Brain aneurysm repairAneurysm repair - cerebral; Cerebral aneurysm repair; Coiling; Saccular aneurysm repair; Berry aneurysm repair; Fusiform aneurysm repair; Dissecting aneurysm repair; Endovascular aneurysm repair - brain; Subarachnoid hemorrhage - aneurysm
Brain aneurysm repair is surgery to correct an aneurysm. This is a weak area in a blood vessel wall that causes the vessel to bulge or balloon out and sometimes burst (rupture). It may cause:
- Bleeding into the cerebrospinal fluid (CSF) around the brain (also called a subarachnoid hemorrhage)
- Bleeding into the brain that forms a collection of blood (hematoma)
There are two common methods used to repair an aneurysm:
- Clipping is done during an open craniotomy.
- Endovascular repair (surgery), most often using a coil or coiling and stenting (mesh tubes), is a less invasive and more common way to treat aneurysms.
During aneurysm clipping:
- You are given general anesthesia and a breathing tube.
- Your scalp, skull, and the coverings of the brain are opened.
- A metal clip is placed at the base (neck) of the aneurysm to prevent it from breaking open (bursting).
During endovascular repair (surgery) of an aneurysm:
- You may have general anesthesia and a breathing tube. Or, you may be given medicine to relax you, but not enough to put you to sleep.
- A catheter is guided through a small cut in your groin to an artery and then to the blood vessel in your brain where the aneurysm is located.
- Contrast material is injected through the catheter. This allows the surgeon to view the arteries and the aneurysm on a monitor in the operating room.
- Thin metal wires are put into the aneurysm. They then coil into a mesh ball. For this reason, the procedure is also called coiling. Blood clots that form around this coil prevent the aneurysm from breaking open and bleeding. Sometimes stents (mesh tubes) are also put in to hold the coils in place and make sure the blood vessel stays open.
- During and right after the procedure, you may be given a blood thinner, such as heparin, clopidogrel, or aspirin. These medicines prevent dangerous blood clots from forming in the stent.
Why the Procedure Is Performed
If an aneurysm in the brain breaks open (ruptures), it is an emergency that needs medical treatment in the hospital. Often a rupture is treated with surgery, especially endovascular surgery.
A person may have an unruptured aneurysm without any symptoms. This kind of aneurysm may be found when an MRI or CT scan of the brain is done for another reason.
- Not all aneurysms need to be treated right away. Aneurysms that have never bled, especially if they are very small (less than 3 mm at their largest point), do not need to be treated right away. These very small aneurysms are less likely to rupture.
- Your surgeon will help you decide whether it is safer to have surgery to block off the aneurysm before it can break open or to monitor the aneurysm with repeated imaging until surgery becomes necessary. Some small aneurysms will never need surgery.
Risks of anesthesia and surgery in general are:
Risks of brain surgery are:
- Blood clot or bleeding in or around the brain
- Brain swelling
- Infection in the brain or parts around the brain, such as the skull or scalp
Surgery on any one area of the brain may cause problems that may be mild or severe. They may last a short while or they may not go away.
Signs of brain and nervous system (neurological) problems include:
- Behavior changes
- Confusion, memory problems
- Loss of balance or coordination
- Problems noticing things around you
- Speech problems
- Vision problems (from blindness to problems with side vision)
- Muscle weakness
Before the Procedure
This procedure is often done as an emergency. If it is not an emergency:
- Tell your health care provider what medicines or herbs you are taking and if you have been drinking a lot of alcohol.
- Ask your provider which medicines you should still take on the morning of the surgery.
- Try to stop smoking.
- Follow instructions on not eating and drinking before the surgery.
- Take the medicines your provider told you to take with a small sip of water.
- Arrive at the hospital on time.
After the Procedure
A hospital stay for endovascular repair of an aneurysm may be as short as 1 to 2 days if there was no bleeding before surgery.
The hospital stay after craniotomy and aneurysm clipping is usually 4 to 6 days. If there is bleeding or other problems, such as narrowed blood vessels in the brain or a buildup of fluid in the brain, the hospital stay can be 1 to 2 weeks, or longer.
You will probably have imaging tests of the blood vessels (angiogram) in the brain before you are sent home, and possibly once a year for a few years.
Follow instructions on caring for yourself at home.
Ask your doctor if it will be safe for you to have imaging tests such as angiogram, CT angiogram, or MRI scans of the head in the future.
After successful surgery for a bleeding aneurysm, it is uncommon for it to bleed again.
The outlook also depends on whether brain damage occurred from bleeding before, during, or after surgery.
Most of the time, surgery can prevent a brain aneurysm that has not caused symptoms from becoming larger and breaking open.
You may have more than one aneurysm or the aneurysm that was coiled might grow back. After coiling repair, you will need to be seen by your provider every year.
Altschul D, Vats T, Unda S. Endovascular treatment of brain aneurysms. In: Ambrosi PB, ed. New Insight Into Cerebrovascular Diseases - An Updated Comprehensive Review. www.intechopen.com/books/new-insight-into-cerebrovascular-diseases-an-updated-comprehensive-review/endovascular-treatment-of-brain-aneurysms. IntechOpen; 2020:chap: 11. Reviewed August 1, 2019. Accessed May 18, 2020.
American Stroke Association website. What you should know about cerebral aneurysms. www.stroke.org/en/about-stroke/types-of-stroke/hemorrhagic-strokes-bleeds/what-you-should-know-about-cerebral-aneurysms. Updated December 5, 2018. Accessed July 10, 2020.
Le Roux PD, Winn HR. Surgical decision making for the treatment of intracranial aneurysms. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 379.
National Institute of Neurological Disorders and Stroke website. Cerebral aneurysms fact sheet. www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Cerebral-Aneurysms-Fact-Sheet. Updated March 13, 2020. Accessed July 10, 2020.
Spears J, Macdonald RL. Perioperative management of subarachnoid hemorrhage. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 380.