, relearn or redefine how one lives. A patient may have difficulty in these ways functioning physically (e.g., unsteady gait, weakness and/or paralysis), cognitively (e.g., memory, language and/or perceptual problems) or emotionally (e.g., anxiety, depression).

Rehabilitation helps individuals return to independent and normal activities of daily living. Each patient is unique and rehabilitation will be tailored to their specific needs. The comprehensive rehabilitation team can include a rehabilitation doctor (physiatrist), rehabilitation nurse, physical therapist, occupational therapist, speech-language therapist, social worker, neuropsychologist and recreation therapist.

Successful rehabilitation depends on:

  • how early rehabilitation begins
  • extent of the disability
  • patient's attitude
  • cooperation of family and friends

The following rehabilitation services are offered by the North Shore-LIJ Health System:

Make an appointment at our Brain Aneurysm Center
Cushing Neuroscience Institute’s Brain Aneurysm Center makes it easy for you to take the first steps in ensuring the best neurological care for yourself or your family. Simply email us at neuro@nshs.edu, call us at (516) 562-3070 or fill out our Request an Appointment form.