Why do women develop cerebral aneurysms at a higher rate than men?

Rosalind Lai, assistant professor of neurosurgery in the Jacobs School of Medicine and Biomedical Sciences at UB and a neurosurgeon with UBNS, has been awarded the CNS Foundation/CV Section Young Investigator Grant for her research on cerebral aneurysms. 

Sponsored by the Congress of Neurological Surgeons Foundation, the award was established to provide sustained research startup funding for early-stage academic neurosurgeon-scientists in the field of cerebrovascular disease.

“Right out of the gate, Dr. Lai is proving to be the academic powerhouse we believed her to be,” says Elad I. Levy, L. Nelson Hopkins Endowed Chair of the Department of Neurosurgery in the Jacobs School, a neurosurgeon with UBNS and president of the Congress of Neurological Surgeons. “We are extremely fortunate to recruit talented neuroscience acumen to UBNS as we continue to establish our group as an international neurovascular center of excellence.”

The grant will provide Lai with $150,000 to support her research until 2026. 

“Women have twice the risk of developing a cerebral aneurysm than men,” Lai explains. She adds that the risk increases for post-menopausal women, suggesting that there is a hormonal association with the disease.

Lai’s interest in research began as an undergraduate at Wellesley College, where she worked in an endocrine lab for all four years. As a first-year student at Harvard Medical School, she was attracted to neurosurgery and cerebrovascular research, working under Rose Du, director of cerebrovascular surgery at Harvard.

“My first encounter with a patient suffering from an aneurysm occurred during my first year of medical school when I shadowed in the operating room for the first time at Brigham,” says Lai. 

That surgery was a clipping of an ophthalmic aneurysm. “I was immediately mesmerized by the surgery and amazed by the neurosurgeon’s ability to operate on such intricate tissue and curing the patient of the disease,” Lai recalls. “It was then that I decided to pursue a career in neurosurgery.”

Lai did her neurosurgery residency at Brigham & Women’s Hospital/Boston Children’s Hospital. She dedicated one year of her residency to investigating genetic risks associated with aneurysms.

“During my residency, I had the privilege of caring for many patients with ruptured aneurysms,” she says. “Each interaction was profoundly meaningful, and it became evident to me that there is still much to learn and understand to prevent and treat this devastating disease.”

She also developed an early interest in women’s health: In 2019, she was a principal investigator on the Nurses’ Health Study I and II, exploring reproductive risk factors associated with cerebral aneurysms.

That work laid the foundation for the research that Lai is pursuing now, as she uses her award to focus on a better understanding of genomic and hormonal factors contributing to cerebral aneurysms in women.

“The goal of my research is to identify genes that may be associated with cerebral aneurysms and explain why women have a higher rate of aneurysms,” says Lai. “By identifying these genes, we can identify potential targets to prevent and treat aneurysms.”

Hormonal influences are likely also at play. “My work with the Harvard Nurses’ Health Study revealed that women with a longer reproductive lifespan, indicating more years of estrogen exposure, seem to have a protective effect against aneurysm,” she says, adding, however, that studies on hormonal supplementation have been mixed and inconclusive.

“It is clear that hormones alone do not provide the comprehensive explanation,” she notes. “That’s why our study aims to uncover underlying genetic factors to enhance our understanding of this difference.”

Lai is especially interested in sharing her fascination with this field with UB medical students and residents.

“I am extremely excited about working with students and residents on this project and our other cerebrovascular research projects,” she says. “I am particularly passionate about advancing women’s health and encouraging women to pursue careers in academic medicine and neurosurgery.”