Raising Awareness for Brain Aneurysms in Neurological Disorders

Italo Linfante, MD

A brain aneurysm is a bulging, weakened area in an artery within the brain, which can lead to serious health issues if it bursts. This weak spot in the blood vessel wall fills with blood, forming a balloon-like bulge. When a brain aneurysm ruptures, it causes bleeding in the brain, known as subarachnoid hemorrhage, which is a medical emergency and can lead to severe brain damage or death. Neurologically, brain aneurysms are significant because of the potential impact on the central nervous system.

About 3.2% of the world’s population will experience a brain aneurysm at some point in their life. National Brain Aneurysm Awareness Month, held each year in September, is dedicated to raising awareness efforts for the estimated 6 million people in the United States who have an unruptured brain aneurysm. The month also aims to fund research and support people living with brain aneurysms.

As part of efforts to continue to raise awareness for brain aneurysms, NeurologyLive® sat down with Italo Linfante, MD, director of interventional neuroradiology at Baptist Health Miami Neuroscience Institute. Linfante, who also serves as a professor of neuroscience and radiology at Florida International University, provided comment on the significance of both ruptured and unruptured aneurysms. In addition, he highlighted advancements in aneurysm treatment, especially the shift from open surgery to endovascular procedures, which are less invasive and have lower mortality rates. Furthermore, he touched on the role of neurologists in intensive care and interventional procedures, as well as ongoing research aimed at developing even safer and more effective treatments for complex aneurysms.

NeurologyLive: For Brain Aneurysm Awareness Month, what are the key aspects of brain aneurysms that clinicians and the general public should be aware of?

Italo Linfante, MD: Yes, so brain aneurysms are a significant area of focus in medicine. While they were once a condition with high mortality, and still are in some parts of the world, treatments have greatly improved outcomes. Brain aneurysms can be divided into two main types: ruptured and unruptured aneurysms.

Aneurysms develop as a bulge in the artery, a weak spot that can burst. When this happens, patients may experience a type of bleeding called subarachnoid hemorrhage, which can present very dramatically. Patients often report, if they’re able to speak, that they suddenly had ‘the worst headache of their life.’ This is a signal to immediately get a CT scan, which can reveal the hemorrhage.

There’s also another group of patients with unruptured aneurysms, which are often discovered incidentally during imaging for unrelated symptoms like headaches or dizziness. It’s usually better to treat these before they rupture. We have various methods to repair aneurysms, and the good news for the general public is that outcomes have improved dramatically with endovascular embolization techniques. The classic method was to open the skull, locate the aneurysm, and place a clip. While effective, it’s invasive and requires a lengthy hospital stay. Now, for many aneurysms, we use less invasive techniques, such as platinum coils, which we insert through endovascular access, allowing us to treat the aneurysm from within without opening the skull. I've been performing these procedures for over 25 years and have done over a thousand aneurysm repairs.

Today, we have various tools to match the treatment to the aneurysm's shape and location, with fantastic outcomes. Mortality rates for ruptured aneurysms used to be around 45% in South America, but with endovascular techniques, it’s now down to 5-10% for ruptured cases and less than 1% for unruptured ones. We can even treat ‘giant aneurysms’ over 25mm in diameter, which used to be nearly untreatable. We developed a device called a flow diverter to treat these, with amazing results. In our hospital, we treat about 150 aneurysms a year. A few decades ago, only 30% of aneurysms were treated endovascularly, while 70% were open surgeries. Now, endovascular techniques make up 95% of treatments.

What are some of the main areas of research dedicated to brain aneurysms?

This field is extremely active, with brilliant minds working on biotech development and clinical research. I love working on projects that move from 'bench to bedside'—where we test ideas in the lab, perform safety studies on patients, and eventually conduct clinical trials.

One main area of research is in flow diverters, which change the blood flow between the artery and aneurysm, helping prevent ruptures. These devices were initially challenging to use, but with advances in engineering, they’ve become much easier to deliver and have fewer complications. Another development is intrasaccular devices, like a small sphere or umbrella that we place inside the aneurysm to secure it. We’re also starting clinical trials on new devices of this type. I’m involved in projects aiming to heal aneurysms even faster, which is an exciting development.

How do brain aneurysms relate to neurological disorders?

When an aneurysm ruptures, it becomes a medical emergency, and neurologists often play a key role in managing these cases in intensive care. In the United States, neurologists now oversee ICU care for these patients. Additionally, there’s a growing specialty called interventional neurology, where neurologists complete fellowships in critical care and then work in interventional radiology. So, neurologists are very involved in both managing critical cases and performing procedures. Some large aneurysms can compress parts of the nervous system, causing symptoms like pupil dilation or posterior circulation ischemia. But the biggest roles for neurologists are in ICU management and interventional procedures, and we also have a fellowship program to train neurologists in these techniques.

How has rehabilitation for aneurysms improved over time?

When a rupture occurs, patients often stay in the hospital for 10 to 14 days, as they’re at risk of vasospasm. If there’s any neurological deficit, they require rehabilitation. The advantage of endovascular repair over open surgery is that it’s less invasive, so recovery is often quicker. For unruptured aneurysms, patients typically stay only one night. However, rehab remains essential for patients with ruptures if there’s brain damage. Less invasive treatments have definitely improved recovery times compared to open surgery, which is more challenging on a ruptured aneurysm.