The first thing that drew Rose Du, MD, PhD, to the study of cerebral vasculature was its visual appeal.
“It’s beautiful,” Du explained.
As a researcher, Du examines the anatomical features of the intricately branching blood vessels of the brain. As a clinician, she looks at the brain scans of patients, identifying telltale shadows that can signal cerebral hemorrhages, ruptured aneurysms and other forms of bleeding.
The beauty of brain anatomy drew her to this field, but the patient populations she sees drive her work.
“Many patients come in very sick,” said Du, an attending cerebrovascular surgeon in BWH’s Neurosurgery Department. “But because of the treatments that are done, including the surgical care, these patients often come back remarkably better than when they presented.”
Du says it is immensely rewarding to see her patients who were comatose from their brain hemorrhage walk into her office on their own a year or two after recovery. It is one of the most gratifying parts of her job as a physician. But she also sees the toll that a ruptured aneurysm can take on a patient and family. In the U.S., about 40 percent of people who suffer a ruptured brain aneurysm do not survive the first 24 hour and up to another 25 percent die from complications within six months. Hemmorhages can cause permanent neurological damage and complications such as hydrocephalus or vasospasm can occur in those who survive an initial aneurysmal rupture.
“A brain hemorrhage is so devastating that about half of people don’t make it,” said Du. “If we could predict who are going have aneurysms and prevent them from ever forming or hemorrhaging from the aneurysms, that would be incredible.”
That’s where research comes in.
Du and her colleagues are searching for ways to predict the occurrence of cerebral aneurysms, which are essentially blisters that develop on the blood vessels in the brain. Those blisters can rupture, leading to bleeding and, ultimately, pressure on brain tissue that causes brain damage. In her most recent paper, published in Neurosurgery in December 2014, Du and her colleagues looked at anatomical features such as artery diameter and the angle of vessels’ branches to see if they were associated with higher risk of developing aneurysms in a particular region of the brain.
Genetics and environmental factors, such as smoking or heavy drinking, are tied to risk of developing aneurysms, but Du describes anatomy as another piece of the puzzle.
“We want to understand the underlying mechanisms that lead to the development of aneurysms,” says Du. “If we could predict who is going to have them, then we could get better at preventing them. That would protect many more people than I can individually take care of.”
Right now, there are no preventive treatments for patients at high risk of forming aneurysms. Clinicians like Du monitor patients with known unruptured aneurysms on a regular basis and weigh the risks of intervening versus observation. They can recommend surgical treatment, such as clipping the vessel or endovascular treatment, which involves passing very fine wires – thinner than a strand of hair – into the aneurysm to divert blood flow.
Du hopes that through her own studies and others’ research, new insights into the causes of aneurysms will emerge.
“It’s nice to be able to tie it all together, to know that the research I’m doing is going to affect my patients and their families, and hopefully future generations.”