Brain Aneurysm Center
The Brain Aneurysm Center, part of the Cushing Neuroscience Institute (CNI) at New York’s North Shore-LIJ Health System, offers a multidisciplinary and highly advanced approach to the diagnosis and treatment of brain aneurysms and other related conditions. Under the co-directorship of Dr. David Chalif and Dr. Avi Setton, the Brain Aneurysm Center employs a collaboration between the departments of Neurosurgery, Interventional Neuroradiology, Neurology and Radiation Oncology. Among the conditions we treat are brain aneurysms, cerebral hemorrhage, arteriovenous malformations (AVMs) and cavernous angiomas.
Our services include:
- 24/7 capability to accept patient transfers
- Diagnostic imaging services, including CT angiography and 3-D angiography
- NeuroInterventional radiology services, such as aneurysm coiling, stent placement and arteriovenous malformation embolization
- Neurosurgery services such as microneurosurgical aneurysm clipping, cerebral bypass, ventriculostomy and cerebrospinal fluid shunting
- Neurosurgery intensive care unit
- Neuroanesthesia services
- Neurorehabilitation services
- Neurosurgery physician assistant and nurse practitioner team
Our neurosurgeons are at the forefront of technical knowledge and skills. 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.
Additionally, the Brain Aneurysm Center organizes a Brain Aneurysm Awareness Walk annually in conjunction with the Brain Aneurysm Foundation. This event draws patients, family and caregivers from all over the area in the spirit of community and education.
Brain Aneurysm Types
A brain aneurysm forms when the wall of a blood vessel in the brain weakens, forming a thin and potentially unstable sack. It may grow silently until reaching a critical size, at which time symptoms may begin to occur. Brain aneurysms are thought to arise from a congenital defect in the wall of an artery. There are two types of brain aneurysms — ruptured and unruptured.
- Ruptured brain aneurysms are known as subarachnoid hemorrhages. This type of brain aneurysm is an acute, life-threatening neurosurgical emergency. Patients who suffer a subarachnoid hemorrhage frequently require a surgical procedure called a ventriculostomy. This procedure is intended to divert the cerebrospinal fluid that is causing pressure in the brain. Following stabilization, patients are treated with surgical aneurysm clipping or endovascular aneurysm coiling to eliminate the aneurysm from the brain circulation and to prevent the possibility of a re-bleed.
- Unruptured brain aneurysms are those found prior to a subarachnoid hemorrhage. This type of brain aneurysm can be found on CT or MRI scans for unrelated neurological issues. Treatment by microsurgical aneurysm clipping or endovascular aneurysm coiling of unruptured aneurysms can eliminate the possibility of a devastating bleed.
Brain Aneurysm Causes
Brain aneurysms have been found in approximately 3% to 6% of the population upon autopsy. Fortunately many of these are small and go unrecognized throughout life and do not rupture. Brain aneurysms are thought to arise from a congenital defect in the wall of an artery. Certain risk factors, however, can contribute to aneurysm formation and the possibility of rupture:
- Alcohol use (in particular, binge drinking)
- Family history
- Inherited disorders such as Ehlers-Danlos syndrome, polycystic kidney disease, Marfan syndrome and neurofibromatosis
Brain Aneurysm Diagnosis
An unruptured aneurysm is typically found incidentally during an unrelated neurological workup or CT or MRI of the brain. Once an aneurysm has been located, a more detailed workup may be required. It is important for your physician to understand the size, shape, location and origin of the aneurysm. This will help to determine how it should be treated. Most of the tests are safe, painless and non-invasive:
- Computerized Tomography (CT) scans create images of intracranial structures using radiation and computer technology. Sequential “slices” of the CT scan can demonstrate sub-arachnoid hemorrhage, hydrocephalus, intracerebral hemorrhage and intraventricular hemorrhage.
- Computed Tomography Angiography (CTA) scans involve the injection of special iodinated contrast material and the use of radiation and computer-reconstruction to create a noninvasive picture of the blood vessels in the brain. CTA results can determine cerebrovascular abnormalities, such as an aneurysm.
- Magnetic Resonance Angiography (MRA) involves a magnetic resonance imaging study of the brain that is then re-formatted to view the cerebral blood vessels. These scans use a high magnetic field to produce images and detect a cerebral aneurysm noninvasively. MRA images can be moved in three dimensions to better visualize the aneurysm.
- Angiography (also known as arteriography or arteriogram) is the most reliable test for diagnosing aneurysms. Special iodinated contrast material is injected through a catheter into the blood vessels leading to the brain and rapid sequential X-rays are taken. This study determines the size, shape and location of aneurysms to be evaluated and aids the multidisciplinary team in deciding which modality of treatment is best for the patient.
- 3D angiography is a state-of-the art computer reconstruction that shows the aneurysm in a three-dimensional, interactive mode. The images it produces are a critically important part of the decision-making process regarding treatment. This modality is available at all times at the Brain Aneurysm Center.
- Transcranial Doppler ultrasonography (TCD) is a noninvasive method of analyzing blood flow in the brain. TCD is a form of ultrasound, in which high-frequency sound waves bounce off or pass through body tissues. The results of TCD are audible sounds that the examiner listens to and records.
The skilled team of physicians at the Brain Aneurysm Center coordinates and collaborates with the following Cushing Neuroscience Institute centers to provide a comprehensive multidisciplinary approach to the treatment and care of patients with brain aneurysms:
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 firstname.lastname@example.org, call us at (516) 562-3059 or fill out our Request an Appointment form.