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Brain aneurysm treatment at United Hospital
United Hospital offers comprehensive and exceptional care for patients with brain aneurysms. Aneurysms are serious medical problems, requiring the expertise of specialists—from neurosurgeons and critical care nurses to rehabilitation specialists.
Our multidisciplinary approach leverages the expertise of world-class neurovascular specialists who collaborate to provide the best individualized care for each patient. Our comprehensive physician team includes neurosurgeons, interventional neuroradiologists, neurologists, psychologists and neurointensivists.
Leading United's brain aneurysm program is vascular neurosurgeon Eric Nussbaum, MD, medical director of United's neurovascular neurosurgery program. Dr. Nussbaum is among a small group of surgeons worldwide who specialize in brain aneurysm surgeries. He performs more than 350 brain surgeries a year and has performed more than 2,000 of the complex surgeries to treat aneurysms.
Neurological Intensive Care Unit
United's new Bentson Family Foundation Neurological Intensive Care Unit provides care for aneurysm patients after surgery and interventional radiology procedures. Directing care in the Neuro ICU are intensive care doctors who specialize in treating neurological patients.
Specialists in brain aneurysms at United Hospital also care for patients with vascular malformations.
Vascular malformations are abnormal connections between the arteries and veins in the brain. They are also called arteriovenous malformations (AVMs). These usually form before birth.
AVMs are located within the brain. Without the normal channels of vessels to handle blood under high pressure, AVMs can bleed. The bleeding causes a blood clot in the brain, which can lead to death or disability.
Although not as dangerous or common as brain aneurysms, AVMs have significant risks.
arteriovenous malformations (AVMs)
An arteriovenous malformation (AVM) is an abnormal connection between arteries and veins. Blood flows too quickly from the arteries and pushes on the walls of the veins. This can damage or weaken the veins and cause them to bulge and get twisted. If they burst, blood will leak into surrounding tissue, and may cause a stroke. People who have AVMs are usually born with this condition. The exact cause is not known.
United Hospital offers exceptional care for patients with brain aneurysms and vascular malformations. United's comprehensive team of specialist physicians is led by Eric Nussbaum, MD, a neurosurgeon who specializes in aneurysm surgery. Dr. Nussbaum's patients have far lower complication rates than the national average for this type of surgery.
An aneurysm forms when an artery in the brain develops a bulge. This is caused by a weak area in the blood vessel's wall.
The aneurysm can break open and bleed. This is a medical emergency and requires treatment right away.
Aneurysms occur in the large arteries at the base of the brain. Arteries carry blood pumped by the heart, and the blood flows at high pressure. When a brain aneurysm breaks open (ruptures), blood escapes into space around the brain called the subarachnoid space. The bleeding is called a subarachnoid hemorrhage.
Sometimes aneurysms that haven't ruptured, which have no symptoms, are discovered by accident. The neurosurgeon (a doctor who specializes in brain surgery) will consider an unruptured aneurysm very carefully. The risks of preventive treatment will be weighed against the aneurysm's likelihood of bleeding.
Brain aneurysms usually have no symptoms until they bleed. Symptoms of a ruptured aneurysm may include:
Most people with brain aneurysms realize that something is wrong and go to a hospital emergency room.
Why aneurysms are dangerous
Aneurysms that bleed are very serious: half of patients die before reaching a hospital or within the first few days. Of the patients who survive a ruptured aneurysm, half develop a serious disability.
A ruptured brain aneurysm requires treatment because it is likely to bleed again. Each time a brain aneurysm bleeds, the risk of death or disability is high.
The possibility of these medical problems reinforces the need for prompt treatment after a ruptured aneurysm.
Extra cerebral spinal fluid builds up in the ventricles of the brain. This fluid moves around the brain and spinal cord at a steady rate. In hydrocephalus, the fluid is blocked and collects in the ventricles, causing swelling and pressure.
To decrease the swelling and pressure, a neurosurgeon may place a drain through the skull and into the ventricle. This drain (called a ventriculostomy) allows the extra cerebral spinal fluid to drain into a collection bag at the bedside. This drain is short-term.
If the fluid and pressure continue to be a problem, the neurosurgeon may place a long-term (permanent) tube.
After an aneurysm, blood spills into the spinal fluid. This exposes the walls of arteries to blood, which can cause them to clamp down (spasm).
The blood vessels inside the brain narrow. This causes decreased blood flow to a region of the brain. This can cause changes such as:
Vasospasm can occur four to 14 days after the bleeding. In severe cases, vasospasm can stop adequate blood flow to the brain, creating a stroke.
A brain aneurysm can cause the body to lose its ability to regulate normal salts (electrolytes) in the blood. The doctor will carefully monitor the electrolyte balance and correct for it.
A seizure is an abnormal electrical discharge in the brain. A seizure may occur after blood from a ruptured brain aneurysm irritates the brain. The patient can lose consciousness and shake violently for seconds or minutes.
Some patients develop problems with the lungs or irregular heart rhythms. Careful monitoring in a neurological intensive care unit is important for this reason.
The John Nasseff Neuroscience Institute at United Hospital offers exceptional care for patients with brain aneurysms and vascular malformations. United's multidisciplinary team of specialists has the experience and expertise to provide the highest quality of care at every step, from a patient's diagnosis and treatment to rehabilitation. In total, the team has completed over 4,000 aneurysm procedures.
Eric Nussbaum, MD, is a board-certified neurosurgeon who has significant experience in diagnosis and treatment of brain aneurysms and vascular malformations. He leads the neurovascular neurosurgery program at United Hospital. Dr. Nussbaum specializes in surgeries to repair brain aneurysms.
Dr. Nussbaum is among a small group of surgeons worldwide who specialize in brain aneurysm surgeries. He performs more than 350 brain surgeries a year and has performed more than 2,000 of the complex surgeries to treat aneurysms.
Nurse practitioners are registered nurses with advanced training and clinical education. Nurse practitioners who specialize in neuroscience work with aneurysm patients and families, coordinating closely with physicians.
At United Hospital, neuroradiologists from St. Paul Radiology work with patients who have brain aneurysms and vascular malformations. These physicians are radiologists who have additional training and experience in radiology interventions that involve the brain, spine and nerves. Neuroradiologists perform the treatment called endovascular coiling, which prevents further bleeding by filling the aneurysm with coiled wire.
These are critical care doctors who specialize in neurology. They direct the care of patients in the Bentson Family Foundation Neurological Intensive Care Unit at United Hospital. Patients who have had surgery to repair a brain aneurysm or an endovascular coiling procedure receive care afterwards in this Neuro ICU. (The ICU also serves patients with stroke and other serious neurological conditions.)
Neurologists are doctors who specialize in disorders of the brain, spinal cord, nerves and muscles.
Physiatrists are part of Courage Kenny Rehabilitation Institute™ and serve patients in the Bentson Family Foundation Neurological Intensive Care Unit and United's neuroscience inpatient units. Physiatrists evaluate patients' physical and mental functioning, mood and motivation, and rehab needs.
Tests in the hospital will show whether a person has an aneurysm and its location. Usually patients need a combination of tests to provide information for diagnosis and treatment. All of these procedures are performed at United Hospital.
This noninvasive X-ray is usually the first test ordered when an aneurysm rupture is suspected. It shows blood that escaped from the aneurysm.
An MRI is a radiology test that uses a magnetic field to show a detailed, three-dimensional view of the brain. MRI shows the aneurysm itself better than the CT scan.
A neuroradiologist (a doctor who specializes in interpreting images of the brain, spine and nerves) conducts the angiogram. The patient is awake, with a mild sedative to relax.
The doctor threads a hollow tube (catheter) from an artery in the groin to the main arteries in the neck that supply the brain. Dye is injected, then an X-ray camera takes pictures of the brain's arteries. The aneurysm shows up as a dilated area on an artery.
The tests provide an indirect picture of the brain's arteries. The MRA and CTA may not show small aneurysms and do not match the angiogram's higher-quality images.
The purpose of treatment is preventing a ruptured aneurysm from bleeding again. (For a patient with an unruptured aneurysm, observation alone may be appropriate.)
United Hospital's treatment team of neurosurgeons and neuroradiologists has the experience to recommend and perform treatment for each patient's unique needs. A number of factors, including the patient's medical condition and age, must be considered carefully in choosing the appropriate treatment. There are two main procedures to treat brain aneurysms.
Surgery to clip the aneurysm
The patient undergoes general anesthesia in the operating room. The neurosurgeon makes an incision to open the skull, then gently lifts the brain to reach the arteries below it.
Using an operating microscope, the neurosurgeon finds the aneurysm and closes it off with a small metal clip. This prevents the aneurysm from filling with blood and bleeding again.
Patients undergo general anesthesia for this procedure, which takes place in a radiology suite. It's performed by a neuroradiologist, a doctor who specializes in radiology interventions of the brain, spine and nerves.
A neuroradiologist inserts a long, narrow catheter to an artery in your groin and guides it to the aneurysm in your brain. The doctor threads small coils through the catheter into the aneurysm. These coils fill the aneurysm and help to prevent it from bleeding again.
Courage Kenny Rehabilitation Institute™
Patients who receive treatment for ruptured brain aneurysms often need rehabilitation to regain their skills and reach their goals. Rehabilitation begins during the patient's stay at United Hospital, with staff from Courage Kenny Rehabilitation Institute, part of Allina Health.
The Institute's staff work with patients in the Bentson Family Foundation Neurological Intensive Care Unit and inpatient units.
The doctor who directs rehabilitation care is a physiatrist, a specialist in physical medicine and rehabilitation. The physiatrist evaluates each patient's physical and mental functioning, mood and motivation, and orders specific types of therapy. The doctor also checks for medication interaction issues and coordinates the timely start for therapy, including providing information to insurance for pre-authorization of therapy.
Physical and occupational therapists, speech-language pathologists and social workers help patients in the Bentson Family Foundation Neurological Intensive Care Unit and in hospital units.
Inpatient unit for rehabilitation
Courage Kenny Rehabilitation Institute's acute inpatient unit at United - 8940 is a comfortable environment where each patient receives care and practices daily living activities. The unit has earned accreditation from the Commission on the Accreditation of Rehabilitation Facilities (CARF). This means it meets the highest industry standards for quality care and service.
Outpatient rehabilitation services
After leaving the hospital, patients may receive ongoing therapies - including physical, occupational and speech therapy - at one of Courage Kenny Rehabilitation Institute's outpatient sites in Minnesota and western Wisconsin. These sites offer a full spectrum of services to improve patients' quality of life and help them achieve their personal best.