Brain Aneurysm and Arteriovenous Malformations Program

Overview: A Multidisciplinary Approach to Neurovascular Care

The Brain Aneurysm and Arteriovenous Malformations Program at the Massachusetts General Hospital Fireman Vascular Center offers sophisticated diagnosis and treatments for patients with intracranial (brain) aneurysms, arteriovenous malformations (AVMs) and other rare vascular conditions of the brain and spinal cord, such as moyamoya, cavernous malformations, dural arteriovenous fistulas, spinal cord AVMs and arteriovenous fistulas, and intracranial vascular occlusive disease.

The Mass General Fireman Vascular Center is one of the only vascular centers in the country with specialists in every area of vascular disease. Our program comprises leading experts within the field of vascular medicine, bringing together a team of clinicians from multiple disciplines to provide care from many perspectives, including:

• Neurosurgery
• Neurointerventional radiology
• Stroke neurology
• Diagnostic neuroradiology

Our patients receive a comprehensive, multidisciplinary evaluation and a treatment plan personalized to their individual needs. Additionally, we collaborate with referring physicians each step of the way to ensure that the patient’s entire care team is in communication around his or her treatment plan.

Mass General is also home to one of the nation’s largest intensive care units dedicated to treating patients with acute brain condition. The Neurosciences Intensive Care Unit (Neuro ICU) comprises stroke and critical care specialists offer leading vascular management using state-of-the-art technology and other resources.

Diagnosis: Specialists Dedicated to Neurovascular Imaging

To accurately diagnose brain aneurysms, AVMs, moyamoya and other vascular malformations, our team includes neurovascular radiologists who are specially trained to detect abnormalities in the vascular system and whose practice focuses specifically on neurovascular disease. These intracranial imaging specialists are board certified in general radiology and fellowship trained with additional specialization in neurovascular procedures. Additionally, our doctors have expertise in diagnosing and treating conditions, such as fibromuscular dysplasia, that place patients at higher risk for developing aneurysms.

At the Fireman Vascular Center, we also offer computed tomography angiography (CTA), a technique that produces detailed 3D images of the blood vessels. CTA is considered less invasive, and our neurovascular specialists are skilled in interpreting its results. Depending on the patient, we may use other diagnostic techniques such as:

• Ultrasound
• CT scan
• Magnetic resonance imaging (MRI)
  Magnetic resonance angiography (MRA), a type of MRI that provides images of blood vessels
• Venograms, a type of X-ray of the veins performed after a special dye is injected into the veins
• Arteriograms, a type of imaging test to view the inside of the arteries

Many of these tests are also available at our convenient Waltham location.

Treatment Options

A brain aneurysm (also known as a cerebral aneurysm or intracranial aneurysm) is a bulging area in the wall of the artery that delivers blood to the brain. Vessel weakness is usually present at birth and the bulging develops slowly over time. While most brain aneurysms cause no symptoms and therefore go unnoticed, small percentages are at risk for leaking or rupturing, causing bleeding into the brain (subarachnoid hemorrhage or hemorrhagic stroke).

Upon diagnosis, our expert clinicians will evaluate each individual case and provide recommendations for treatment or monitoring. It is important to consider all options. Not all aneurysms require treatment and for aneurysms that require treatment, multiple options need to be considered. Patients who do not require treatment will continue to be closely followed by their team of clinicians in the Brain Aneurysm and AVM Program.

In the Brain Aneurysm and AVM Program, our main goal is to evaluate the patient and, for aneurysms that require treatment, design an individualized treatment plan that closes the aneurysm to prevent rupture. Treatment is determined according to the patient’s age, medical condition, and the size, shape and location of the brain aneurysm. Treatment options available include minimally invasive endovascular techniques and surgical techniques. 

Minimally Invasive Endovascular Techniques

• Coil Embolization: During this minimally invasive endovascular procedure, a catheter (thin, flexible tube) is used to insert a metal coil into the aneurysm. This blocks blood flow from entering into the aneurysm, preventing future rupture. Micro-stents (metal-mesh tubes) can be used with the coils to assist in keeping the coils within the aneurysm
• Flow Diversion: During this minimally invasive endovascular procedure, a catheter is used to insert a mesh stent across the base of an aneurysm to divert blood flow away from the aneurysm, preventing future risk of rupture. Newer flow diversion techniques also allow placement of devices within the aneurysm to divert blood flow away from the aneurysm

Surgical Techniques

• Microsurgical Clip Occlusion: This surgical procedure involves identifying the aneurysm between the folds of the brain through micro-dissection, a technique that uses a surgical microscope to dissect the aneurysm. A titanium clip is then placed across the “neck” (base) of the aneurysm, closing it off. This treatment approach may be recommended if the aneurysm is not suited for endovascular techniques because of its shape and relationship to the normal vessels. Although microsurgical clip occlusion is not “minimally invasive,” it has lower recurrence rates compared with embolization techniques
• Microsurgical bypass: This surgical procedure involves bypassing blood flow around a large aneurysm by using microsurgical techniques to divert blood flow

Research & Clinical Trials

In addition to seeing patients, specialists within our center also conduct research, and participate in major clinical studies evaluating new technologies and devices to treat brain aneurysms, AVMs and other vascular disorders of the brain and spinal cord. This allows us to bring our patients promising new treatments as quickly as possible.

Patients interested in participating in a trial can browse online for open clinical trials or contact a member of their care team to learn more.

What to Expect at Your First Appointment

During your first consultation, your care team will conduct a physical examination and review your medical history.

If you are a new patient to Mass General, we ask that you bring a list of the medications, vitamins and herbal supplements that you take, along with information on dosages. Additionally, please bring any medical records, CDs of images, consultation notes, and notes on previous treatments and their effectiveness. We use this information at the time of your first visit to get a complete picture of you and your overall condition in order to develop an appropriate treatment plan.

We may recommend additional testing, if needed, and will help coordinate any scheduling. Our team will collaborate with your referring physician, and ensure that he or she is aware of any test results and next steps in your treatment.

One Call Coordinates Care

Our dedicated our access specialist is available Monday through Friday from 8:30 am to 5:00 pm to take relevant information about your condition and symptoms, and to make a timely appointment with the most appropriate specialist. Call 877-644-8346 or request an appointment online

The Mass General Difference

Mass General is consistently recognized as a top hospital in the nation by U.S. News & World Report. Our recognition is based on our quality of care, patient safety, and reputation in different specialties. Our commitment to excellence means that we work to ensure that you receive the best care.

Our specialists have a long tradition of excellence in clinical care, and are national leaders in the diagnosis and treatment of brain aneurysms and AVMs. Our physicians are at the forefront of new research and serve on national and international professional societies.